Opioid therapy in patients with liver cirrhosis

Abstract

Opioid therapy in patients with liver cirrhosis Abstract. There are currently no endogenous markers representing the metabolic activity and the extent of portacaval shunts in patients with liver cirrhosis. The pharmacokinetic properties of the applied drugs must therefore be taken into account when adjusting the dose in patients with liver cirrhosis. For drugs with a high degradation during the first passage across the liver (first-pass metabolism) the bioavailability is going to increase and the clearance to decrease after oral application. After topical, buccal or parenteral administration, only the impaired clearance will play a role. For drugs with a high bioavailability (> 70 %) only the impaired hepatic clearance has to be considered. In the following article, the relevant pharmacokinetic properties of the most common opioids in Switzerland and the resulting consequences regarding dose adjustment in liver cirrhosis are going to be discussed. Buprenorphine, fentanyl, hydromorphone, morphine, naloxone und tapentadol are drugs with a high first-pass effect, while the bioavailability of methadone, oxycodone and tramadol is > 70 %.