Neurotoxic metabolite
- Direct CNS excitation: myoclonus, tremor, agitation
- Not reversed by naloxone
- Marks a metabolite whose clinical significance is direct CNS excitation rather than anything it binds
- Normeperidine wears this alongside the proconvulsant peg: myoclonus, tremor and agitation are the same syndrome’s quieter half, and they precede the seizures
- Accumulates in renal impairment and with repeated dosing; naloxone does not reverse it
Drugs with this mechanism (1)
- Normeperidine — Neurotoxic meperidine metabolite; accumulation, especially with renal impairment, can cause tremor and seizures.
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