Opioid to avoid in palliative patient with severe hepatic dysfunction?

Opioid to avoid in palliative patient with severe hepatic dysfunction?

• A. Morphine
• B. Methadone
• C. Hydromorphone
• D. Oxycodone

Answer: (B)

In severe hepatic dysfunction, how an opioid is made and cleared from the body matters a lot, because impaired liver function can slow metabolism and make drug levels rise unpredictably. Methadone is almost entirely processed by the liver through multiple cytochrome P450 pathways, and its clearance becomes markedly reduced in severe liver disease. This leads to a prolonged and unpredictable half-life, with drug levels that can accumulate and cause extended sedation and increased risk of respiratory depression. Methadone also has a known risk of QT interval prolongation, which can trigger serious arrhythmias, a danger that is amplified when the liver isn’t functioning well. Because of these pharmacokinetic and safety concerns, methadone is the opioid to avoid in patients with severe hepatic dysfunction.

In severe hepatic dysfunction, how an opioid is made and cleared from the body matters a lot, because impaired liver function can slow metabolism and make drug levels rise unpredictably. Methadone is almost entirely processed by the liver through multiple cytochrome P450 pathways, and its clearance becomes markedly reduced in severe liver disease. This leads to a prolonged and unpredictable half-life, with drug levels that can accumulate and cause extended sedation and increased risk of respiratory depression. Methadone also has a known risk of QT interval prolongation, which can trigger serious arrhythmias, a danger that is amplified when the liver isn’t functioning well. Because of these pharmacokinetic and safety concerns, methadone is the opioid to avoid in patients with severe hepatic dysfunction.