A patient Manoj with severe pain thought to be of gastrointestinal origin received 60 mg of meperidine subsequent to which he developed reaction characterized by tachycardia, hypeension, hyperpyrexia and seizures. He gave the history that he is also taking some medicine for his psychiatric condition. Which of the following drug can be held responsible for this so of reaction?
Meperidine (pethidine) is metabolized mainly to meperidinic acid (inactive) by MAO inhibitors. Minor pathway is conversion to nor-meperidine (possesses excitatory propeies and shows cumulation) MAO inhibitors like phenelzine inhibits the major pathway; therefore minor pathway assumes impoance resulting in generation of nor-pethidine that can cause seizures. Long term use of meperidine can result in accumulation of normeperidine and thus seizures can occur.
Alprazolam
Imipramine
Lithium
Phenelzine
Opioids and Alcohols