嗎啡藥物動力學臨床應用

癌症是台灣地區十大死因第一位，每年有三萬多病患死於癌症。近年來國內安寧療護／緩和醫療的興起，顯示癌末病患照顧受到重視。疼痛是癌末病患最常見的症狀。依照世界衛生組織提倡的控制疼痛的三階段方法實施，在使用嗎啡治療後，大部分病患的疼痛都能解除。過去使用嗎啡大致靠經驗法則，劑量不適當不僅影響療效，並且會產生嚴重的副作用。最近的研究發現副作用來自嗎啡的尿甘酸代謝物；同時癌末病患常併發多重器官系統衰竭，藥物代謝排泄障礙，使用嗎啡更需要注意。本文獻回顧探討代謝障礙對嗎啡代謝與藥物動力學之影響，以作為臨床在癌末病患使用嗎啡的參考，進而訂定使用準則以提昇癌末病患的生活品質。

關鍵字

緩和醫療；嗎啡；藥物動力學；癌症；藥物代謝

並列摘要

Despite the remarkable progress of the past two decades in cancer therapy and prevention, cancer is still the leading cause of death among all diseases in Taiwan, contributing to more than 30,000 death per year. In many major hospitals in Taiwan, palliative care represents the terminal stage of treatment for cancer patients, of which an important function is to provide medications to help patients alleviate pain and other physical distresses caused by cancer. According to the three-step method proposed by WHO in 1986, morphine has been successfully used for pain control in terminal cancer patients. However, a major difficulty in the morphine therapy is to define a therpautic dosage for cancer patients, which often relies upon the expereinces of the caretakers and the responses from the patients. Inappropriate dosage results in not only ineffective treatment but also untoward side effects. Morphine undergoes metabolism via glucuronidation in the liver, of which the major metabolites, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G), are reported to interfere with its therapeutic efficacy and cause the side effects. Thus, it is imperative to understand the pharmacokinetic and pharmcodynamic behaviors of morphine in these patients, which are often modified by the disease state and accompanied organ dysfunctions. Therefore, the impetus of this review is to find out an effective therapeutic strategy of morphine used in terminally cancer patients in order to improve their quality of life.

並列關鍵字

Palliative care ； morphine ； pharmacokinetics ； cancer ； Morphine metabolites

國際替代計量

嗎啡藥物動力學臨床應用

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