Effects of smoking and body mass index on the exposure of fentanyl in patients with cancer.

Evelien J M Kuip,Peter De Bruijn,Astrid W Oosten,Carin C D Van Der Rijt,Ron H J Mathijssen,Esther Oomen—De Hoop,Stijn L W Koolen,Wendy H Oldenmenger,Martine F Thijs—Visser

doi:10.1371/journal.pone.0198289

Abstract

The transdermal fentanyl patch is widely used to treat cancer-related pain despite its wide inter- and intrapatient variability in pharmacokinetics. The aim of this study was to investigate whether smoking and body size (i.e. body mass index) influence fentanyl exposure in patients with cancer. These are factors that typically change during treatment and disease trajectories. We performed an explorative cohort study in patients with cancer using transdermal fentanyl patches (Durogesic®), by taking a blood sample for pharmacokinetic analysis one day after applying a patch in patients with a stable fentanyl dose. A total of 88 patients were evaluable. Although no statistically significant difference was found, the plasma concentrations of non-smokers was 28% (95% CI [-14%; +89-%]) higher than those of smokers normalizing for a dose of 25μg/min. Patients with a low BMI (< 20 kg/m2) had almost similar (10% (95% CI [-39%; +97%]) higher) plasma concentrations compared to patients with a high BMI (> 25 kg/m2). A wider variation in fentanyl plasma concentrations was found in this study than anticipated. Due to this variation, studies in larger patient cohorts are needed to further investigate the effect of smoking on plasma concentration of fentanyl and thereby clarify the clinical significance of our findings.

Highlights

Fentanyl is one of the most commonly used opioids to treat cancer-related pain [1,2,3] and it is often preferred over morphine, especially in patients with renal failure
Our study was performed as a prospective single-center pharmacokinetic study at the Erasmus MC Cancer Institute
Based on our findings, the 27.7% higher normalized plasma concentrations of non-smokers compared to smokers, we cannot exclude an effect of smoking on fentanyl exposure

Summary

Introduction

Fentanyl is one of the most commonly used (strong acting) opioids to treat cancer-related pain [1,2,3] and it is often preferred over morphine, especially in patients with renal failure. Fentanyl usually results in less obstipation than other opioids [4,5,6]. The fentanyl transdermal patch has been used since decades to treat chronic pain. Fentanyl is available in a liquid formulation for intravenous and subcutaneous administration and in various immediate release forms for oromucosal and nasal use [7, 8]. Fentanyl is highly lipophilic and is rapidly absorbed by the subcutaneous fat-tissue.

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