Morphine absorption

Opioids such as diamorphine, pethidine, and pentazocine strongly inhibit gastric emptying and greatly reduce the absorption rate of paracetamol. Codeine, however, has no significant effect on paracetamol absorption. Morphine and diamorphine have been shown to reduce the absorption of antiarrhyth-mics such as mexiletine in patients with myocardial infarction. 

In situ quantitation The absorption photometric evaluation in reflectance was carried out at the wavelength k = 540 nm (Fig. 3). The detection limits in substance per chromatogram zone were 20 ng for thebaine and papaverine, 200 ng for codeine, 300 ng for morphine and 500 ng for narceine. 

Opioids maybe administered in a variety of routes including oral (tablet and liquid), sublingual, rectal, transdermal, transmucosal, intravenous, subcutaneous, and intraspinal. While the oral and transdermal routes are most common, the method of administration is based on patient needs (severity of pain) and characteristics (swallowing difficulty and preference). Oral opioids have an onset of effect of 45 minutes, so intravenous or subcutaneous administration maybe preferred if more rapid relief is desired. Intramuscular injections are not recommended because of pain at the injection site and wide fluctuations in drug absorption and peak plasma concentrations achieved. More invasive routes of administration such as PCA and intraspinal (epidural and intrathecal) are primarily used postoperatively, but may also be used in refractory chronic pain situations. PCA delivers a self-administered dose via an infusion pump with a preprogrammed dose, minimum dosing interval, and maximum hourly dose. Morphine, fentanyl, and hydromorphone are commonly administered via PCA pumps by the intravenous route, but less frequently by the subcutaneous or epidural route. 

Rectal Administration. The administration of drugs by a solid rectal dosage form (i.e., suppositories) results in a wide variability in the rate and extent of absorption in children [79]. This fact, coupled with the inflexibility of a fixed dose, makes this a route that should not be promoted for pediatric patients. At least one death involving a 7-month-old infant can be directly attributed to the use of solid rectal dosage form of a therapeutic dose of morphine [80]. 

F. Stain-Texier, P. Sandouk, J. M. Scherrmann, Intestinal Absorption and Stability of Morphine 6-Glucuronide in Different Physiological Compartments of the Rat , Drug Metab. Dispos. 1998, 26, 383 - 387. 

CR/ER/SR tablets/capsules Swallow whole do not break, chew, crush, or dissolve because of the risk of acute overdose. Ingesting chewed or crushed beads or pellets will lead to the rapid release and absorption of a potentially toxic dose of morphine. 

T Pancreatic insulin release Metformin Peripheral insulin sensitivity hepatic glucose output/production i intestinal glucose absorption Dose Ist-line (naive pts), 1.25/250 mg PO daily-bid 2nd-line, 2.5/500 mg or 5/500 mg bid (max 20/2000 mg) take w/ meals, slowly T dose hold before 48 h after ionic contrast media Caution [C, -] Contra SCr >1.4 mg/dL in females or >1.5 mg/dL in males hypoxemic conditions (sepsis, recent MI) alcoholism metabolic acidosis liver Dz Disp Tabs SE HA, hypoglycemia, lactic acidosis, anorexia, N/V, rash Additional Interactions T Effects W/ amiloride, ciprofloxacin cimetidine, digoxin, miconazole, morphine, nifedipine, procainamide, quinidine, quinine, ranitidine, triamterene,... 

Oxycodone is nearly 10 times as strong as codeine, with absorption equal to that of orally administered morphine. Neither hydromorphone nor oxycodone is approved for use in children, and hydromorphone is contraindicated in obstetrical analgesia and in asthmatics. 

Pharmacokinetics plays a very important role in the manner in which opioids are abused. Morphine and many of its derivatives are slowly and erratically absorbed after oral administration, which makes this route suitable for long-term management of pain but not for producing euphoria. In addition, opioids undergo considerable first-pass metabolism, which accounts for their low potency after oral administration. Heroin is more potent than morphine, although its effects arise primarily from metabolism to morphine. The potency difference is attributed to heroin s greater membrane permeability and resultant increased absorption into the brain. 

The non-irritant substances can be injected by this route. The rate of absorption of drug is constant and slow to provide a sustained effect. The site of injection is usually the outer surface of the arm, or front of the thigh. Self medication (e.g. insulin) is possible because deep penetration is not needed. Other drugs which are administered subcutaneously are adrenaline, morphine and certain hormonal preparations. 

Morphine orally is less effective and absorption is very slow. It has variable and high first pass metabolism when given by subcutaneous route, its analgesic effect starts within 10 minutes which persists for 4 to 5 hours and by IV route, it produces immediate action. In plasma, it binds to plasma proteins (approx. 30%). In liver it is metabolized by conjugation to glucuronic acid to form active and inactive products, which are excreted in urine. It is also excreted though bile and in the faeces. 

Buprenorphine is a semi-synthetic derivative of thebaine, one of the opium alkaloids. It is approximately 30 times as potent as morphine. A dose of 0.3 mg intramuscularly has a duration of analgesic action of 6-18 h. Buprenorphine is also effective sublingually. The average bio-availability by this route is about 55%, but absorption is slow and the time to achieve peak plasma concentrations is variable, with a range of 90-360 min. The onset of action is rather slow (5-15 min) after both intramuscular and intravenous administration, possibly due to slow receptor association. Buprenorphine binds to and dissociates from the p receptor very slowly, which may account for its low potential for physical abuse. It also means that buprenorphine-induced respiratory depression is difficult to reverse with naloxone, even with very high doses. Doxapram may in these circumstances be useful. Drowsiness and dizziness are the most common side effects, although they rarely... 

In addition to injections, pulmonary administration also allows rapid absorption of analgesics into the blood stream. The AerX pain management system, which is currently being developed jointly by Aradigm and Glaxo Smith Kline for morphine and fentanyl, produces an aerosol from an active substance solution (Fig. 17). 

The mechanisms underlying (he development of tolerance are not fully understood. Biochemically, it may he attractive to explain tolerance by decreased absorption, altered distribution, increased biotransfomiatiun, and/or increased excretion of the drug However, these processes have been shown to he unrelated to (he development of tolerance. Thus, cellular adaptation offers the greatest likelihood for clarifying the phenomenon. Evidence for cellular adaptation is the finding that (he respiration of chemically stimulated cortical slices of brain front normal rats is markedly deptessed by morphine, whereas the respiration of those from rats chronically dosed with morphine is unaffected... 

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