Morphine Inhalation by Cancer Patients: A Comparison of Different Nebulization Techniques Using Pharmacokinetic, Spirometric, and Gasometric Parameters

Journal of Pain and Symptom Management

Volumn 38, Issue 5, 2009, Pages 747-757

  Krajnik, Małgorzata ^a   Podolec, Zygmunt ^b   Siekierka, Monika ^a   Sykutera, Marzena ^a   Pufal, Ewa ^a   Sobanski, Piotr ^c   Makarewicz, Roman ^a   Neef, Cees ^d   Punt, Nieko ^d   Zylicz, Zbigniew ^e  

^a NICOLAUS COPERNICUS UNIVERSITY   (Poland)

^b Cent for Electronics   (Poland)

^c University Hospital   (Poland)

^d MAASTRICHT UNIVERSITY MEDICAL CENTER   (Netherlands)

^e Dove House Hospice   (United Kingdom)

Author keywords

cancer patients; morphine deposition; morphine pharmacokinetics; morphine 3 glucuronide; morphine 6 glucuronide; Pneumodosimetric nebulization

Indexed keywords

GLUCURONIDE; MORPHINE; MORPHINE 3 GLUCURONIDE; MORPHINE 6 GLUCURONIDE;

ADULT; AEROSOL; AGED; AREA UNDER THE CURVE; ARTICLE; BITTER TASTE; BRONCHIAL CONTROL TREATMENT SYSTEM MICRO CIRRUS; BRONCHIAL CONTROL TREATMENT SYSTEM SIDESTREAM; CANCER PATIENT; CLINICAL ARTICLE; CONTROLLED STUDY; DOSIMETRY; DRUG BLOOD LEVEL; DRUG DELIVERY SYSTEM; DRUG METABOLISM; FEMALE; GASOMETRY; HUMAN; HYPOTENSION; INTERMETHOD COMPARISON; LUNG ALVEOLUS; LUNG FUNCTION TEST; MALE; NEBULIZATION; SIDE EFFECT; SPIROMETRY; SWEATING; TRACHEA; TRACHEOBRONCHIAL TREE; URINARY EXCRETION; XEROSTOMIA;

ADMINISTRATION, INHALATION; ADULT; AGED; ANALGESICS, OPIOID; BIOTRANSFORMATION; FEMALE; HUMANS; KARNOFSKY PERFORMANCE STATUS; MALE; MIDDLE AGED; MORPHINE; NEOPLASMS; PAIN; SPIROMETRY;

EID: 70350536525     PISSN: 08853924     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.jpainsymman.2009.03.008     Document Type: Article

References (50)

1. Jennings A.L., Davies A.N., Higgins J.P., Gibbs J.S., and Broadley K.E. A systematic review of the use of opioids in the management of dyspnoea. Thorax 57 (2002) 939-944
2. Bruera E., Sala R., Spruyt O., et al. Nebulized versus subcutaneous morphine for patients with cancer dyspnea: a preliminary study. J Pain Symptom Manage 29 (2005) 613-618
3. Coyne P.J. The use of nebulized fentanyl for the management of dyspnea. Clin J Oncol Nurs 7 (2003) 334-335
4. Kallet R.H. The role of inhaled opioids and furosemide for the treatment of dyspnea. Respir Care 52 (2007) 900-910
5. Charles M.A., Reymond L., and Israel F. Relief of incident dyspnea in palliative cancer patients: a pilot, randomized, controlled trial comparing nebulized hydromorphone, systemic hydromorphone, and nebulized saline. J Pain Symptom Manage 36 (2008) 29-38
6. Ray N.J., Jones A.J., and Keen P. Morphine, but not sodium cromoglycate, modulates the release of substance P from capsaicin-sensitive neurones in the rat trachea in vitro. Br J Pharmacol 102 (1991) 797-800
7. Auberson S., Lacroix J.S., Kordestani R.K., and Lundberg J.M. Prejunctional control of pH 6-induced bronchoconstriction by NK1, NK2, mu-opioid, alpha2-adrenoceptor and glucocorticoid receptors in guinea-pig isolated perfused lung. J Pharm Pharmacol 50 (1998) 899-905
8. Lindstrom E.G., and Andersson R.G. Morphine modulates contractile responses and neurokinin A-LI release elicited by electrical field stimulation or capsaicin in a guinea pig bronchial-tube preparation. Am J Respir Crit Care Med 151 (1995) 1175-1179
9. Belvisi M.G., Stretton C.D., Verleden G.M., et al. Inhibition of cholinergic neurotransmission in human airways by opioids. J Appl Physiol 72 (1992) 1096-1100
10. Fischer A., and Undem B.J. Naloxone blocks endomorphin-1 but not endomorphin-2 induced inhibition of tachykinergic contractions of guinea-pig isolated bronchus. Br J Pharmacol 127 (1999) 605-608
11. Rogers D.F., and Barnes P.J. Opioid inhibition of neurally mediated mucus secretion in human bronchi. Lancet 1 (1989) 930-932
12. Lei Y.H., and Rogers D.F. Effects and interactions of opioids on plasma exudation induced by cigarette smoke in guinea pig bronchi. Am J Physiol 276 (1999) L391-L397
13. Karlsson J.A., Lanner A.S., and Persson C.G. Airway opioid receptors mediate inhibition of cough and reflex bronchoconstriction in guinea pigs. J Pharmacol Exp Ther 252 (1990) 863-868
14. Cabot P.J., Dodd P.R., Cramond T., and Smith M.T. Characterization of non-conventional opioid binding sites in rat and human lung. Eur J Pharmacol 268 (1994) 247-255
15. Bhargava H.N., Villar V.M., Cortijo J., and Morcillo E.J. Binding of [3H][D-Ala2, MePhe4, Gly-ol5] enkephalin, [3H][D-Pen2, D-Pen5]enkephalin, and [3H]U-69,593 to airway and pulmonary tissues of normal and sensitized rats. Peptides 18 (1997) 1603-1608
16. Cabot P.J., Cramond T., and Smith M.T. Quantitative autoradiography of peripheral opioid binding sites in rat lung. Eur J Pharmacol 310 (1996) 47-53
17. Sunday M.E., Haley K.J., Emanuel R.L., et al. Fetal alveolar epithelial cells contain [D-Ala(2)]-deltorphin I-like immunoreactivity: delta- and mu-opiate receptors mediate opposite effects in developing lung. Am J Respir Cell Mol Biol 25 (2001) 447-456
18. Krajnik M, Mousa SA, Stein C, et al. Opioid receptors and endogenous opioids in human lung tissue. Proceedings of the 11th World Congress on Pain, Sydney, Australia, 2005:419.
19. Podolec P., Kaznica-Wiatr M., Podolec Z., et al. [Vasodilatator testing with nitric oxide (bronchial control treatment system-BCTS) in patients with pulmonary hypertension]. [Polish]. Przegl Lek 61 (2004) 737-742
20. Krajnik M., Podolec Z., Zylicz Z., and Jassem E. Air humidity may influence the aerosol distribution of normal saline administered by closed or vented nebulizers operated continuously or dosimetrically. J Aerosol Med Pulm Drug Deliv (2009) 22-34
21. Wilcock A., Crosby V., Clarke D., Corcoran R., and Tattersfield A. Reading numbers aloud: a measure of the limiting effect of breathlessness in patients with cancer. Thorax 54 (1999) 1099-1103
22. Ward R.J., Ward C., Johns D.P., et al. European Community Respiratory Health Survey calibration project of dosimeter driving pressures. Eur Respir J 19 (2002) 252-256
23. Bogusz M.J., Maier R.D., and Driessen S. Morphine, morphine-3-glucuronide, morphine-6-glucuronide, and 6-monoacetylmorphine determined by means of atmospheric pressure chemical ionization-mass spectrometry-liquid chromatography in body fluids of heroin victims. J Anal Toxicol 21 (1997) 346-355
24. Proost J.H., and Meijer D.K. MW/Pharm, an integrated software package for drug dosage regimen calculation and therapeutic drug monitoring. Comput Biol Med 22 (1992) 155-163
25. Brack A., Rittner H.L., Machelska H., et al. Endogenous peripheral antinociception in early inflammation is not limited by the number of opioid-containing leukocytes but by opioid receptor expression. Pain 108 (2004) 67-75
26. Mousa S.A., Straub R.H., Schafer M., and Stein C. Beta-endorphin, met-enkephalin and corresponding opioid receptors within synovium of patients with joint trauma, osteoarthritis and rheumatoid arthritis. Ann Rheum Dis 66 (2007) 871-879
27. Mousa S.A., Bopaiah C.P., Richter J.F., Yamdeu R.S., and Schafer M. Inhibition of inflammatory pain by CRF at peripheral, spinal and supraspinal sites: involvement of areas coexpressing CRF receptors and opioid peptides. Neuropsychopharmacology 32 (2007) 2530-2542
28. Risdahl J.M., Huether M.J., Gustafson K.V., and Molitor T.W. Morphine alteration of histamine release in vivo. Adv Exp Med Biol 373 (1995) 161-168
29. Schurig J.E., Cavanagh R.L., and Buyniski J.P. Effect of butorphanol and morphine on pulmonary mechanics, arterial blood pressure and venous plasma histamine in the anesthetized dog. Arch Int Pharmacodyn Ther 233 (1978) 296-304
30. Brashear R.E., Kelly M.T., and White A.C. Elevated plasma histamine after heroin and morphine. J Lab Clin Med 83 (1974) 451-457
31. Otulana B., Okikawa J., Linn L., Morishige R., and Thipphawong J. Safety and pharmacokinetics of inhaled morphine delivered using the AERx system in patients with moderate-to-severe asthma. Int J Clin Pharmacol Ther 42 (2004) 456-462
32. Ward M.E., Woodhouse A., Mather L.E., et al. Morphine pharmacokinetics after pulmonary administration from a novel aerosol delivery system. Clin Pharmacol Ther 62 (1997) 596-609
33. Dershwitz M., Walsh J.L., Morishige R.J., et al. Pharmacokinetics and pharmacodynamics of inhaled versus intravenous morphine in healthy volunteers. Anesthesiology 93 (2000) 619-628
34. Usmani O.S., Biddiscombe M.F., and Barnes P.J. Regional lung deposition and bronchodilator response as a function of beta2-agonist particle size. Am J Respir Crit Care Med 172 (2005) 1497-1504
35. Usmani O.S., Biddiscombe M.F., Nightingale J.A., Underwood S.R., and Barnes P.J. Effects of bronchodilator particle size in asthmatic patients using monodisperse aerosols. J Appl Physiol 95 (2003) 2106-2112
36. Christrup L.L., Sjogren P., Jensen N.H., et al. Steady-state kinetics and dynamics of morphine in cancer patients: is sedation related to the absorption rate of morphine?. J Pain Symptom Manage 18 (1999) 164-173
37. Cepeda M.S., Farrar J.T., Roa J.H., et al. Ethnicity influences morphine pharmacokinetics and pharmacodynamics. Clin Pharmacol Ther 70 (2001) 351-361
38. Hasselstrom J., and Sawe J. Morphine pharmacokinetics and metabolism in humans. Enterohepatic cycling and relative contribution of metabolites to active opioid concentrations. Clin Pharmacokinet 24 (1993) 344-354
39. Fitzgibbon D., Morgan D., Dockter D., Barry C., and Kharasch E.D. Initial pharmacokinetic, safety and efficacy evaluation of nasal morphine gluconate for breakthrough pain in cancer patients. Pain 106 (2003) 309-315
40. Peterson G.M., Randall C.T., and Paterson J. Plasma levels of morphine and morphine glucuronides in the treatment of cancer pain: relationship to renal function and route of administration. Eur J Clin Pharmacol 38 (1990) 121-124
41. Mazoit J.X., Butscher K., and Samii K. Morphine in postoperative patients: pharmacokinetics and pharmacodynamics of metabolites. Anesth Analg 105 (2007) 70-78
42. Quigley C., Joel S., Patel N., Baksh A., and Slevin M. Plasma concentrations of morphine, morphine-6-glucuronide and morphine-3-glucuronide and their relationship with analgesia and side effects in patients with cancer-related pain. Palliat Med 17 (2003) 185-190
43. Illum L., Watts P., Fisher A.N., et al. Intranasal delivery of morphine. J Pharmacol Exp Ther 301 (2002) 391-400
44. Quigley C., Joel S., Patel N., Baksh A., and Slevin M. A phase I/II study of nebulized morphine-6-glucuronide in patients with cancer-related breathlessness. J Pain Symptom Manage 23 (2002) 7-9
45. Davis C., Hodder C., Love S., et al. Effect of nebulized morphine and morphine-6-glucuronide on exercise endurance in patients with chronic obstructive airway disease [abstract]. Thorax 49 (1994) 393
46. Stone A.N., Mackenzie P.I., Galetin A., Houston J.B., and Miners J.O. Isoform selectivity and kinetics of morphine 3- and 6-glucuronidation by human udp-glucuronosyltransferases: evidence for atypical glucuronidation kinetics by UGT2B7. Drug Metab Dispos 31 (2003) 1086-1089
47. Fisher M.B., Vandenbranden M., Findlay K., et al. Tissue distribution and interindividual variation in human UDP-glucuronosyltransferase activity: relationship between UGT1A1 promoter genotype and variability in a liver bank. Pharmacogenetics 10 (2000) 727-739
48. Zheng Z., Fang J.L., and Lazarus P. Glucuronidation: an important mechanism for detoxification of benzo[a]pyrene metabolites in aerodigestive tract tissues. Drug Metab Dispos 30 (2002) 397-403
49. Ren Q., Murphy S.E., Zheng Z., and Lazarus P. O-glucuronidation of the lung carcinogen 4-(methylnitrosamino)-1- (3-pyridyl)-1-butanol (NNAL) by human UDP-glucuronosyltransferases 2B7 and 1A9. Drug Metab Dispos 28 (2000) 1352-1360
50. Yamada H., Ishii K., Ishii Y., et al. Formation of highly analgesic morphine-6-glucuronide following physiologic concentration of morphine in human brain. J Toxicol Sci 28 (2003) 395-401