Liver Metabolism of Analgesic Agents
The importance of the liver in the metabolism of analgesic agents has long been recognized. Important changes in the elimination of these drugs may occur in critically ill patients. Changes in liver blood flow are particularly important since hypotension, anesthesia and surgery , trauma, sepsis, hypoxia and possibly inotropic therapy lead to significant alterations, resulting in large changes in the clearance of these drugs. To date there has been little systematic study of commonly used drugs in acute hepatic insufficiency, a common accompaniment of serious illness. Furthermore the concurrent administration of some of the many drugs used to treat such illness including benzodiazepines, cimetidine etc. may interfere with the liver enzymatic activity, decreasing or increasing the rate of metabolism. Of all of the analgesics in common use in the critically ill, morphine is the commonest in use worldwide. This review will predominately concentrate on the altered metabolism of morphine in critically ill humans although the newer synthetic opiates will also be discussed.
KeywordsHigh Performance Liquid Chromatography Biliary Atresia Hepatic Blood Flow Liver Blood Flow Liver Metabolism
Unable to display preview. Download preview PDF.
- 16.Jacqz E, Ward S, Johnson R, Schenker S, Gerkens J, Branch R (1986) Extrahepatic glucu-ronidation of morphine in the dog. Drug Metab Disp 14:627–630Google Scholar
- 17.Morse TS, Wilkinson GR, Johnson RF, Shenker MD (1975) Effect of acute viral hepatitis in man on the disposition and elimination of meperidine. Gastroenterology 68:775–780Google Scholar
- 20.Mather LE, Tucker GT, Pflug A, Lindop MJ, Wilkinson C (1975) Meperidine kinetics in man. Clin Pharm Ther 17:21–30Google Scholar
- 22.Sear JW, Fisher A, Summerfield RJ (1987) Is alfentanil by infusion useful for sedation on the ITU. Eur J Anaesth S1:55–61Google Scholar
- 25.Shelly M, Quinn K, Park G (1986) Pharmacokinetic study of morphine in the postoperative period following liver transplantation: a preliminary communication. In: Band P, Stewart J, Towson T (eds) Advances in the management of chronic pain. The international symposium on pain control. Purdue Frederick, TorontoGoogle Scholar
- 26.Intussi CF, Umans JG (1983) Pethidine and its active metabolite norpethidine. Clin AnaesthGoogle Scholar