Abstract
1. The kinetics of codeine and seven of its metabolites codeine-6-glucuronide (C6G), norcodeine (NC), NC-glucuronide (NCG), morphine (M), M-3 (M3G) and 6-glucuronides (M6G), and normorphine (NM) were investigated after a single oral dose of 50 mg codeine phosphate in 14 healthy Caucasian subjects including eight extensive (EM) and six poor (PM) hydroxylators of debrisoquine. The plasma and urine concentrations of codeine and the metabolites were measured by h.p.l.c. 2. The mean area under the curve (AUC), half-life and total plasma clearance of codeine were 1020 +/- 340 nmol l-1 h, 2.58 +/- 0.57 h and 2.02 +/- 0.73 l h-1 kg-1, respectively. There were no significant differences between EM and PM in these aspects. 3. PM had significantly lower AUC of M3G, the active metabolites M6G, NM and M (P less than 0.0001), and lower partial metabolic clearance by O-demethylation (P less than 0.0001). In contrast, the PM had higher AUC of NC (P less than 0.05) than the EM. There was no difference between PM and EM in the AUC of C6G and NCG, nor in the partial clearances by N-demethylation and glucuronidation. 4. Among EM, the AUC of C6G was 15 times higher than that of codeine, which in turn was 50 times higher than that of M. The AUCs of M6G and NM were about 6 and 10 times higher than that of M, respectively. The partial clearance by glucuronidation was about 8 and 12 times higher than those by N- and O-demethylations, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Full text
PDF







Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Abbott F. V., Palmour R. M. Morphine-6-glucuronide: analgesic effects and receptor binding profile in rats. Life Sci. 1988;43(21):1685–1695. doi: 10.1016/0024-3205(88)90479-1. [DOI] [PubMed] [Google Scholar]
- Bechtel W. D., Sinterhauf K. Plasma level and renal excretion of [3H] codeine phosphate in man and in the dog. Arzneimittelforschung. 1978;28(2):308–311. [PubMed] [Google Scholar]
- Bodd E., Beylich K. M., Christophersen A. S., Mørland J. Oral administration of codeine in the presence of ethanol: a pharmacokinetic study in man. Pharmacol Toxicol. 1987 Nov;61(5):297–300. doi: 10.1111/j.1600-0773.1987.tb01822.x. [DOI] [PubMed] [Google Scholar]
- Brøsen K., Gram L. F. Clinical significance of the sparteine/debrisoquine oxidation polymorphism. Eur J Clin Pharmacol. 1989;36(6):537–547. doi: 10.1007/BF00637732. [DOI] [PubMed] [Google Scholar]
- Chen Z. R., Somogyi A. A., Bochner F. Polymorphic O-demethylation of codeine. Lancet. 1988 Oct 15;2(8616):914–915. doi: 10.1016/s0140-6736(88)92529-9. [DOI] [PubMed] [Google Scholar]
- Dahlström B., Tamsen A., Paalzow L., Hartvig P. Patient-controlled analgesic therapy, Part IV: pharmacokinetics and analgesic plasma concentrations of morphine. Clin Pharmacokinet. 1982 May-Jun;7(3):266–279. doi: 10.2165/00003088-198207030-00006. [DOI] [PubMed] [Google Scholar]
- Dayer P., Desmeules J., Leemann T., Striberni R. Bioactivation of the narcotic drug codeine in human liver is mediated by the polymorphic monooxygenase catalyzing debrisoquine 4-hydroxylation (cytochrome P-450 dbl/bufI). Biochem Biophys Res Commun. 1988 Apr 15;152(1):411–416. doi: 10.1016/s0006-291x(88)80729-0. [DOI] [PubMed] [Google Scholar]
- Evans D. A., Mahgoub A., Sloan T. P., Idle J. R., Smith R. L. A family and population study of the genetic polymorphism of debrisoquine oxidation in a white British population. J Med Genet. 1980 Apr;17(2):102–105. doi: 10.1136/jmg.17.2.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Findlay J. W., Butz R. F., Welch R. M. Codeine kinetics as determined by radioimmunoassay. Clin Pharmacol Ther. 1977 Oct;22(4):439–446. doi: 10.1002/cpt1977224439. [DOI] [PubMed] [Google Scholar]
- Findlay J. W., Jones E. C., Butz R. F., Welch R. M. Plasma codeine and morphine concentrations after therapeutic oral doses of codeine-containing analgesics. Clin Pharmacol Ther. 1978 Jul;24(1):60–68. doi: 10.1002/cpt197824160. [DOI] [PubMed] [Google Scholar]
- Guay D. R., Awni W. M., Findlay J. W., Halstenson C. E., Abraham P. A., Opsahl J. A., Jones E. C., Matzke G. R. Pharmacokinetics and pharmacodynamics of codeine in end-stage renal disease. Clin Pharmacol Ther. 1988 Jan;43(1):63–71. doi: 10.1038/clpt.1988.12. [DOI] [PubMed] [Google Scholar]
- Guay D. R., Awni W. M., Halstenson C. E., Findlay J. W., Opsahl J. A., Abraham P. A., Jones E. C., Matzke G. R. Pharmacokinetics of codeine after single- and multiple-oral-dose administration to normal volunteers. J Clin Pharmacol. 1987 Dec;27(12):983–987. doi: 10.1002/j.1552-4604.1987.tb05601.x. [DOI] [PubMed] [Google Scholar]
- Hand C. W., Blunnie W. P., Claffey L. P., McShane A. J., McQuay H. J., Moore R. A. Potential analgesic contribution from morphine-6-glucuronide in CSF. Lancet. 1987 Nov 21;2(8569):1207–1208. doi: 10.1016/s0140-6736(87)91341-9. [DOI] [PubMed] [Google Scholar]
- Hasselström J., Berg U., Löfgren A., Säwe J. Long lasting respiratory depression induced by morphine-6-glucuronide? Br J Clin Pharmacol. 1989 Apr;27(4):515–518. doi: 10.1111/j.1365-2125.1989.tb05401.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Joel S. P., Osborne R. J., Nixon N. S., Slevin M. L. Morphine-6-glucuronide, an important metabolite. Lancet. 1985 May 11;1(8437):1099–1100. doi: 10.1016/s0140-6736(85)92397-9. [DOI] [PubMed] [Google Scholar]
- LASAGNA L., DE KORNFELD T. J. Analgesic potency of normorphine in patients with postoperative pain. J Pharmacol Exp Ther. 1958 Nov;124(3):260–263. [PubMed] [Google Scholar]
- Lennard M. S., Silas J. H., Smith A. J., Tucker G. T. Determination of debrisoquine and its 4-hydroxy metabolite in biological fluids by gas chromatography with flame-ionization and nitrogen-selective detection. J Chromatogr. 1977 Mar 11;133(1):161–166. doi: 10.1016/s0021-9673(00)89216-x. [DOI] [PubMed] [Google Scholar]
- MILLER J. W., ANDERSON H. H. The effect of N-demethylation on certain pharmacologic actions of morphine, codeine, and meperidine in the mouse. J Pharmacol Exp Ther. 1954 Oct;112(2):191–196. [PubMed] [Google Scholar]
- Mahgoub A., Idle J. R., Dring L. G., Lancaster R., Smith R. L. Polymorphic hydroxylation of Debrisoquine in man. Lancet. 1977 Sep 17;2(8038):584–586. doi: 10.1016/s0140-6736(77)91430-1. [DOI] [PubMed] [Google Scholar]
- Osborne R. J., Joel S. P., Slevin M. L. Morphine intoxication in renal failure: the role of morphine-6-glucuronide. Br Med J (Clin Res Ed) 1986 Jun 14;292(6535):1548–1549. doi: 10.1136/bmj.292.6535.1548. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Osborne R., Joel S., Trew D., Slevin M. Analgesic activity of morphine-6-glucuronide. Lancet. 1988 Apr 9;1(8589):828–828. doi: 10.1016/s0140-6736(88)91691-1. [DOI] [PubMed] [Google Scholar]
- Osborne R., Joel S., Trew D., Slevin M. Morphine and metabolite behavior after different routes of morphine administration: demonstration of the importance of the active metabolite morphine-6-glucuronide. Clin Pharmacol Ther. 1990 Jan;47(1):12–19. doi: 10.1038/clpt.1990.2. [DOI] [PubMed] [Google Scholar]
- Paul D., Standifer K. M., Inturrisi C. E., Pasternak G. W. Pharmacological characterization of morphine-6 beta-glucuronide, a very potent morphine metabolite. J Pharmacol Exp Ther. 1989 Nov;251(2):477–483. [PubMed] [Google Scholar]
- Quiding H., Anderson P., Bondesson U., Boréus L. O., Hynning P. A. Plasma concentrations of codeine and its metabolite, morphine, after single and repeated oral administration. Eur J Clin Pharmacol. 1986;30(6):673–677. doi: 10.1007/BF00608214. [DOI] [PubMed] [Google Scholar]
- Shimomura K., Kamata O., Ueki S., Ida S., Oguri K. Analgesic effect of morphine glucuronides. Tohoku J Exp Med. 1971 Sep;105(1):45–52. doi: 10.1620/tjem.105.45. [DOI] [PubMed] [Google Scholar]
- Steiner E., Bertilsson L., Säwe J., Bertling I., Sjöqvist F. Polymorphic debrisoquin hydroxylation in 757 Swedish subjects. Clin Pharmacol Ther. 1988 Oct;44(4):431–435. doi: 10.1038/clpt.1988.176. [DOI] [PubMed] [Google Scholar]
- Sullivan A. F., McQuay H. J., Bailey D., Dickenson A. H. The spinal antinociceptive actions of morphine metabolites morphine-6-glucuronide and normorphine in the rat. Brain Res. 1989 Mar 20;482(2):219–224. doi: 10.1016/0006-8993(89)91184-0. [DOI] [PubMed] [Google Scholar]
- Säwe J. High-dose morphine and methadone in cancer patients. Clinical pharmacokinetic considerations of oral treatment. Clin Pharmacokinet. 1986 Mar-Apr;11(2):87–106. doi: 10.2165/00003088-198611020-00001. [DOI] [PubMed] [Google Scholar]
- Säwe J., Kager L., Svensson Eng J. O., Rane A. Oral morphine in cancer patients: in vivo kinetics and in vitro hepatic glucuronidation. Br J Clin Pharmacol. 1985 Apr;19(4):495–501. doi: 10.1111/j.1365-2125.1985.tb02675.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Yoshimura H., Ida S., Oguri K., Tsukamoto H. Biochemical basis for analgesic activity of morphine-6-glucuronide. I. Penetration of morphine-6-glucuronide in the brain of rats. Biochem Pharmacol. 1973 Jun 15;22(12):1423–1430. doi: 10.1016/0006-2952(73)90320-1. [DOI] [PubMed] [Google Scholar]
- Yue Q. Y., Svensson J. O., Alm C., Sjöqvist F., Säwe J. Codeine O-demethylation co-segregates with polymorphic debrisoquine hydroxylation. Br J Clin Pharmacol. 1989 Dec;28(6):639–645. doi: 10.1111/j.1365-2125.1989.tb03556.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Yue Q. Y., Svensson J. O., Alm C., Sjöqvist F., Säwe J. Interindividual and interethnic differences in the demethylation and glucuronidation of codeine. Br J Clin Pharmacol. 1989 Dec;28(6):629–637. doi: 10.1111/j.1365-2125.1989.tb03555.x. [DOI] [PMC free article] [PubMed] [Google Scholar]