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Updated: May 19, 2026

Assessment of Morphine-induced Hyperalgesia and Analgesic Tolerance in Mice Using Thermal and Mechanical Nociceptive Modalities
Published on: July 29, 2014
Contribution of morphine and morphine-6-glucuronide to respiratory depression in a child
1Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. j.hannam@auckland.ac.nz
Abstract:
A morphine plasma concentration/respiratory rate relationship has been described for both adults and children although that of its metabolite, morphine-6-glucuronide, remains uncertain. We describe this relationship in a child with end-stage renal failure who received repeat morphine administration over two days. An EMAX model for additive morphine and morphine-6-glucuronide respiratory effects described respiratory rate better than models describing either alone. Failure to clear morphine-6-glucuronide renally led to respiratory depression episodes occurring later than those predicted by modelling morphine levels only. These findings support the use of alternative analgesics (e.g. fentanyl) that are cleared by non-renal pathways and have no active metabolites in patients with end-stage renal disease.
Insights
Morphine-6-glucuronide, a metabolite of morphine, can cause delayed respiratory depression in patients with end-stage renal disease. Alternative analgesics like fentanyl are recommended for pain management in these patients.
Area of Science:
- Pharmacology
- Nephrology
- Critical Care Medicine
Background:
- The relationship between morphine plasma concentration and respiratory rate is established in adults and children.
- The pharmacokinetic and pharmacodynamic profile of morphine-6-glucuronide (M6G), a key morphine metabolite, regarding respiratory effects remains unclear, particularly in renally impaired patients.
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