Open Access Open Access  Restricted Access Subscription or Fee Access

High dose of buprenorphine in terminally ill patient with liver failure: Efficacy and tolerability

Alessandra Ciccozzi, MD, Chiara Angeletti, MD, Giada Baldascino, MD, Emiliano Petrucci, MD, Cristina Bonetti, MD, Stefania De Santis, MD, Antonella Paladini, MD, Giustino Varrassi, PhD, Franco Marinangeli, MD

Abstract


Pain in terminally ill patients with cancer can be often hard to manage, due to the unpredictable kinetics of drugs caused by progressive kidney and liver dysfunction. Plasma concentrations of active metabolites–also a cause of dangerous side effects–could be difficult to estimate. This case report holds the idea that buprenorphine, a partial agonist of µ-receptors, even at high dosage, may be effective and safe to use in terminally ill patients with significant liver and kidney impairment.


Keywords


terminal-illness, pain management, buprenorphine, palliative care

Full Text:

PDF

References


Marinangeli F, Ciccozzi A, Leonardis M, et al.: Use of strong opioids in advanced cancer pain: A randomized trial. J Pain Symptom Manage. 2004; 27: 409-416.

Johnson RE, Strain EC, Amass L: Buprenorphine: How to use it right. Drug Alcohol Depend. 2003; 70: S59-S77.

Raehal KM, Schmid CL, Groer CE, et al.: Functional selectivity at the _-opioid receptor: Implications for understanding opioid analgesia and tolerance. Pharmacol Rev. 2011; 63(4): 1001-1019.

Ding Z, Raffa RB: Identification of an additional supraspinal component to the analgesic mechanism of action of buprenorphine. Br J Pharmacol. 2009; 157(5): 831-843.

Bulka A, Kouya PF, Bottiger Y, et al.: Comparison of the antinociceptive effects of morphine, methadone, buprenorphine and codeine in two substrains of Sprague-Dawley rats. Eur J Pharmacol. 2004; 492: 27-34.

Davis M: Buprenorphine in cancer pain. Support Care Cancer. 2005; 13: 878-887.

Thomas JM, Hoffman BB: Buprenorphine prevents and reverses the expression of chronic etorphine-induced sensitization of adenylyl cyclase in SK-N-SH human neuroblastoma cells. J Pharamacol Exp Ther. 1993; 264(1): 368-374.

Andresen T, Upton RN, Foster DJ, et al.: Pharmacokinetic/pharmacodynamics relationships of transdermal buprenorphine and fentanyl in experimental human pain models. Basic Clin Pharmacol Toxicol. 2011; 108(4): 274-284.

Sittl R: Transdermal buprenorphine in cancer pain and palliative care. Palliat Med. 2006; 20 Suppl 1: s25-s30.

Mercadante S, Fulfaro F: Alternatives to oral opioids for cancer pain. Oncology. 1999; 13: 215-220.

Mercadante S, Casuccio A, Tirelli W, et al.: Equipotent doses to switch from high doses of opioids to transdermal buprenorphine. Support Care Cancer. 2009; 17(6): 715-718.

Ang-Lee K, Oreskovich MR, Saxon AJ, et al.: Single dose of 24 milligrams of buprenorphine for heroin detoxification: An openlabel study of five inpatients. J Psychoactive Drug. 2006; 38: 505-512.

Pedersen JE, Chraemmer-Jorghensen B, Schmidt JF, et al.: Peroperative buprenorphine: Do high dosages shorten analgesia postoperatively? Acta Anaesthesiol Scand. 1986; 30: 660-663.

Kogel B, Christoph T, Strassburger W, et al.: Interaction of mu-opioid receptor agonists and antagonists with the analgesic effect of buprenorphine in mice. Eur J Pain. 2005; 9: 599-611.

Dahan A: Opioid-induced respiratory effects: New data on buprenorphine. Palliat Med. 2006; 20 Suppl 1: 3-8.

Yassen A, Olofsen E, van Dorp E, et al.: Mechanism-based PK/PD modeling of the respiratory depressant effect of buprenorphine and fentanyl in healthy volunteers. Clin Pharmacol Ther. 2007; 81(1): 50-58.

Martin HA: The possible consequences of combining Lorazepam and buprenorphine/naloxone: A case review. J Emerg Nurs. 2011; 37(2): 200-202.

Chang Y, Moody DE: Glucuronidation of buprenorphine and norbuprenorphine by human liver microsomes and UDPglucuronosyltransferases. Drug Metab Lett. 2009; 3(2): 101-107.

Barutell C, Camba A, Gonzalez-Escalada J-R, et al.: Opioid group of the Spanish Society for the study of pain: High dose transdermal buprenorphine for moderate to severe pain in Spanish pain centres–A retrospective multicenter safety and efficacy study. Pain Pract. 2008; 8: 355-361.

Poulen P, Denier W, Douma J, et al.: Efficacy and safety of transdermal buprenorphine: A randomized placebo-controlled trial in 289 patients with severe cancer pain. J Pain Symptom Manage. 2008; 36: 117-125.

Gastmeier K, Freye E: High-dose buprenorphine for outpatient palliative pain therapy. Schmerz. 2009; 23(2): 180-186.

Berson A, Fau D, Fornacciari R, et al.: Mechanisms for experimental buprenorphine hepatotoxicity: Major role of mitochondrial dysfunction versus metabolic activation. J Hepatol. 2001; 34: 261-269.

Zuin M, Giorgini A, Selmi C, et al.: Acute liver and renal failure during treatment with buprenorphine at therapeutic dose. Dig Liver Dis. 2009; 41: e8-e10.

Peyrière H, Tatem L, Bories C, et al.: Hepatitis after intravenous injection of sublingual buprenorphine in acute hepatitis C carriers: Report of two cases of disappearance of viral replication after acute hepatitis. Ann Pharmacother. 2009; 43: 973-977.

Gruber VA, McCance-Katz EF: Methadone, buprenorphine, and street drug interactions with antiretroviral medications. Curr HIV/AIDS Rep. 2010; 7(3): 152-160.

McCAnce-Katz EF, Mandell TW: Drug interactions of clinical importance with methadone and buprenorphine. Am J Addict. 2010; 19(1): 2-3.

Hassan HE, Myers AL, Coop A, et al.: Differential involvement of P-glycoprotein (ABCB1) in permeability, tissue distribution, and antinociceptive activity of methadone, buprenorphine, and diprenorphine: In vitro and in vivo evaluation. J Pharm Sci. 2009; 98(12): 4928-4940.

Pergolizzi J, Aloisi AM, Dahan A, et al.: Current knowledge of buprenorphine and its unique pharmacological profile. Pain Pract. 2010; 10: 428-450.

Ikeda K, Ide S, Han W, et al.: How individual sensitivity to opiates can be predicted by gene analyses. Trends Pharmacol Sci. 2005; 26: 311-317.

Weinberg DS, Inturrisi CE, Reidenberg B, et al.: Sublingual absorption of selected opioid analgesics. Clin Pharmacol Ther. 1988; 44(3): 335-342.

Nagashima M, Katoh R, Sato Y, et al.: Is there genetic polymorphism evidence for individual human sensitivity to opiates? Curr Pain Headache Rep. 2007; 11: 115-123.

Webster LR: Pharmacogenetics in pain management: The clinical need. Clin Lab Med. 2008; 28: 569-579.

Niscola P, Scaramucci L, Vischini G, et al.: The use of major analgesics in patients with renal dysfunction. Curr Drug Targets. 2010; 11: 752-758.

Pergolizzi J, Böger RH, Budd K, et al.: Opioids and the management of chronic severe pain in the elderly: Consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization. Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008; 8: 287-313.




DOI: https://doi.org/10.5055/jom.2012.0123

Refbacks

  • There are currently no refbacks.