Age and Fentanyl Pharmacokinetics

Bentley, John B.; Borel, J. D.; Nenad, Robert E.; Gillespie, Terrance

doi:10.1097/00132586-198308000-00017

Cited by 49 publications

(38 citation statements)

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“…Although not routinely applied in many standard urine drug-testing panels, fentanyl-specific immunoassays have been developed [27,61,62]. A number of other analytical methods including gas chromatography-mass spectroscopy (GC-MS) [63][64][65][66] and LC-MS have also been described [67][68][69][70]. Some of these methods also include detection of fentanyl-like compounds in addition to fentanyl [32].…”

Section: Fentanylmentioning

confidence: 99%

Laboratory Testing for Prescription Opioids

Milone

2012

J. Med. Toxicol.

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Opioid analgesic misuse has risen significantly over the past two decades, and these drugs now represent the most commonly abused class of prescription medications. They are a major cause of poisoning deaths in the USA exceeding heroin and cocaine. Laboratory testing plays a role in the detection of opioid misuse and the evaluation of patients with opioid intoxication. Laboratories use both immunoassay and chromatographic methods (e.g., liquid chromatography with mass spectrometry detection), often in combination, to yield high detection sensitivity and drug specificity. Testing methods for opioids originated in the workplace-testing arena and focused on detection of illicit heroin use. Analysis for a wide range of opioids is now required in the context of the prescription opioid epidemic. Testing methods have also been primarily based upon urine screening; however, methods for analyzing alternative samples such as saliva, sweat, and hair are available. Application of testing to monitor prescription opioid drug therapy is an increasingly important use of drug testing, and this area of testing introduces new interpretative challenges. In particular, drug metabolism may transform one clinically available opioid into another. The sensitivity of testing methods also varies considerably across the spectrum of opioid drugs. An understanding of opioid metabolism and method sensitivity towards different opioid drugs is therefore essential to effective use of these tests. Improved testing algorithms and more research into the effective use of drug testing in the clinical setting, particularly in pain medicine and substance abuse, are needed.

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Section: Fentanylmentioning

confidence: 99%

Laboratory Testing for Prescription Opioids

Milone

2012

J. Med. Toxicol.

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“…While an intravenous fentanyl study was planned in these subjects to determine clearance and hence allow analy sis of bioavailability, it was concluded that the risk of adverse events would be too great givfor young subjects compared to individual data for en their previous response to transdermal fen tanyl. However, previous studies examining differences in intravenous fentanyl disposi tion between young and elderly patients failed to identify significant reductions in clearance in the elderly [5,14], Although one previous study did identify lower clearance values in an elderly population, their results are suspect since their sampling duration was less than 50% of the half-life value which they reported for their elderly patients [15], Another impor tant consideration is that many of our elderly subjects were female while all of the young subjects were male. However, previous phar macokinetic studies of fentanyl in both males and females have not demonstrated impor tant gender differences [4,5,16].…”

Section: Discussionmentioning

confidence: 87%

Transdermal Fentanyl Disposition in Elderly Subjects

Holdsworth¹,

Forman

Killilea³

et al. 1994

Gerontology

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The pharmacokinetic characteristics of a 20-cm² fentanyl 24-hour transdermal patch were compared between 10 healthy elderly subjects 67-87 years and 6 young subjects 19-27 years. All 10 elderly subjects required patch removal prior to 24 h due to adverse effects versus none of the young subjects. The mean patch duration (PD) in elderly subjects was 11.7 ± 4.9 h, yielding a mean area under the curve from 0 to 60 h (AUC_0-60) of 20.4 ± 10.3 ng h/ml versus a mean AUC_0-60 of 21.0 ± 10.4 ng h/ml in young subjects. Correcting AUC_0-60 for PD(AUC_0-60/PD)gave a mean value of 2.05 ± 1.10 ng/ml for elderly subjects, which was significantly greater than the AUC_0-60/PD of 0.88 ± 0.44 ng/ml in young subjects (p = 0.034, Student’s t test). The higher serum concentrations reflect increased absorption and/or decreased clearance in the elderly.

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“…The pharmacokinetics of fentanyl were first studied in elderly patients by Bentley et al 17 They reported that elderly patients (over age 60 yr), when compared with younger patients, had a reduced plasma clearance (4.0 --+ 0.6 vs 15.4 +--1.6 ml.min -I kg -I) and a prolonged t 89 (945 -4--64 vs 265 +--22 rain). There was no significant age-related difference in volumes of distribution.…”

Section: Discussionmentioning

confidence: 99%