Analytic reviews: Neuropsychiatric Toxicity of Meperidine

The use of meperidine can lead to neuropsychiatric tox icity manifested by excitatory states and seizure. Nor meperidine, an active metabolite, is the agent responsi ble for this toxicity; its long half-life of elimination allows for significant accumulation with repeated dosing of the parent compound. Normeperidine is proconvul sant, and this property alone may account for the toxic symptoms. Psychiatric symptoms often herald the onset of toxicity and may be the result of complex partial seizure. A pathophysiological mechanism of toxicity is suggested, and management of the toxic patient is dis cussed.