Pharmacokinetics of a Single-Dose IV Morphine in Normal Volunteers and Patients with End-Stage Renal Failure

Aitkenhead, A. R.; Vater, Margit; Achola, K.; Cooper, C. M. S.; Smith, George Davey; Gibbs, J. M.

doi:10.1097/00132586-198504000-00005

Cited by 31 publications

(40 citation statements)

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“…Most pharmacokinetic parameters for morphine in BMT patients studied here were similar to those reported for postsurgical patients [Dahlstrom et al 1982;Murphy and Hug 1981;Stanski et al 1976;Stanski et al 1978], healthy volunteers [Stanski et al 1978;Aitkenhead et al 1984;Owen et al 1983], and other cancer patients (Gourlay et al 1986;Sawe et al 1981]. Distributional and elimination halflives and distribution volumes reported here are nearly identical to previous reports.…”

Section: Value Of Individual Tailoring Methodssupporting

confidence: 87%

Evaluation of the accuracy of a pharmacokinetically-based patient-controlled analgesia system

Hill

Mackie

Coda

et al. 1992

Eur J Clin Pharmacol

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Bone marrow transplant patients having severe, prolonged oral mucositis pain (expected to last for one to three weeks) used a computer-controlled infusion system to self-administer morphine for pain control. Individual patient pharmacokinetic information, derived from a pretreatment bolus morphine dose, was used in a new bolus-elimination transfer algorithm to produce rapid adjustments of steady plasma morphine concentrations when the patient requested more or less drug. We evaluated the performance characteristics (bias and precision) of this pharmacokinetically based patient-controlled analgesic infusion system (PKPCA) in a group of 15 cancer patients over six to 14 days. Although we found a three- to fivefold pharmacokinetic variability in the tailoring morphine dose data, the PKPCA system was free of systematic bias (insignificant overall prediction error) during the patient-controlled infusions in this study population. The absolute prediction error was 19.9% for the group on the first study day and 25.6% over the entire study period (aggregate results; 6-14 days of continuous use). Two-thirds of the patients exhibited no bias throughout the study period, and individual bias in the others was symmetrically distributed (three patients with underpredictions and two overpredicted). Magnitude of prediction error during the patient-controlled morphine infusions was not related to the magnitude of pharmacokinetic deviation of individual subjects from group parameters. Our results indicate that this PKPCA system provides accurate control of plasma morphine concentration when used by patients to self-administer opioid for prolonged pain relief continuously over 1 to 2 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Value Of Individual Tailoring Methodssupporting

confidence: 87%

Evaluation of the accuracy of a pharmacokinetically-based patient-controlled analgesia system

Hill

Mackie

Coda

et al. 1992

Eur J Clin Pharmacol

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“…In addition, renal function in the newborn is usually impaired (Aperia et al, 1981). The clearance of morphine in adult patients is not affected by renal failure (Aitkenhead et al, 1984;Chauvin et al, 1987;Sawe & Odar-Cederlof, 1987). The impaired renal function in the newborn will, however, result in higher plasma concentrations of M3G as the glucuronides are excreted more slowly in patients with impaired renal function (Chauvin et al, 1987;Sawe & Odar-Cederlof, 1987).…”

Section: Discussionmentioning

confidence: 99%

Morphine metabolism in children.

Choonara

McKay

Hain

et al. 1989

Brit J Clinical Pharma

141

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1 The metabolism of morphine was studied in 12 children and nine premature neonates on a continuous infusion of morphine (10-360 ,g kg-' h-1). 2 The mean plasma clearance of morphine was significantly higher in children than neonates (25.7 and 4.7 ml min-' kg-', respectively) (P < 0.01). 3 All the neonates and children had detectable concentrations of morphine-3-glucuronide (M3G) in plasma. All the children and five neonates had detectable concentrations of morphine-6-glucuronide (M6G) in plasma or urine. 4 The M3G/morphine ratios in plasma and urine, and M6G/morphine ratios in urine were significantly higher in children than neonates (P < 0.01), suggesting that morphine glucuronidation capacity is enhanced after the neonatal period. 5There was no difference in the M3G/M6G ratio in children and neonates, indicating a parallel development of both glucuronidation pathways.

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“…Plasma paracetamol concentrations were measured subsequently by high performance liquid chromatography (Howie et al, 1977). Plasma morphine concentrations in the venous blood samples taken 20 min after the premedication were also measured by high performance liquid chromatography (Aitkenhead et al, 1984). …”

Section: Introduction Methodsmentioning

confidence: 99%

Comparison of the effect of cisapride and metoclopramide on morphine‐ induced delay in gastric emptying.

Rowbotham

Bamber

Nimmo

1988

Brit J Clinical Pharma

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1. The effects of metoclopramide or cisapride on morphine‐induced delay in gastric emptying in patients before surgery were compared. 2. Forty patients were allocated randomly to receive one of four premedications i.m.: placebo only, morphine 10 mg alone, morphine 10 mg with metoclopramide 10 mg and morphine 10 mg with cisapride 10 mg. Gastric emptying after each premedication was assessed indirectly from the rate of absorption of oral paracetamol. 3. Cisapride 10 mg reversed the delay in gastric emptying due to morphine. Its effects were significantly greater than those of metoclopramide 10 mg.

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Pharmacokinetics of a Single-Dose IV Morphine in Normal Volunteers and Patients with End-Stage Renal Failure

Cited by 31 publications

References 0 publications

Evaluation of the accuracy of a pharmacokinetically-based patient-controlled analgesia system

Evaluation of the accuracy of a pharmacokinetically-based patient-controlled analgesia system

Morphine metabolism in children.

Comparison of the effect of cisapride and metoclopramide on morphine‐ induced delay in gastric emptying.

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