Plasma concentrations of morphine, morphine-6-glucuronide and morphine-3-glucuronide and their relationship with analgesia and side effects in patients with cancer-related pain
| Autor: | Columba Quigley, Maurice L. Slevin, Amina Baksh, N. Patel, Simon P. Joel |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Adult
Male Drug media_common.quotation_subject Administration Oral Pain Pharmacology 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine 030502 gerontology Oral administration Neoplasms medicine Humans In patient Aged Pain Measurement media_common Morphine-3-glucuronide Aged 80 and over Morphine Derivatives Dose-Response Relationship Drug Morphine business.industry General Medicine Middle Aged Morphine-6-glucuronide Analgesics Opioid Anesthesiology and Pain Medicine chemistry 030220 oncology & carcinogenesis Anesthesia Toxicity Central Nervous System Stimulants Female 0305 other medical science Cancer pain business medicine.drug |
| Zdroj: | Palliative Medicine. 17:185-190 |
| ISSN: | 1477-030X 0269-2163 |
| DOI: | 10.1191/0269216303pm658oa |
| Popis: | Morphine, the recommended drug for the management of moderate to severe cancer pain, is metabolized predominantly to the glucuronides morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G). The quantitative clinical importance of these metabolites following the administration of oral morphine is unclear. This study investigates the relationship between plasma concentrations of morphine (M), M6G, M3G and clinical effects in patients receiving sustained release oral morphine for cancer-related pain. Peak and trough plasma concentrations of morphine and its metabolites were determined by high-performance liquid chromatography (HPLC). At corresponding time points, pain [Visual Analogue Scales (VAS), Verbal Rating Scales (VRS), Pain Relief Scores (PRS)] and toxicity (VAS and VRS) were assessed. Renal and liver function tests were performed. Forty-six patients were included in the study. There was a significant correlation between dose and both peak and trough plasma M, M6G and M3G (r>0.60, P There were no differences in peak or trough morphine and metabolite concentrations or ratios between patients with low (< median) or high pain scores. Similarly, there was no significant relationship between high and low plasma concentrations and clinical effect. This study did not identify a simple relationship between plasma concentrations of morphine, morphine metabolites or metabolite ratios and clinical effects in patients with cancer and pain who were receiving chronic oral morphine therapy. Although overall pain control was good, there was marked interpatient variability in the dose of morphine and the plasma concentrations necessary to achieve this degree of analgesia. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|