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Pharmacokinetics of controlled release morphine (MST) in patients with liver carcinoma

H I M Kotb1, S A El-Kady, S E S Emara

  • 1Department of Anesthesia, Faculty of Medicine, Assiut University, Assiut, Egypt. kotbhi@yahoo.com

British Journal of Anaesthesia
|November 2, 2004
PubMed
Abstract

Insights

Pharmacokinetics of controlled release morphine (MST) are altered in liver cancer patients, with increased bioavailability and impaired elimination in primary carcinoma. Careful MST dosing is advised for these patients.

Area of Science:

  • Pharmacology
  • Oncology
  • Hepatology

Background:

  • Limited pharmacokinetic data exists for controlled release morphine (MST) in hepatocellular carcinoma patients.
  • Hepatocellular carcinoma is the fifth most common cancer globally.
  • Understanding MST pharmacokinetics is crucial for effective pain management in cancer patients.

Purpose of the Study:

  • To investigate the pharmacokinetic profile of controlled release morphine (MST) in patients with hepatocellular carcinoma.
  • To compare MST pharmacokinetics in primary liver cancer and secondary metastatic liver cancer patients with healthy controls.
  • To assess the impact of liver cancer on morphine bioavailability, clearance, and elimination.

Main Methods:

  • A pharmacokinetic study of MST (30 mg) was conducted in 15 liver carcinoma patients.
  • Plasma morphine concentrations were measured using high-pressure liquid chromatography.
  • Total body clearance and systemic bioavailability were estimated using compartmental modeling, compared to published data from healthy controls.

Main Results:

  • Morphine bioavailability was significantly increased in both primary (64.8%) and metastatic (62.1%) liver cancer patients compared to controls (16.8%).
  • The area under the serum concentration-time curve (AUC) was 4-fold higher in primary and 3-fold higher in metastatic liver cancer patients.
  • Impaired morphine elimination (t1/2 = 5.99 h) was observed in primary liver carcinoma patients, but not in metastatic cases.

Conclusions:

  • Morphine pharmacokinetics are significantly altered in patients with liver cancer, necessitating dose adjustments.
  • Increased bioavailability and potential for accumulation require careful morphine administration in these patients.
  • Further research into optimal dosing strategies for controlled release morphine in liver cancer patients is warranted.

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