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Demerol Interactions: What to Avoid

Documented interactions for Demerol (Meperidine (tablet and injection)). Each entry cites the prescribing information or FDA safety communication it is based on.

2 contraindicated6 major

Interaction summary

SeverityInteracts withClassConcern
ContraindicatedMAO inhibitors (phenelzine, tranylcypromine, linezolid, methylene blue)Monoamine oxidase inhibitorMeperidine with MAO inhibitors is contraindicated
ContraindicatedMAO inhibitors (phenelzine, tranylcypromine, linezolid, methylene blue)Monoamine oxidase inhibitorOpioid with MAO inhibitors is contraindicated
MajorAlcohol (ethanol)CNS depressantMeperidine with alcohol: additive respiratory depression
MajorAlcohol (ethanol)CNS depressantOpioid with alcohol: additive respiratory depression
MajorOther benzodiazepines (diazepam, clonazepam, lorazepam, alprazolam, temazepam)BenzodiazepineMeperidine with benzodiazepine: risk of profound sedation, respiratory depression, coma, and death
MajorOther benzodiazepines (diazepam, clonazepam, lorazepam, alprazolam, temazepam)BenzodiazepineOpioid with benzodiazepine: risk of profound sedation, respiratory depression, coma, and death
MajorOther CNS depressants (opioids, benzodiazepines, sleep aids, sedating antihistamines, gabapentinoids, muscle relaxants)CNS depressantOpioid with other CNS depressants: additive respiratory depression
MajorOther gabapentinoids (gabapentin, pregabalin)GabapentinoidOpioid with gabapentinoid: serious breathing difficulties

Detailed interactions

Contraindicated

Meperidine with MAO inhibitors is contraindicated

With: MAO inhibitors (phenelzine, tranylcypromine, linezolid, methylene blue) Monoamine oxidase inhibitor

Why it happens

MAO inhibitors potentiate meperidine and its metabolite normeperidine unpredictably; normeperidine accumulates and is neuroexcitatory.

What can happen

Severe reactions including respiratory depression, hypotension, tremor, seizures, and death.

What to do

The combination is contraindicated. Meperidine itself is generally avoided in older adults for this reason.

Basis: Meperidine prescribing information, Contraindications and Warnings. source

Contraindicated

Opioid with MAO inhibitors is contraindicated

With: MAO inhibitors (phenelzine, tranylcypromine, linezolid, methylene blue) Monoamine oxidase inhibitor

Why it happens

MAO inhibitors potentiate opioid effects and impair metabolism.

What can happen

Severe unpredictable reactions including respiratory depression and death.

What to do

Do not combine.

Basis: Opioid-containing product labeling, Contraindications. source

Major

Meperidine with alcohol: additive respiratory depression

With: Alcohol (ethanol) CNS depressant

Why it happens

Combined central nervous system and respiratory depression.

What can happen

Respiratory depression, deep sedation, and death.

What to do

Avoid alcohol during meperidine therapy.

Basis: Meperidine prescribing information, Warnings. source

Major

Opioid with alcohol: additive respiratory depression

With: Alcohol (ethanol) CNS depressant

Why it happens

Both agents depress the central nervous system and breathing.

What can happen

Respiratory depression, deep sedation, coma, and death.

What to do

Avoid alcohol during opioid therapy.

Basis: Opioid-containing product labeling, Warnings and Precautions. source

Major

Meperidine with benzodiazepine: risk of profound sedation, respiratory depression, coma, and death

With: Other benzodiazepines (diazepam, clonazepam, lorazepam, alprazolam, temazepam) Benzodiazepine

Why it happens

Additive depression of the central nervous system and respiratory drive.

What can happen

FDA requires a boxed warning on meperidine-containing products describing this combination.

What to do

Avoid where possible; if used, lowest effective doses for the shortest duration with monitoring.

Basis: Meperidine prescribing information, Boxed Warning. source

Major

Opioid with benzodiazepine: risk of profound sedation, respiratory depression, coma, and death

With: Other benzodiazepines (diazepam, clonazepam, lorazepam, alprazolam, temazepam) Benzodiazepine

Why it happens

Additive depression of the central nervous system and respiratory drive.

What can happen

FDA requires a boxed warning on opioid-containing products describing this combination.

What to do

Avoid where possible. If used, lowest effective doses for the shortest duration with monitoring.

Basis: FDA Drug Safety Communication (2016); opioid boxed warning. source

Major

Opioid with other CNS depressants: additive respiratory depression

With: Other CNS depressants (opioids, benzodiazepines, sleep aids, sedating antihistamines, gabapentinoids, muscle relaxants) CNS depressant

Why it happens

Additive central nervous system depression and slowed breathing.

What can happen

Respiratory depression and overdose, particularly in older adults.

What to do

Disclose all sedating medications to the prescriber and pharmacist.

Basis: Opioid-containing product labeling, Warnings and Precautions. source

Major

Opioid with gabapentinoid: serious breathing difficulties

With: Other gabapentinoids (gabapentin, pregabalin) Gabapentinoid

Why it happens

Additive respiratory depression.

What can happen

FDA warns of serious breathing difficulties and increased risk of death.

What to do

Use the lowest effective gabapentinoid dose and monitor for slowed breathing.

Basis: FDA Drug Safety Communication (2021). source

Common questions

What should I know about Demerol interactions?

We have documented 8 interaction classes for Demerol in our dataset. Usually avoided, or used only with explicit prescriber oversight and close monitoring. The most serious items on this page are marked contraindicated or major.

Can I take Demerol with alcohol?

Alcohol interacts with most of the medications on this site because it adds to sedation and slows breathing. For the specific documented risk, see the relevant entry above. The general rule from labeling is to avoid alcohol.

Does an empty result mean Demerol is safe with other drugs?

No. An empty result only means our curated dataset has no matching rule. A pharmacist can run a full interaction screen against every medication and supplement you take.

Related

Editorial Review Board

Clinical review by licensed pharmacists (PharmD)

Every page on this site is reviewed against current FDA prescribing information, DailyMed labelling, DEA scheduling regulations and MedlinePlus monographs before publication. Reviewers have no commercial relationship with any manufacturer or pharmacy.

Last substantive review: October 01, 2026

Sources & references

DailyMed — full prescribing information (National Library of Medicine)
MedlinePlus drug information (National Library of Medicine)
PubChem compound record (National Institutes of Health)
21 CFR Part 1308 — Controlled Substances (eCFR)
Drug Enforcement Administration — drug scheduling

Important

This site provides educational information only and does not sell, prescribe or dispense medications. Always consult a licensed healthcare provider. This page is not medical advice.