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Opioid Metabolism
Mayo Clinic proceedings, 2009-07, Vol.84 (7), p.613-624
[Peer Reviewed Journal]
Mayo Foundation for Medical Education and Research ;2009 Mayo Foundation for Medical Education and Research ;ISSN: 0025-6196 ;EISSN: 1942-5546 ;DOI: 10.4065/84.7.613
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Title:
Opioid Metabolism
Author:
Smith, Howard S., MD
Subjects:
Internal Medicine
Is Part Of:
Mayo Clinic proceedings, 2009-07, Vol.84 (7), p.613-624
Description:
Clinicians understand that individual patients differ in their response to specific opioid analgesics and that patients may require trials of several opioids before finding an agent that provides effective analgesia with acceptable tolerability. Reasons for this variability include factors that are not clearly understood, such as allelic variants that dictate the complement of opioid receptors and subtle differences in the receptor-binding profiles of opioids. However, altered opioid metabolism may also influence response in terms of efficacy and tolerability, and several factors contributing to this metabolic variability have been identified. For example, the risk of drug interactions with an opioid is determined largely by which enzyme systems metabolize the opioid. The rate and pathways of opioid metabolism may also be influenced by genetic factors, race, and medical conditions (most notably liver or kidney disease). This review describes the basics of opioid metabolism as well as the factors influencing it and provides recommendations for addressing metabolic issues that may compromise effective pain management. Articles cited in this review were identified via a search of MEDLINE, EMBASE, and PubMed. Articles selected for inclusion discussed general physiologic aspects of opioid metabolism, metabolic characteristics of specific opioids, patient-specific factors influencing drug metabolism, drug interactions, and adverse events.
Publisher:
Elsevier Inc
Language:
English
Identifier:
ISSN: 0025-6196
EISSN: 1942-5546
DOI: 10.4065/84.7.613
Source:
Geneva Foundation Free Medical Journals at publisher websites
AUTh Library subscriptions: ProQuest Central
PubMed Central
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