Pain, sedation and morphine metabolism in cancer patients during long-term treatment with sustained-release morphine

Title

Pain, sedation and morphine metabolism in cancer patients during long-term treatment with sustained-release morphine

Creator

Andersen G; Jensen NH; Christrup L; Hansen SH; Sjogren P

Publisher

Palliative Medicine

Date

2002

Subject

Female; Male; Adult; Analgesics; Aged; Delayed-Action Preparations; Human; Middle Age; Neoplasms/complications/metabolism; effects/pharmacokinetics; Morphine Derivatives/blood; Morphine/administration & dosage/adverse effects/pharmacokinetics; Opioid/administration & dosage/adverse; Pain/etiology/metabolism/prevention & control

Description

BACKGROUND: Morphine-6-glucuronide (M-6-G) and morphine-3-glucuronide (M-3-G) are the two most important metabolites of morphine. Both are pharmacologically active, however, with different effects. M-6-G has been demonstrated capable of inducing anti-nociception and sedation, and M-3-G may induce behavioural excitation and possibly antagonise anti-nociception. Their impact on pharmacodynamics in patients in long-term treatment with oral morphine remains to be settled. METHODS: Forty-two cancer patients treated with oral sustained-release (SR) morphine were assessed for pain, sedation and other side effects related to morphine treatment. Blood samples were analysed for morphine, M-3-G and M-6-G by high-performance liquid chromatography (HPLC). RESULTS: Significant correlations were found between the daily dose of SR morphine and plasma morphine (M) (r = 0.535, P < 0.001), plasma M-6-G (r = 0.868, P < 0.001) and plasma M-3-G (r = 0.865, P < 0.001). There was no relationship between plasma morphine, M-6-G, M-6-G/M and pain and sedation scores. Seventy-nine percent of the patients suffered from dryness of the mouth, which was the most frequent side effect observed. Patients in this group had higher plasma morphine and M-6-G concentrations than patients who did not suffer from this side effect. CONCLUSION: The plasma concentrations of morphine and its metabolites, M-3-G and M-6-G, are significantly correlated to the daily dose of SR morphine. Although M-6-G has analgesic properties, no associations were found between pain and plasma morphine and morphine metabolites. This may be due to the multitudinous factors affecting the dose-effect relationship. Patients with dryness of the mouth had higher concentrations of morphine and M-6-G than patients without this side effect.
2002

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

107-14

Issue

2

Volume

16

Citation

Andersen G; Jensen NH; Christrup L; Hansen SH; Sjogren P, “Pain, sedation and morphine metabolism in cancer patients during long-term treatment with sustained-release morphine,” Pediatric Palliative Care Library, accessed December 8, 2021, https://pedpalascnetlibrary.omeka.net/items/show/12595.

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