Paliatívna medicína a liečba bolesti 1/2010

News in pharmacology of opioids relevant for praxis

None of strong opioids in usual doses is able to inhibit pain in everybody. This is mostly due to a genetic polymorphism expressed in receptors, enzymes, transporters and other protein structures which play role in drug actions. A moderate analgesic efficacy of weak opioids can be increased by their combination with nonopioid analgesics, as is proposed in the second step of the WHO analgesic ladder and well documented in combinations of opioids with paracetamol. Novel opioid analgesics, that have been or might be introduced in our market, are briefly described (preparations reducing opioid constipation, for breakthrough pain, 24-hours effective, new generics). Important or less known (in tramadol) adverse drug interactions of opioids are reported in the final part of the paper.

Keywords: opioid analgesics, WHO analgesic ladder, combined opiod analgesics, opioid interactions, new opioid preparations.