Serum and urine concentrations of morphine and morphine metabolites in patients with advanced cancer receiving continuous intravenous morphine: an observational study.

Abstract

BACKGROUND:

The feasibility and clinical implication of drug monitoring of morphine, morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G) need further investigation. This study aimed to determine what predicts serum concentrations of morphine in cancer patients receiving continuously intravenous morphine, the relationships between serum concentration of morphine/its metabolites and urinary concentrations, and the relation between morphine concentrations and with clinical outcomes.

METHODS:

We collected serum and urine samples from 24 patients with advanced cancer undergoing continuously intravenous morphine therapy. Serum samples were obtained at day one. Spot urine samples were collected once daily on three consecutive days. Pain and adverse drug events were assessed using the Korean version of MD Anderson Symptom Inventory.

RESULTS:

A total of 96 samples (72 urine and 24 serum samples) were collected. Median dose of morphine was 82.0 mg/24 h. In a multivariate analysis, total daily morphine dose was the most significant predictors of both serum and urine concentration of morphine. Morphine, M6G, and M3G in serum and urine were statistical significantly correlated (correlation coefficient = 0.81, 0.44, 0.56; p values < 0.01, 0.03, 0.01, respectively).

CONCLUSION:

Spot urine concentrations of morphine and its metabolites were highly correlated to those of serum. Total dose of daily morphine was related to both serum and urine concentration of morphine and its metabolites.

• Authors: Yong Joo Lee, Sang-Yeon Suh, Junghan Song, Sanghee Shiny Lee, Ah-Ram Seo, Hong-Yup Ahn, Myung Ah Lee, Chul-Min Kim, Pål Klepstad
• Journal: BMC palliative care (BMC Palliat Care) Vol. 14 Pg. 53 (Oct 27 2015) ISSN: 1472-684X [Print] England
• PMID: 26507979 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Morphine Derivatives
• morphine-6-glucuronide
• Morphine
• morphine-3-glucuronide

Topics

• Administration, Intravenous
• Adult
• Aged
• Aged, 80 and over
• Dose-Response Relationship, Drug
• Drug Monitoring (methods)
• Female
• Humans
• Male
• Middle Aged
• Morphine (blood, metabolism, pharmacology, urine)
• Morphine Derivatives (metabolism)
• Neoplasms (drug therapy)
• Republic of Korea