Opioid metabolism.

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Smith HS

Opioid metabolism.

Mayo Clin Proc. 2009 Jul;84(7):613-24. doi: 10.1016/S0025-6196(11)60750-7.

PubMed ID

19567715 [ View in PubMed

]

Abstract

Clinicians understand that individual patients differ in their response to specific opioid analgesics and that patients may require trials of several opioids before finding an agent that provides effective analgesia with acceptable tolerability. Reasons for this variability include factors that are not clearly understood, such as allelic variants that dictate the complement of opioid receptors and subtle differences in the receptor-binding profiles of opioids. However, altered opioid metabolism may also influence response in terms of efficacy and tolerability, and several factors contributing to this metabolic variability have been identified. For example, the risk of drug interactions with an opioid is determined largely by which enzyme systems metabolize the opioid. The rate and pathways of opioid metabolism may also be influenced by genetic factors, race, and medical conditions (most notably liver or kidney disease). This review describes the basics of opioid metabolism as well as the factors influencing it and provides recommendations for addressing metabolic issues that may compromise effective pain management. Articles cited in this review were identified via a search of MEDLINE, EMBASE, and PubMed. Articles selected for inclusion discussed general physiologic aspects of opioid metabolism, metabolic characteristics of specific opioids, patient-specific factors influencing drug metabolism, drug interactions, and adverse events.

DrugBank Data that Cites this Article

Drugs

Butyrfentanyl

Drug Enzymes

Drug	Enzyme	Kind	Organism	Pharmacological Action	Actions
Methadone	Cytochrome P450 2B6	Protein	Humans	Unknown	Substrate Inducer	Details

Drug Interactions

• Approved
• Vet approved
• Nutraceutical
• Illicit
• Withdrawn
• Investigational
• Experimental
• All Drugs

Drugs	Interaction
Integrate drug-drug interactions in your software
Hydrocodone Mitotane	The metabolism of Hydrocodone can be increased when combined with Mitotane.
Hydrocodone Rifampicin	The metabolism of Hydrocodone can be increased when combined with Rifampicin.
Hydrocodone Enzalutamide	The metabolism of Hydrocodone can be increased when combined with Enzalutamide.
Hydrocodone Lumacaftor	The metabolism of Hydrocodone can be increased when combined with Lumacaftor.
Hydrocodone Apalutamide	The metabolism of Hydrocodone can be increased when combined with Apalutamide.