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Pharmacokinetics of morphine and oxycodone following intravenous administration in elderly patients.

Villesen HH, Banning AM, Petersen RH, Weinelt S, Poulsen JB, Hansen SH, Christrup LL - Ther Clin Risk Manag (2007)

Bottom Line: An increased and prolonged duration of pain relief after morphine administration has been found in elderly patients.Similar for oxycodone, no changes in the pharmacokinetic could be found when comparing the parameters found in elderly patients with those from younger healthy volunteers.Therefore, we recommend that treatment with morphine and oxycodone in elderly patients is initiated very conservatively and is titrated slowly to effect.

View Article: PubMed Central - PubMed

ABSTRACT

Background: An increased and prolonged duration of pain relief after morphine administration has been found in elderly patients. Whether this is due to alterations in pharmacokinetics, receptor binding profile or other factors remains unsolved. The aims were to elucidate the pharmacokinetics after intravenous administration of morphine and oxycodone in elderly patients older than 70 years.

Methods: A randomized non-blinded study with 16 patients aged older than 70 years scheduled for elective hip replacement receiving morphine or oxycodone 0.05 mg/kg as an IV infusion over 15 minutes.

Results: A 2-compartment pharmacokinetic model best described the disposition of morphine and oxycodone. The estimated elimination half-lives for morphine and oxycodone were (mean +/- SD) 2.7 +/- 3.6 (range 0.8-11.6) and 3.1 +/- 1.3 (range 1.1-4.8) hr, respectively. Volume of distribution at steady state was estimated to be 243 +/- 256 and 277 +/- 187 L, and clearance to be 1748 +/- 623 and 1206 +/- 546 ml/min for morphine and oxycodone, respectively.

Conclusion: The increased and prolonged duration of pain relief after morphine administration seen in some elderly patients cannot, based on these findings, be ascribed to changes in the pharmacokinetic parameters between elderly and younger patients. Similar for oxycodone, no changes in the pharmacokinetic could be found when comparing the parameters found in elderly patients with those from younger healthy volunteers. A great variability within the individual pharmacokinetic parameters was seen for both drugs. Therefore, we recommend that treatment with morphine and oxycodone in elderly patients is initiated very conservatively and is titrated slowly to effect.

No MeSH data available.


Related in: MedlinePlus

The individual serum concentrations versus time profiles of morphine, M3G and M6G after IV administration of morphine and of oxycodone and noroxycodone after IV administration of oxycodone. Please notice the different axes.
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fig1: The individual serum concentrations versus time profiles of morphine, M3G and M6G after IV administration of morphine and of oxycodone and noroxycodone after IV administration of oxycodone. Please notice the different axes.

Mentions: The individual serum concentrations versus time profiles after IV administration of morphine, M3G and M6G, and oxycodone and noroxycodone are shown in Figure 1. Mean dose of morphine and oxycodone was 10744 ± 3017 and 9393 ± 1015 nmol, respectively. Peak drug serum concentrations (Cmax) occurred at 15 min (end of infusion) and were 150 ± 50 nmol/L and 98 ± 62 nmol/L for morphine and oxycodone, respectively. The metabolites M3G and M6G were measurable in the samples after 10 and 20 min, respectively. Maximum concentration was reached at 75 min for both metabolites, for M3G 166 ± 46 nmol/L and for M6G 30 ± 8 nmol/L. Oxymorphone was not quantifiable in any of the samples, but noroxycodone was measurable in 4 patients after 20 min. Maximum concentration was after 6 hours, 8 ± 4 nmol/L. In a single patient (no. 14) noroxycodone was not quantifiable in any of the samples.


Pharmacokinetics of morphine and oxycodone following intravenous administration in elderly patients.

Villesen HH, Banning AM, Petersen RH, Weinelt S, Poulsen JB, Hansen SH, Christrup LL - Ther Clin Risk Manag (2007)

The individual serum concentrations versus time profiles of morphine, M3G and M6G after IV administration of morphine and of oxycodone and noroxycodone after IV administration of oxycodone. Please notice the different axes.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2376067&req=5

fig1: The individual serum concentrations versus time profiles of morphine, M3G and M6G after IV administration of morphine and of oxycodone and noroxycodone after IV administration of oxycodone. Please notice the different axes.
Mentions: The individual serum concentrations versus time profiles after IV administration of morphine, M3G and M6G, and oxycodone and noroxycodone are shown in Figure 1. Mean dose of morphine and oxycodone was 10744 ± 3017 and 9393 ± 1015 nmol, respectively. Peak drug serum concentrations (Cmax) occurred at 15 min (end of infusion) and were 150 ± 50 nmol/L and 98 ± 62 nmol/L for morphine and oxycodone, respectively. The metabolites M3G and M6G were measurable in the samples after 10 and 20 min, respectively. Maximum concentration was reached at 75 min for both metabolites, for M3G 166 ± 46 nmol/L and for M6G 30 ± 8 nmol/L. Oxymorphone was not quantifiable in any of the samples, but noroxycodone was measurable in 4 patients after 20 min. Maximum concentration was after 6 hours, 8 ± 4 nmol/L. In a single patient (no. 14) noroxycodone was not quantifiable in any of the samples.

Bottom Line: An increased and prolonged duration of pain relief after morphine administration has been found in elderly patients.Similar for oxycodone, no changes in the pharmacokinetic could be found when comparing the parameters found in elderly patients with those from younger healthy volunteers.Therefore, we recommend that treatment with morphine and oxycodone in elderly patients is initiated very conservatively and is titrated slowly to effect.

View Article: PubMed Central - PubMed

ABSTRACT

Background: An increased and prolonged duration of pain relief after morphine administration has been found in elderly patients. Whether this is due to alterations in pharmacokinetics, receptor binding profile or other factors remains unsolved. The aims were to elucidate the pharmacokinetics after intravenous administration of morphine and oxycodone in elderly patients older than 70 years.

Methods: A randomized non-blinded study with 16 patients aged older than 70 years scheduled for elective hip replacement receiving morphine or oxycodone 0.05 mg/kg as an IV infusion over 15 minutes.

Results: A 2-compartment pharmacokinetic model best described the disposition of morphine and oxycodone. The estimated elimination half-lives for morphine and oxycodone were (mean +/- SD) 2.7 +/- 3.6 (range 0.8-11.6) and 3.1 +/- 1.3 (range 1.1-4.8) hr, respectively. Volume of distribution at steady state was estimated to be 243 +/- 256 and 277 +/- 187 L, and clearance to be 1748 +/- 623 and 1206 +/- 546 ml/min for morphine and oxycodone, respectively.

Conclusion: The increased and prolonged duration of pain relief after morphine administration seen in some elderly patients cannot, based on these findings, be ascribed to changes in the pharmacokinetic parameters between elderly and younger patients. Similar for oxycodone, no changes in the pharmacokinetic could be found when comparing the parameters found in elderly patients with those from younger healthy volunteers. A great variability within the individual pharmacokinetic parameters was seen for both drugs. Therefore, we recommend that treatment with morphine and oxycodone in elderly patients is initiated very conservatively and is titrated slowly to effect.

No MeSH data available.


Related in: MedlinePlus