Meperidine is not recommended as a first line narcotic for a sickle cell crisis because it needs to be given every two hours and a form of meperidine, chemically changed by the body, can accumulate to toxic levels, causing agitation and even seizures. When narcotics are needed, morphine or hydromorphone are better choices. The Agency for Health Care Policy and Research has developed pain management guidelines that are very useful. They should be adjusted according to the patient's past experience.
...[P]atients are, unfortunately, too often given inadequate and infrequent doses of meperidine, a narcotic pain killer.