Opioid Pharmacokinetics and Drug Interactions in Palliative Care

Thomas B. Strouse, MD

Medical Director
Stewart and Lynda Resnick Neuropsychiatric Hospital
Depts. of Psychiatry and Biobehavioral Science and Medicine/Palliative Care
David Geffen–UCLA School of Medicine
Los Angeles, California
Optimal palliative care often requires simultaneous management of active disease and associated symptoms. As a result, many palliative care patients are treated with complex multidrug regimens, thereby increasing the risk of drug–drug interactions. Because opioids are an essential component of pain management for most patients receiving palliative care, it is imperative that clinicians understand the metabolic pathways associated with various opioids and the potential effects of disease and other medications on opioid pharmacokinetic and pharmacodynamic profiles. Depending on the interaction, the analgesic and toxic effects of opioids can be augmented or attenuated.

References

Strouse TB. Pharmacokinetic Drug Interactions in Palliative Care: Focus On Opioids. J Palliat Med. 2009 Aug 20.
Emmanuel LL, von Gunten CF, Farris F. The Education for Physicians on End of Life Care (EPEC) Curriculum. Chicago IL: 1999.
Armstrong SC, Wynn GH, Sandson NB. Pharmacokinetic drug interactions of synthetic opiate analgesics. Psychsomatics. 2009;50:169-176.

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