Metabolismo de los opioides y Una inundación de los opioides, una marea creciente de defunciones

Metabolismo de los opioides Opioid Metabolism Howard S. Smith, MD Department of Anesthesiology, Albany Medical College, Albany, NY Mayo Clin Proc. 2009;84(7):613-62 Abstract Clinicians understand that individual patients differ in their response to specific opioid analgesics and that patients may require trials of several opioids before finding an agent that provides effective analgesia with acceptable tolerability. Reasons for this variability include factors that are not clearly understood, such as allelic variants that dictate the complement of opioid receptors and subtle differences in the receptor-binding profiles of opioids. However, altered opioid metabolism may also influence response in terms of efficacy and tolerability, and several factors contributing to this metabolic variability have been identified. For example, the risk of drug interactions with an opioid is determined largely by which enzyme systems metabolize the opioid. The rate and pathways of opioid metabolism may also be influenced by genetic factors, race, and medical conditions (most notably liver or kidney disease). This review describes the basics of opioid metabolism as well as the factors influencing it and provides recommendations for addressing metabolic issues that may compromise effective pain management. Articles cited in this review were identified via a search of MEDLINE, EMBASE, and PubMed. Articles selected for inclusion discussed general physiologic aspects of opioid metabolism, metabolic characteristics of specific opioids, patient-specific factors influencing drug metabolism, drug interactions, and adverse events.  Link para leer en PDF:  http://www.mayoclinicproceedings.com/content/84/7/613.full.pdf+html Una inundación de los opioides, una marea creciente de defunciones A Flood of Opioids, a Rising Tide of Deaths Susan Okie, M.D. NEJM 2010;363;21november 18, 2010 Faced with an epidemic of drug abuse and overdose deaths involving prescription opioid pain relievers, the Food and Drug Administration (FDA) plans to require opioid makers to provide training for physicians and patient-education materials on the appropriate prescribing and use of extendedrelease and long-acting versions of these drugs. But since July, FDA officials have been scrambling to revise their proposed Risk Evaluation and Mitigation Strategy (REMS), after an advisory panel (the agency's Anesthetic and Life Support Drugs Advisory Committee and Drug Safety and Risk Management Advisory Committee) voted 25 to 10 against the FDA's plan, saying it didn't go far enough. Advisors urged that training in appropriate use of opioids be made mandatory for all physicians who prescribe them. Enlace para bajar o leer este artículo en PDF: http://www.nejm.org/doi/pdf/10.1056/NEJMp1011512?ssource=hcrc    Artículo en PDF

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