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Opioids in liver failure



Opioids in Patients with Renal or Hepatic Dysfunction

12.22.2018 | Alexander Mercer
Opioids in liver failure
Opioids in Patients with Renal or Hepatic Dysfunction

The use of opioids in geriatric patients and those with hepatic or renal insufficiency can present significant challenges for clinicians.

Clinicians are often confronted with patients who have renal and/or hepatic dysfunction, including the elderly. In this review, Dr. Carbonara provides the clinician with practical pharmacokinetic/ pharmacodynamic information from which to base rational treatment decisions. These patients pose unique challenges related to opioid choice and dosing considerations.

The absorption, metabolism, and renal clearance of opioid analgesics are often quite complex requiring frequent dose adjustments and medication changes.3,4 The properties of the parent drug and its metabolites must be considered when selecting an opioid analgesic for this patient population.4,5 For example, meperidine is metabolized in the liver to the metabolite normeperidine—a CNS excitotoxin—and then excreted by the kidneys.

Use of Opioids in Hepatic Failure

11.21.2018 | Dylan Leapman
Opioids in liver failure
Use of Opioids in Hepatic Failure

In the presence of liver failure, increasing levels of an opioid and decreasing levels of its metabolites may necessitate modifications to therapy.

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Pharmacokinetics of Opioids in Liver Disease SpringerLink

9.19.2018 | Destiny Laird
Opioids in liver failure
Pharmacokinetics of Opioids in Liver Disease SpringerLink

The liver is the major site of biotransformation for most opioids. Thus, the disposition of these drugs may be affected in patients with liver insufficiency. The major metabolic pathway for most opioi.

The consequence of reduced drug metabolism is the risk of accumulation in the body, especially with repeated administration. On the other hand, the analgesic activity of codeine and tilidine depends on transformation into the active metabolites, morphine and nortilidine, respectively. Finally, the disposition of a few opioids, such as fentanyl, sufentanil and remifentanil, appears to be unaffected in liver disease. Special risks are known for pethidine, with the potential for the accumulation of norpethidine, a metabolite that can cause seizures, and for dextropropoxyphene, for which several cases of hepatotoxicity have been reported.

Pharmacokinetics of opioids in liver disease

3.13.2018 | Destiny Laird
Opioids in liver failure

Clin Pharmacokinet. 1999 Jul;37(1):17-40. Pharmacokinetics of opioids in liver disease. Tegeder I(1), Lötsch J, Geisslinger G. Author information: (1)Center of Pharmacology, Johann Wolfgang Goethe-University of Frankfurt, Frankfurt am Main, Germany. The liver is the major site of biotransformation for most opioids. Thus.

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Oxidation of opioids is reduced in patients with hepatic cirrhosis, resulting in decreased drug clearance [for pethidine (meperidine), dextropropoxyphene, pentazocine, tramadol and alfentanil] and/or increased oral bioavailability caused by a reduced first-pass metabolism (for pethidine, dextropropoxyphene, pentazocine and dihydrocodeine). Special risks are known for pethidine, with the potential for the accumulation of norpethidine, a metabolite that can cause seizures, and for dextropropoxyphene, for which several cases of hepatotoxicity have been reported. Although glucuronidation is thought to be less affected in liver cirrhosis, and clearance of morphine was found to be decreased and oral bioavailability increased. The consequence of reduced drug metabolism is the risk of accumulation in the body, especially with repeated administration. The liver is the major site of biotransformation for most opioids. The exceptions are morphine and buprenorphine, which primarily undergo glucuronidation, and remifentanil, which is cleared by ester hydrolysis. Thus, the disposition of these drugs may be affected in patients with liver insufficiency. Finally, the disposition of a few opioids, such as fentanyl, sufentanil and remifentanil, appears to be unaffected in liver disease. If metabolism is decreased in patients with chronic liver disease, the analgesic action of these drugs may be compromised. Lower doses or longer administration intervals should be used to remedy this risk. On the other hand, the analgesic activity of codeine and tilidine depends on transformation into the active metabolites, morphine and nortilidine, respectively. The major metabolic pathway for most opioids is oxidation.

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Opiods in Organ Failure

10.20.2018 | Robert Albertson
Opioids in liver failure

OPIOIDS USED IN LIVER FAILURE / CIRRHOSIS. METHADONE ? FENTANYL; BUPRENORPHINE; HYDROMORPHONE > MORPHINE. SUMMARY. OPIOIDS USED IN RENAL FAILURE. Case History 1. 42 year old male with hepatitis C with hepatocellular carcinoma and abdominal pain from hepatic capsular invasion.