title: Interindividual variation in the ratio between plasma morphine and its metabolites in cancer patients.
abstract: In 25 cancer patients treated with slow-release oral morphine and in 10 cancer patients treated with continuous infusion of morphine, plasma steady-state concentrations of morphine (M), morphine-3-glucuronide (M-3-G) and morphine-6-glucuronide (M-6-G) were determined by high-performance liquid chromatography. Blood samples were withdrawn at 0, 2 and 6 h after oral administration in patients treated with slow-release oral morphine and once or twice a day in patients treated with continuous infusion of morphine. In four cancer patients treated with continuous infusion of morphine, in order to analyze chronopharmacokinetic variability, the M-3-G/M ratio was observed at 12:00 h and 24:00 h. No significant changes were observed in M-3-G/M ratios and M-6-G ratios at 0, 2, and 6 h after oral administration of morphine. The M-3-G/M ratio (38.6 +/- 25.7) in the oral morphine group was significantly higher than that (15.3 +/- 12.9) in the continuous infusion group (p < 0.01). There was an approximately 10-fold interindividual variation in the M-3-G/M ratio both in the continuous infusion group and in the oral morphine group. These results suggest that the activity of UDP glucuronosyltransferase 2B7 in the intestinal metabolism of morphine may play an active part in a large interindividual variation in the ratio of metabolites to morphine. Further studies are needed to clarify this hypothesis.
authors.affiliation: Department of Hospital Pharmacy, National Fukuokahigashi Hospital, Koga, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tateishi
authors.forename: K
authors.initials: K
authors.lastname: Ohashi
authors.forename: K
authors.initials: K
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Hashimoto
authors.forename: J
authors.initials: J
authors.lastname: Yamaguchi
authors.forename: H
authors.initials: H
authors.lastname: Fujioka
authors.forename: K
authors.initials: K
authors.lastname: Izawa
authors.forename: M
authors.initials: M
authors.lastname: Masada
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002851:Chromatography, High Pressure Liquid; D003692:Delayed-Action Preparations; D006801:Humans; D007262:Infusions, Intravenous; D008099:Liver / Q000378:metabolism; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D009022:Morphine Derivatives / Q000378:metabolism; D009369:Neoplasms / Q000150:complications / Q000378:metabolism*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D013607:Tablets
chemical_list: D003692:Delayed-Action Preparations; D009022:Morphine Derivatives; D013607:Tablets; C035349:morphine-6-glucuronide; D009020:Morphine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; C018108:morphine-3-glucuronide