Opioid Analgesic Choices Based On Pharmacokinetics

Abstract

Introduction: This study looks the multiple factors- specifically the pharmacokinetics that are involved while selecting an opioid to ensure its optimum efficacy. Combinations of analgesics are an enticing option, for achieving maximal analgesia with minimal adverse reactions. The choice of analgesic depends on the sub-population it caters to, and the etiology of pain involved. Methodology: 112 articles involving an inclusion criteria of “pharmacokinetic aspects in combination of opioid” from a Pubmed search were assessed. Associations among the opioids and suggested guidelines were drawn after thoughtful analysis. Discussion: Single-injection neuraxial; fentanyl and sufentanil are preferred over parenteral opioids. Remifentanil and Dexmedetomidine are preferred for ICU patients. Tramadol can be used for mild to moderate pain, and morphine is the choice for severe and intractable pain. The parenteral routes is commonly used but it is beset with pain and other adverse drug reactions. Conclusion: Combination of analgesics having varied mechanisms of action is advocated for optimizing analgesic therapy. Opioid analgesics are widely used but ferreting out the appropriate dose, route and agent is the crux in effect analgesic. A holistic approach that considers all aspects of an opioid need to be considered before selection, and the pharmacokinetics aspect plays a pivotal role.