Plasma morphine and morphine-6-glucuronide during chronic morphine therapy for cancer pain: Plasma profiles, steady-state concentrations and the consequences of renal failure Journal Article

  

Authors:	Portenoy, R. K.; Foley, K. M.; Stulman, J.; Khan, E.; Adelhardt, J.; Layman, M.; Cerbone, D. F.; Inturrisi, C. E.
Article Title:	Plasma morphine and morphine-6-glucuronide during chronic morphine therapy for cancer pain: Plasma profiles, steady-state concentrations and the consequences of renal failure
Abstract:	Morphine-6-glucuronide (M-6-G) is an active metabolite of morphine that may contribute to drug effects. To understand better the relationship between morphine and M-6-G in cancer patients receiving chronic therapy, we employed high performance liquid chromatography with electrochemical detection to measure: 1. (1) morphine and M-6-G plasma concentrations following discontinuation of dosing in 2 patients, one receiving oral therapy and the other an intravenous infusion 2. (2) morphine and M-6-G concentrations in random blood samples taken at apparent steady state from 8 patients, 7 with normal renal function and 1 with mild renal insufficiency, who were receiving continuous morphine infusions 3. (3) morphine and M-6-G concentrations in random blood samples taken over a period of weeks from 4 patients, 2 with stable and 2 with declining renal function. Results demonstrated a slightly slower decline in plasma M-6-G than morphine concentrations following drug discontinuation, as would be expected for metabolite and parent relationship; roughly similar M-6-G: morphine ratios (mean molar ratio = 1.22) across a broad range of morphine doses in patients with normal renal function; and an increase in this ratio over time in patients with progressive renal dysfunction. These data illustrate the kinetics of M-6-G in cancer patients receiving chronic morphine therapy and confirm the importance of renal function in determining the concentration of the metabolite. © 1991.
Keywords:	adult; clinical article; controlled study; human tissue; aged; neoplasms; pain; cancer pain; kidney failure; drug blood level; high performance liquid chromatography; opioids; morphine; infusions, intravenous; morphine 6 glucuronide; oral drug administration; middle age; kidney failure, chronic; morphine-6-glucuronide; morphine derivatives; human; male; female; priority journal; article; support, non-u.s. gov't; support, u.s. gov't, p.h.s.; morphine metabolites
Journal Title:	Pain
Volume:	47
Issue:	1
ISSN:	0304-3959
Publisher:	Elsevier Science BV
Date Published:	1991-10-01
Start Page:	13
End Page:	19
Language:	English
DOI:	10.1016/0304-3959(91)90005-i
PUBMED:	1771088
PROVIDER:	scopus
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-0025955839&doi=10.1016%2f0304-3959%2891%2990005-I&partnerID=40&md5=13aa23048cfb7617780f5d7e8e877d5c
Notes:	Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/154626