Morphine-6-glucuronide disposition in renal impairment.
Twelve patients with chronic renal failure (dialysis-dependent) and six with good renal function after renal transplantation received i.v. morphine-6-glucuronide (M6G) 30 micrograms kg-1 as part of a standardized anaesthetic technique for minor surgery. Continuous peritoneal dialysis was commenced 6 h after M6G administration in six of the dialysis-dependent patients. Serum was sampled for up to 12 h and analysed for morphine and M6G by high pressure liquid chromatography. Morphine was not detected. Mean (SD) derived pharmacokinetic variables for the three groups (transplant, renally impaired non-dialysed and renally impaired dialysed, respectively) were: elimination half-life 2.14 (0.69) h, 27.10 (15.8) h, 17.33 (4.6) h; clearance 96.0 (34.9) ml min-1, 10.57 (5.57) ml min-1, 14.3 (6.2) ml min-1; volume of distribution 0.19 (0.03) litre kg-1, 0.25 (0.06) litre kg-1, 0.27 (0.06) litre kg-1. The elimination half-life was shorter (P < 0.01) and the clearance greater (P < 0.01) for the transplanted group compared with the dialysed and non-dialysed groups. Peritoneal dialysis for the second 6 h after drug administration had little effect on M6G disposition as assessed by comparison with data obtained from the non-dialysed group.
Hanna
M H
MH
Department of Anaesthesia, King's College Hospital, London.
D'Costa
F
F
Peat
S J
SJ
Fung
C
C
Venkat
N
N
Zilkha
T R
TR
Davies
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D003404:Creatinine / Q000097:blood; D006207:Half-Life; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism*; D016030:Kidney Transplantation; D008875:Middle Aged; D013511:Minor Surgical Procedures; D009022:Morphine Derivatives / Q000493:pharmacokinetics; D010530:Peritoneal Dialysis; D013997:Time Factors
D009022:Morphine Derivatives; C035349:morphine-6-glucuronide; D003404:Creatinine