The effect of ageing on the pharmacokinetics of dihydrocodeine

Davies, Kari; Castleden, C. M.; McBurney, A; Jagger, Carol

doi:10.1007/bf00558503

Cited by 16 publications

(5 citation statements)

References 8 publications

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“… 36 In general, these changes lead to higher initial plasma levels after opioid administration. However, considering a previous study, in which age-related increases in maximum plasma concentrations were shown not for a single dose but only after multiple repeat doses, 37 remifentanil seems to be closer to single dosing administration despite infusion in the elderly patients, due to no in vivo accumulative characteristics and short context sensitive half-time (approximately 3 min). Second, although the relationship between perioperative pain and aging remains controversial, 36 a study of approximately 500 cancer patients found that the elderly had similar pain levels to the younger.…”

Section: Discussionmentioning

confidence: 76%

Effects of age on effect-site concentration of remifentanil for suppressing anesthetic emergence cough in male patients undergoing laparoscopic cholecystectomy

Kim

Lee

Kang

et al. 2018

CIA

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BackgroundRemifentanil infusion during emergence lowers cough. Effect-site concentration (Ce) of remifentanil using target-controlled infusion (TCI) has been evaluated in previous studies. Recent studies revealed the existence of sex-related differences in remifentanil Ce in young and elderly patients. Thus, there was the need to re-evaluate the effect of age in single sex. We investigated the remifentanil Ce for suppressing emergence cough in young and elderly male patients and evaluated the age-related differences.Patients and methodsIn total, 25 young (ages between 20 and 50 years) and 24 elderly (ages between 65 and 75 years) male patients undergoing laparoscopic cholecystectomy were enrolled. Anesthesia was implemented with remifentanil using TCI and sevoflurane. The remifentanil Ce for suppressing emergence cough was estimated for each group using Dixon’s up-and-down method and isotonic regression method with a bootstrapping approach.ResultsThe remifentanil Ce for suppressing emergence cough in 50% (EC50) and 95% (EC95) of the patients was comparable between the young and elderly patients. Isotonic regression demonstrated that the EC50 (83% confidence interval [CI]) of remifentanil was 2.56 (2.39−2.75) ng/mL in the young patients and 2.15 (1.92−2.5) ng/mL in the elderly patients. The EC95 (95% CI) of remifentanil was 3.33 (2.94−3.46) ng/mL in the young patients and 3.41 (3.18−3.48) ng/mL in the elderly patients. Dixon’s up-and-down method also demonstrated that the EC50 was comparable between the two groups (2.69±0.32 ng/mL vs 2.39±0.38 ng/mL, P=0.132).ConclusionThe remifentanil Ce for suppressing emergence cough following extubation during general anesthesia was comparable between young and elderly male patients. It indicates that age-related differences in remifentanil requirement for suppressing emergence cough did not exist in male sex.

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Section: Discussionmentioning

confidence: 76%

Effects of age on effect-site concentration of remifentanil for suppressing anesthetic emergence cough in male patients undergoing laparoscopic cholecystectomy

Kim

Lee

Kang

et al. 2018

CIA

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“…25% in maximum plasma concentrations and areas under the curve. This was attributed to decreases in plasma clearance with age, with some evidence of greater effect in females (Davies et al, 1989). An early study using transdermal fentanyl application by patch demonstrated more than doubled mean plasma concentrations over 60 h for old (67–87 years) as compared to young (19–27 years) subjects (2.1 vs. 0.9 ng/ml) (Holdsworth et al, 1994).…”

Section: Summary Of Available Human Clinical Datamentioning

confidence: 99%

Opioid use in the elderly

Wilder–Smith

2005

European Journal of Pain

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Pain treatment in the elderly is an important challenge to Western societies due to increasing numbers of old persons, their higher incidence of pain, and their greater susceptibility to adverse effects of pain medication. We provide an overview of the factors liable to influence opioid action in the elderly population. A major challenge for the physician prescribing opioids in the elderly is their greater risk of medication-associated problems. Thus, older patients suffer increased vulnerability to adverse drug effects and interactions, higher rates of polypharmacy, and more comorbidity. These problems are compounded by a relative lack of definitive published information. There is clearly a need for more research in this area. Aging affects opioid pharmacokinetics via altered body composition (distribution volumes) and organ function (liver=metabolism, kidney=excretion). Pharmacodynamics is affected via impaired neurotransmitter/peptide production and changed receptor affinities/populations. Older women may need less morphine analgesia postoperatively, while pain sensitivity tends to increase particularly in older men. However, the net effects of changes in opioid pharmacology with age on clinical opioid analgesia remain unclear, probably due to the significantly greater variability in body function with increasing age. Practical recommendations for opioid prescription in the elderly include meticulous review of indication for opioid use, not only initially but also at regular intervals thereafter. A policy of careful titration should be followed, with conservative choice of dosage on starting. Dosing intervals may need to be lengthened subsequently. Finally, it should be remembered that old persons do not necessarily need less opioid than younger ones.

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“…Additionally, no clear guidelines can be given on the therapeutic dose of codeine in elderly patients, not to mention the dose used in those on HD. Davies et al 17 suggested that a small dose of narcotics should be initially administered to elderly patients because they are more sensitive to narcotics. Therefore, oral codeine 30 mg every 6 hours instead of 60 mg every 6 hours may be a suitable initial dose for elderly patients with normal renal function.…”

Section: Discussionmentioning

confidence: 99%