ReviewEuropean journal of clinical pharmacology2009
Role of active metabolites in the use of opioids.
Review in European journal of clinical pharmacology, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 112 citations in OpenAlex.
- Trial
- A pharmacokinetic and pharmacodynamic study of oral oxycodone in a human experimental pain model of hyperalgesia.Clinical pharmacokinetics · 2010Trial
- Opioids to Treat Chronic Pain in the Older Adult: A Clinical Consensus to Guarantee Safety and Avoid Adverse Events.Drugs & aging · 2026Review
- High-Throughput Drug Derivatization and Bioassay by Desorption Electrospray Ionization Mass Spectrometry.ChemPlusChem · 2025Article
- Hydrocodone, Oxycodone, and Morphine Metabolism and Drug-Drug Interactions.The Journal of pharmacology and experimental therapeutics · 2023Review
- An Examination of the Complex Pharmacological Properties of the Non-Selective Opioid Modulator Buprenorphine.Pharmaceuticals (Basel, Switzerland) · 2023Review
- Acute Pain Management Pearls: A Focused Review for the Hospital Clinician.Healthcare (Basel, Switzerland) · 2022Review
- Predicting the efficacy of opioid sequestration by intravenous lipid emulsion using biologically relevant in vitro models of drug distribution.Scientific reports · 2022Article
- Use of Drug Claims Data and a Medication Risk Score to Assess the Impact of CYP2D6 Drug Interactions among Opioid Users on Healthcare Costs.Journal of personalized medicine · 2021Article
- Clinical pharmacogenomics in action: design, assessment and implementation of a novel pharmacogenetic panel supporting drug selection for diseases of the central nervous system (CNS).Journal of translational medicine · 2021Article
- Perioperative Pain Management and Opioid Stewardship: A Practical Guide.Healthcare (Basel, Switzerland) · 2021Review
- Modulation of Opioid Transport at the Blood-Brain Barrier by Altered ATP-Binding Cassette (ABC) Transporter Expression and Activity.Pharmaceutics · 2018Review
- [Differential indications of opioids in pain therapy].Der Anaesthesist · 2017Review
- Opioid Toxicity.Academic forensic pathology · 2017Review
- European Pain Federation position paper on appropriate opioid use in chronic pain management.European journal of pain (London, England) · 2017Article
- The efficacy of low-dose transdermal fentanyl in opioid-naïve cancer patients with moderate-to-severe pain.The Korean journal of internal medicine · 2015Article
- Codeine-induced hyperalgesia and allodynia: investigating the role of glial activation.Translational psychiatry · 2014Article
- Toward a systematic approach to opioid rotation.Journal of pain research · 2014Review
- Pharmacokinetics of tramadol after subcutaneous administration in a critically ill population and in a healthy cohort.BMC anesthesiology · 2014Article
- Differences between opioids: pharmacological, experimental, clinical and economical perspectives.British journal of clinical pharmacology · 2013Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The opioid class of drugs, a large group, is mainly used for the treatment of acute and chronic persistent pain. All are eliminated from the body via metabolism involving principally CYP3A4 and the highly polymorphic CYP2D6, which markedly affects the drug's function, and by conjugation reactions mainly by UGT2B7. In many cases, the resultant metabolites have the same pharmacological activity as the parent opioid; however in many cases, plasma metabolite concentrations are too low to make a meaningful contribution to the overall clinical effects of the parent drug. These metabolites are invariably more water soluble and require renal clearance as an important overall elimination pathway. Such metabolites have the potential to accumulate in the elderly and in those with declining renal function with resultant accumulation to a much greater extent than the parent opioid. The best known example is the accumulation of morphine-6-glucuronide from morphine. Some opioids have active metabolites but at different target sites. These are norpethidine, a neurotoxic agent, and nordextropropoxyphene, a cardiotoxic agent. Clinicians need to be aware that many opioids have active metabolites that will become therapeutically important, for example in cases of altered pathology, drug interactions and genetic polymorphisms of drug-metabolizing enzymes. Thus, dose individualisation and the avoidance of adverse effects of opioids due to the accumulation of active metabolites or lack of formation of active metabolites are important considerations when opioids are used.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.