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Pain, sedation and morphine metabolism in cancer patients during long-term treatment with sustained-release morphine

N-H Jensen

Multidisciplinary Pain Centre, Herlev University Hospital, Herlev, Copenhagen

L Christrup

S H Hansen

The Royal Danish School of Pharmacy, Copenhagen

P Sjøgren

Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen

Background: Morphine-6-glucuronide (M-6-G) and morphine-3-glucuronide (M-3-G) are the two most important metabolites of morphine. Both are pharmacologically active, however, with different effects. M-6-G has been demonstrated capable of inducing anti-nociception and sedation, and M-3-G may induce behavioural excitation and possibly antagonise anti-nociception. Their impact on pharmacodynamics in patients in long-term treatment with oral morphine remains to be settled.

Methods: Forty-two cancer patients treated with oral sustained-release (SR) morphine were assessed for pain, sedation and other side effects related to morphine treatment. Blood samples were analysed for morphine, M-3-G and M-6-G by high-performance liquid chromatography (HPLC).

Results: Significant correlations were found between the daily dose of SR morphine and plasma morphine (M) (r=0.535, P<0.001), plasma M-6-G (r =0.868, P<0.001) and plasma M-3-G (r =0.865, P<0.001). There was no relationship between plasma morphine, M-6-G, M-6-G/M and pain and sedation scores. Seventy-nine percent of the patients suffered from dryness of the mouth, which was the most frequent side effect observed. Patients in this group had higher plasma morphine and M-6-G concentrations than patients who did not suffer from this side effect.

Conclusion: The plasma concentrations of morphine and its metabolites, M-3-G and M-6-G, are significantly correlated to the daily dose of SR morphine. Although M-6-G has analgesic properties, no associations were found between pain and plasma morphine and morphine metabolites. This may be due to the multitudinous factors affecting the dose effect relationship. Patients with dryness of the mouth had higher concentrations of morphine and M-6-G than patients without this side effect.

Key Words: morphine • morphine metabolites • pharmacodynamics • pharmacokinetics • side effects

Palliative Medicine, Vol. 16, No. 2, 107-114 (2002)
DOI: 10.1191/0269216302pm512oa


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