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Influence of a high fat meal on blood concentrations of morphine following oral morphine solution
S183
INFLUENCE OF A HIGH FAT MEAL ON BLOOD CONCENTRATIONS OF MORPHINE FOLLOWING ORAL MORPHINE SOLUTION. G.K.Gour@, J.L.Plummer, D.A.Cheny, J.A.Foate* and M.J.Cousins, Pain Management Unit, Department of Anaesthesia and Intensive Care, Flinders Medical Centre, Bedford Park, S.A., 5042
BROWN Mon-Tues Abs No
360
AIM OF INVESTIGATION: Oral administration of morphine is widely used in the control of pain in patients with advanced cancer. However, the effect of food on the blood mo hine concentration-time profile has not been established. This study investigated blood concentrations o‘F morphine following oral administration of 50 mg morphine HCI on either an empty stomach (fasted) or following a high fat meal (fed). METHODS: Twelve atients with chronic pain associated with non-terminal disease states were studied using a cross-over Besign. Patients were fasted from 2200 hr. on the evening preceding the study and the oral morphine dose was administered in a total volume of 200 ml at o800 hr. either immediately after food or in the fasting state Blood samples were collected for mo hine assay by HPLC using an electrochemical detector. One week later the patients returned for t‘ge second phase of the study. Patients were randomly allocated to first receive the fed or fasted re en . RESULQ: Area under the blood concentration-time curve (A!_7C) was 34% greater when morphine was administered immediately after food compared to the AUC obtained in the fasting state (P < 0.02). However, there was no significant difference between the the two treatments with res ct to the maximum blood morphine concentration and the time to maximum concentration. The s&” ape of the blood morphine concentration-time curve was consistently altered in the fed compared to the fasting state in that the blood morphine concentrations were maintained at a higher level from 240 to 600 min after the dose when the mo hme was administered with food (P < 0.02). CONCLUSIO!$ These results indicate that morphine concentrations are maintained at higher levels when morphine is administered with food compared to the same dose administered in the fasting state.
A LABORATORY EVALUATION OF A NEW GENERATION PROGRAMMABLE INFUSION DEVICE. A.H. Ilsleh H.Owen, J.Currie and R.R.L. Fronsko*, De artment of Anaesthesia and Intensive Care, Flinders Medical Centre, Bedford Ipark, South Australia 5042,Australia.
Poster 54 BROWN Mon-Tues ACC Hall E Abs No
361
AIM OF INVESTIGATION: The Bard Harvard Mini Infuser is one of the first of a new generation of intra-operative uroeramable infusion mmms desipJled for the administration of potent intravenous on pharmacokineiic ptinciples. This study aimed to evaluati the accuracy and when it infused alfentanil. Accuracy of delivery of the device was tested over its full ran e of settings by weighing the fluid delivered every 10 seconds in the first 10 minutes and every 3 minutes Bor 1 hour using a Mettle1 PL 1200 electronic balance accurate to 0.01~ The safe? features which alert the operator to partial and complete line occlusion, “low battery” and “syrmge empty’,, were &o tested. RESUJXS: The syringe pump underdelivered durmfi the initial hase of all constant infusions, but once the working line pressure was reached delive was urlthin 5% of tx e nominal value in the dose ran e above 2 mcg/kg/min and within 10% for lower r oses. All bolus doses tested were within 10% of t %e nominal value and were more accurate at the higher doses. Alarm features all worked consistently but it took LIPto 10 minutes to warn about line occlusion for doses of 1 mcg/kg/min. Also, line pressure was not reheved in the alarm state so that, on unblocking the occlusion, a bolus of up to 600 mcg of alfentanil could be administered. CONCLUSION: We have found the infuser to be acceptably accurate and reliable during the maintenance phase of operation but stress that to avoid underdelivery, the delivery line must be- pyged time Enor to connecting it to the patient’s intravenous line. On the other hand, if an occlusion is “7 sud enly re eved, the infuser can deliver an accidental bolus of up to 600 mcg of alfentanil.
INFLUENCE OF A HIGH FAT MEAL ON BLOOD CONCENTRATIONS OF MORPHINE FOLLOWING ORAL MORPHINE SOLUTION. G.K.Gour@, J.L.Plummer, D.A.Cheny, J.A.Foate* and M.J.Cousins, Pain Management Unit, Department of Anaesthesia and Intensive Care, Flinders Medical Centre, Bedford Park, S.A., 5042
BROWN Mon-Tues Abs No
360
AIM OF INVESTIGATION: Oral administration of morphine is widely used in the control of pain in patients with advanced cancer. However, the effect of food on the blood mo hine concentration-time profile has not been established. This study investigated blood concentrations o‘F morphine following oral administration of 50 mg morphine HCI on either an empty stomach (fasted) or following a high fat meal (fed). METHODS: Twelve atients with chronic pain associated with non-terminal disease states were studied using a cross-over Besign. Patients were fasted from 2200 hr. on the evening preceding the study and the oral morphine dose was administered in a total volume of 200 ml at o800 hr. either immediately after food or in the fasting state Blood samples were collected for mo hine assay by HPLC using an electrochemical detector. One week later the patients returned for t‘ge second phase of the study. Patients were randomly allocated to first receive the fed or fasted re en . RESULQ: Area under the blood concentration-time curve (A!_7C) was 34% greater when morphine was administered immediately after food compared to the AUC obtained in the fasting state (P < 0.02). However, there was no significant difference between the the two treatments with res ct to the maximum blood morphine concentration and the time to maximum concentration. The s&” ape of the blood morphine concentration-time curve was consistently altered in the fed compared to the fasting state in that the blood morphine concentrations were maintained at a higher level from 240 to 600 min after the dose when the mo hme was administered with food (P < 0.02). CONCLUSIO!$ These results indicate that morphine concentrations are maintained at higher levels when morphine is administered with food compared to the same dose administered in the fasting state.
A LABORATORY EVALUATION OF A NEW GENERATION PROGRAMMABLE INFUSION DEVICE. A.H. Ilsleh H.Owen, J.Currie and R.R.L. Fronsko*, De artment of Anaesthesia and Intensive Care, Flinders Medical Centre, Bedford Ipark, South Australia 5042,Australia.
Poster 54 BROWN Mon-Tues ACC Hall E Abs No
361
AIM OF INVESTIGATION: The Bard Harvard Mini Infuser is one of the first of a new generation of intra-operative uroeramable infusion mmms desipJled for the administration of potent intravenous on pharmacokineiic ptinciples. This study aimed to evaluati the accuracy and when it infused alfentanil. Accuracy of delivery of the device was tested over its full ran e of settings by weighing the fluid delivered every 10 seconds in the first 10 minutes and every 3 minutes Bor 1 hour using a Mettle1 PL 1200 electronic balance accurate to 0.01~ The safe? features which alert the operator to partial and complete line occlusion, “low battery” and “syrmge empty’,, were &o tested. RESUJXS: The syringe pump underdelivered durmfi the initial hase of all constant infusions, but once the working line pressure was reached delive was urlthin 5% of tx e nominal value in the dose ran e above 2 mcg/kg/min and within 10% for lower r oses. All bolus doses tested were within 10% of t %e nominal value and were more accurate at the higher doses. Alarm features all worked consistently but it took LIPto 10 minutes to warn about line occlusion for doses of 1 mcg/kg/min. Also, line pressure was not reheved in the alarm state so that, on unblocking the occlusion, a bolus of up to 600 mcg of alfentanil could be administered. CONCLUSION: We have found the infuser to be acceptably accurate and reliable during the maintenance phase of operation but stress that to avoid underdelivery, the delivery line must be- pyged time Enor to connecting it to the patient’s intravenous line. On the other hand, if an occlusion is “7 sud enly re eved, the infuser can deliver an accidental bolus of up to 600 mcg of alfentanil.