Saliva Drug Analysis
Steven H. Y. Wong, Iraving Sunshine in Handbook of Analytical Therapeutic Drug Monitoring and Toxicology, 2017
Hydromorphone is a potent semisynthetic derivative of morphine that is abused by heroin addicts. It is excreted in saliva in a pattern similar to that observed for morphine. Ritschel et al.113 reported that saliva hydromorphone concentrations were lower than plasma concentrations immediately after intravenous drug administration. After achieving peak concentrations, saliva concentrations declined in a similar manner to hydromorphone plasma concentrations. The S/P (total) ratio was lower (0.25) in the beginning, then attained a maximum of 2.32, followed by a constant ratio of approximately 1.0 in the elimination phase. The authors concluded that saliva was not useful for the estimation of pharmacokinetic parameters because of the lack of constant S/P (total) ratios during the distribution phase; however, estimations of terminal elimination half-life based on plasma (t1/2 = 2.36 ± 0.58 hr) or saliva (t1/2 = 2.12 ± 0.93 hr) data were similar.
Critical care, neurology and analgesia
Evelyne Jacqz-Aigrain, Imti Choonara in Paediatric Clinical Pharmacology, 2021
Hydromorphone, a ketone congener of morphine (dihydromorphinone), has ~5–7.5 times morphine’s potency [85]. Hydromorphone is used for chronic cancer pain and for post-operative analgesia, but it does not convincingly demonstrate clinical superiority in adults over other strong opioid analgesics [86]. Its intermediate hydrophilic and lipophilic activity, lying between that of morphine and fentanyl (Tables 1 and 2), may offer advantages for epidural use [87–92]. Patient-controlled analgesia with hydromorphone results in similar analgesia and side effects compared to morphine in children for the management of mucositis pain after bone marrow transplantation. Effective plasma concentrations of around 4.7 ng/ml (range 1.9–8.9 ng/ml) were in these children [85].
Palliative care
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
This is another alternative strong opioid. It has for many years been available as a suppository, but is now also produced as an oral drug in both immediate-release and controlled-release formulations. With hydromorphone it represents a suitable alternative to morphine for patients who cannot tolerate morphine because of limiting side effects, although since it is also a strong opioid a similar spectrum of unwanted effects are to be expected with both these drugs, in particular nausea and constipation. The use of these drugs should therefore follow guidelines similar to those for morphine with the accompanying use of regular prophylactic laxatives and anti-emetics.
Pharmacological approaches to treat intestinal pain
Published in Expert Review of Clinical Pharmacology, 2023
Mikolaj Swierczynski, Adam Makaro, Agata Grochowska, Maciej Salaga
The third step includes the use of strong opioids such as morphine, fentanyl, buprenorphine, tapentadol, methadone and hydromorphone. Morphine and its metabolic products are direct agonists of the μ and κ opioid receptors (ORs) whose activation provides anesthesia. Fentanyl gives a better analgesic effect, even 50 to 100 times more potent than morphine [16]. Buprenorphine is also a solid working agent, available in transdermal patches. It has a binding capacity to the three ORs, μ, δ, and κ. Compared to parenteral morphine, parenteral buprenorphine is 30–40 times more potent [17]. Methadone’s way of action is comparable to that of morphine and due to its low cost it is commonly used in developing countries. Hydromorphone is also a useful opioid derived from morphine, mainly applied for cancerous pain.
Ending the War on Drugs Requires Decriminalization. Does It Also Require Legalization?
Published in The American Journal of Bioethics, 2021
What all of this makes clear is that it is not obvious “how legal” drugs need to be in order to achieve the goal of reducing harm through a safe supply. The authors sometimes seem to imply that legalization requires a publicly-accessible market—even if regulated and restricted somewhat, as in the case of tobacco and alcohol. However, the inclusion of prescription medications under the descriptor of legal and regulated substances, suggests another—less radical—option, which is liberalized prescribing laws. Hydromorphone, for instance, is already a Schedule II medication, legal to prescribe for severe pain; revising health law could make it permissible to prescribe to those with an active addiction, providing a form of safe supply akin to what heroin-assisted treatment provides in other countries.2 In short: an expanded harm reduction view that advocates for safe supply interventions does not require that all recreational drugs be legalized in the colloquial sense, since good health law and policy could make pharmaceutical grade drugs available to those with an addiction without full legalization.
An update on the safety of prescribing opioids in pediatrics
Published in Expert Opinion on Drug Safety, 2019
Jagroop M. Parikh, Patricia Amolenda, Joseph Rutledge, Alexandra Szabova, Vidya Chidambaran
Infants have reduced renal function compared to older children and young adults. Great caution should be exercised when prescribing opioids in infants and patients with chronic kidney disease (CKD). Increased risk of adverse effects occurs due to accumulation of toxic or active metabolites, altered drug distribution, decreased drug binding, increased sensitivity to central nervous system side effects, and increased permeability of the blood–brain barrier. The use of hydromorphone, oxycodone, hydrocodone, methadone, and fentanyl appears safe, but renal dose adjustment may be necessary. Methadone and its metabolites do not accumulate significantly in patients with renal insufficiency [52]. Although fentanyl is a potent synthetic opioid and follows the same pattern of drug elimination as other opioids, its metabolites are inactive and non-toxic [45]. Morphine, meperidine, tramadol, and codeine are not recommended due to accumulation of their toxic metabolites in renal failure [52,53]. Table 1 summarizes the recommendations of opioid use for CKD patients.
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