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.