CLINICAL USE

Analgesia for intrathecal use

DOSE IN NORMAL RENAL FUNCTION

2.4–21.6 mcg daily; majority require <9.6 mcg/day

PHARMACOKINETICS

  • Molecular weight                           : 2639.1 (2699.2 as acetate)
  • %Protein binding                           : 53
  • %Excreted unchanged in urine     : <1
  • Volume of distribution (L/kg)       : 30 litres
  • half-life – normal/ESRD (hrs)      : 1.3/Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           : Dose as in normal renal function. Use with caution

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                : Unknown dialysability. Dose as in GFR <10 mL/min
  • HD                     : Unknown dialysability. Dose as in GFR <10 mL/min
  • HDF/high flux   : Unknown dialysability. Dose as in GFR <10 mL/min
  • CAV/VVHD      : Unknown dialysability. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Contraindicated with IT chemotherapy

    ADMINISTRATION

    Reconstition

    –

    Route

    Intrathecal

    Rate of Administration

    Over 24 hours

    Comments

    Dilute with preservative-free sodium chloride 0.9%; concentration should be no lower than 5 mcg/mL in an external pump and 25 mcg/mL in an internal pump

    OTHER INFORMATION

    Use with caution in renal impairment due to lack of studies Has rarely caused rhabdomyolysis, myositis, acute renal failure and urinary retention .

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