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Cholestasis and Endogenous Opioids

Liver Disease and Exogenous Opioid Pharmacokinetics

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Abstract

A class of endogenous Opioids is upregulated in liver disease particular to cholestasis, which contributes to symptoms in liver disease such as pruritus, hypotension and encephalopathy. Symptoms associated with cholestasis are reversed or at least ameliorated by μ opioid receptor antagonists. Palliation of symptoms related to cholestatic liver disease also involves bile acid binding agents. Opioid receptor antagonists, unlike bile acid binding agents, have been reported to relieve multiple symptoms, except for pruritus, and improve liver function as demonstrated in experimental cholestasis. Exogenous opioid pharmacology is altered by liver disease. Dose reduction or prolongation of dose intervals is necessary depending on the severity of liver disease.

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Acknowledgements

The author would like to acknowledge the skills of Joan Scharf in the preparation of this manuscript. The author provided consultancy to Valeant Pharmaceuticals and Mallinkrodt Pharmaceuticals. No sources of funding were used to assist in the preparation of this review. The author has no conflicts of interest that are directly relevant to the content of this review.

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    Mellar Davis

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Davis, M. Cholestasis and Endogenous Opioids. Clin Pharmacokinet 46, 825–850 (2007). https://doi.org/10.2165/00003088-200746100-00002

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