Tarja Heiskanen1, Kaarina Langel2, Teemu Gunnar2, Pirjo Lillsunde3, Eija A Kalso4. 1. Pain Clinic, Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: tarja.heiskanen@hus.fi. 2. Alcohol and Drug Analytics Unit, National Institute for Health and Welfare, Helsinki, Finland. 3. Injury Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland. 4. Pain Clinic, Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland; Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland.
Abstract
CONTEXT: Measuring opioid concentrations in pain treatment is warranted in situations where optimal opioid analgesia is difficult to reach. OBJECTIVES: To assess the usefulness of oral fluid (OFL) as an alternative to plasma in opioid concentration monitoring in cancer patients on chronic opioid therapy. METHODS: We collected OFL and plasma samples from 64 cancer patients on controlled-release (CR) oral morphine, CR oral oxycodone, or transdermal (TD) fentanyl for pain. Samples were obtained on up to five separate days. RESULTS: A total of 213 OFL and plasma samples were evaluable. All patients had detectable amounts of the CR or TD opioid in both plasma and OFL samples. The plasma concentrations of oxycodone and fentanyl (determination coefficient R(2) = 0.628 and 0.700, respectively), but not morphine (R(2) = 0.292), were moderately well correlated to the daily opioid doses. In contrast to morphine and fentanyl (mean OFL/plasma ratio 2.0 and 3.0, respectively), the OFL oxycodone concentrations were significantly higher than the respective plasma concentrations (mean OFL/plasma ratio 14.9). An active transporter could explain the much higher OFL vs. plasma concentrations of oxycodone compared with morphine and fentanyl. CONCLUSION: OFL analysis is well suited for detecting the studied opioids. For morphine and fentanyl, an approximation of the plasma opioid concentrations is obtainable, whereas for oxycodone, the OFL/plasma concentration relationship is too variable for reliable approximation results.
CONTEXT: Measuring opioid concentrations in pain treatment is warranted in situations where optimal opioid analgesia is difficult to reach. OBJECTIVES: To assess the usefulness of oral fluid (OFL) as an alternative to plasma in opioid concentration monitoring in cancerpatients on chronic opioid therapy. METHODS: We collected OFL and plasma samples from 64 cancerpatients on controlled-release (CR) oral morphine, CR oral oxycodone, or transdermal (TD) fentanyl for pain. Samples were obtained on up to five separate days. RESULTS: A total of 213 OFL and plasma samples were evaluable. All patients had detectable amounts of the CR or TD opioid in both plasma and OFL samples. The plasma concentrations of oxycodone and fentanyl (determination coefficient R(2) = 0.628 and 0.700, respectively), but not morphine (R(2) = 0.292), were moderately well correlated to the daily opioid doses. In contrast to morphine and fentanyl (mean OFL/plasma ratio 2.0 and 3.0, respectively), the OFL oxycodone concentrations were significantly higher than the respective plasma concentrations (mean OFL/plasma ratio 14.9). An active transporter could explain the much higher OFL vs. plasma concentrations of oxycodone compared with morphine and fentanyl. CONCLUSION: OFL analysis is well suited for detecting the studied opioids. For morphine and fentanyl, an approximation of the plasma opioid concentrations is obtainable, whereas for oxycodone, the OFL/plasma concentration relationship is too variable for reliable approximation results.
Authors: Ashley M Gesseck; Justin L Poklis; Carl E Wolf; Jie Xu; Aamir Bashir; Karen D Hendricks-Muñoz; Michelle R Peace Journal: J Anal Toxicol Date: 2020-10-12 Impact factor: 3.367
Authors: Niklas Wester; Elsi Mynttinen; Jarkko Etula; Tuomas Lilius; Eija Kalso; Esko I Kauppinen; Tomi Laurila; Jari Koskinen Journal: ACS Omega Date: 2019-10-16