Which drug class may cause paradoxical reactions when used with meperidine?

The drug class that may cause paradoxical reactions when used with meperidine is monoamine oxidase inhibitors (MAOIs). This interaction occurs because meperidine is an opioid analgesic that can increase the release of serotonin and have sympathomimetic effects; when combined with MAOIs, there is a risk of serotonin syndrome, which can lead to hyperreflexia, agitation, confusion, and increased muscle tone, among other symptoms. This could provoke a paradoxical reaction, meaning it could lead to effects that are opposite to what is typically expected with meperidine use.

Opioid agonists, partial-antagonist opioid analgesics, and non-steroidal anti-inflammatory drugs (NSAIDs) do not typically interact with meperidine in this manner. Opioid agonists generally enhance analgesia without the specific risks associated with MAOIs, while partial-antagonist opioids may produce less intense effects. NSAIDs also do not have a pharmacological interaction with meperidine that causes paradoxical responses, as they operate via different mechanisms, primarily targeting inflammation and pain relief rather than neurotransmitter modulation. Therefore, the distinct interaction profile of MAOIs makes them the drug class of concern when considering paradoxical reactions in combination