From the FDA Drug Label
Morphine pharmacokinetics are altered in patients with cirrhosis. Clearance was found to decrease with a corresponding increase in half-life The M3G and M6G to morphine AUC ratios also decreased in these subjects, indicating diminished metabolic activity. Morphine sulfate pharmacokinetics are altered in patients with renal failure. Start these patients with a lower than usual dosage of morphine sulfate tablets and titrate slowly while monitoring for signs of respiratory depression, sedation, and hypotension
The FDA drug label does not answer the question.
From the Research
Effectiveness of Morphine and Dialysis in Patients with Liver Disease
- The effectiveness of morphine and dialysis in patients with liver disease is a complex issue, with various studies providing insights into their pharmacokinetics and clinical implications 1, 2, 3, 4, 5.
- Dialysis has been shown to be effective in controlling plasma urea and creatinine levels in patients with liver disease, but its effectiveness is limited in patients with cirrhosis and fulminant hepatic failure 1.
- Morphine, on the other hand, has a decreased clearance in patients with liver disease, which can lead to accumulation and increased risk of adverse effects 2, 4, 5.
Pharmacokinetics of Morphine in Liver Disease
- The liver is the major site for biotransformation of most opioids, including morphine, which undergoes glucuronidation 2.
- In patients with liver cirrhosis, the clearance of morphine is decreased, and its oral bioavailability is increased, leading to a risk of accumulation 2, 4.
- The active metabolite of morphine, morphine-6-glucuronide (M6G), can accumulate in patients with renal insufficiency, leading to narcotic effects or respiratory depression 2, 3.
Comparison of Morphine and Dialysis
- While dialysis can effectively control plasma urea and creatinine levels, its effectiveness is limited in patients with cirrhosis and fulminant hepatic failure 1.
- Morphine, on the other hand, has a decreased clearance in patients with liver disease, which can lead to accumulation and increased risk of adverse effects 2, 4, 5.
- The choice between morphine and dialysis depends on the individual patient's condition and the underlying liver lesion, with dialysis being more effective in patients with recoverable liver lesions 1.
Alternative Opioids for Patients with Liver Disease
- Certain opioids, such as fentanyl, sufentanil, and remifentanil, have pharmacokinetics that are unaffected in liver disease, making them safer alternatives for patients with liver disease 2, 4, 5.
- Buprenorphine is also a safe choice for patients with reduced renal function, as its pharmacokinetics are unchanged in haemodialysis patients 3.