Hydromorphone: Evolving to Meet the Challenges of Today’s Health Care Environment

Gregory, Thomas B.

doi:10.1016/j.clinthera.2013.09.027

Cited by 17 publications

(15 citation statements)

References 74 publications

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“…In vitro characterization of mitragynine receptor binding in the central nervous system reveals the complexity with which Kratom acts (see Table 1) [10]. In regard to its antinociceptive actions, mitragynine is one third as potent as morphine and three times as potent as codeine [18,19].…”

Section: Introductionmentioning

confidence: 99%

Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine

et al. 2016

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Introduction Kratom (Mitragyna speciosa), a plant native to Southeast Asia, has been used for centuries for its stimulant and opium-like effects. Mitragynine and 7-hydroxymitragynine, exclusive to M. speciosa, are the alkaloids primary responsible for Kratom's biologic and psychoactive profile, and likely contribute to its problematic use. We purchased several commercially available Kratom analogs for analysis and through our results, present evidence of probable adulteration with the highly potent and addictive plant alkaloid, 7-hydroxymitragynine. Methods A simple and sensitive LC-MS/MS method was developed for simultaneous quantification of mitragynine and 7-hydroxymitragynine in methanol extract of marketed Kratom supplements. Results We found multiple commercial Kratom products to have concentrations of 7-hydroxymitragynine that are substantially higher than those found in raw M. speciosa leaves. Conclusions We have found multiple packaged commercial Kratom products likely to contain artificially elevated concentrations of 7-hydroxymitragynine, the alkaloid responsible for M. speciosa's concerning mechanistic and side effect profile. This study describes a unique form of product adulteration, which stresses the importance of increased dietary supplement oversight of Kratom-containing supplements.

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Section: Introductionmentioning

confidence: 99%

Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine

et al. 2016

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“…Hydromorphone is a semi‐synthetic full µ‐opioid receptor agonist, structurally similar to morphine. It is widely used as an alternative to morphine for the relief of acute and chronic pain and is included in several international guidelines for the treatment of pain . Opioid therapy frequently requires switching from one opioid to another to improve the response to analgesic therapy or to reduce adverse effects.…”

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confidence: 99%

Single‐dose evaluation of safety, tolerability and pharmacokinetics of newly formulated hydromorphone immediate‐release and hydrophilic matrix extended‐release tablets in healthy Japanese subjects without co‐administration of an opioid antagonist

Toyama

Uchida

Ishizuka

et al. 2015

The Journal of Clinical Pharma

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This single dose, open-label study investigated the safety, tolerability and pharmacokinetics of single oral doses of newly formulated immediate-release (IR) and hydrophilic matrix extended-release (ER) hydromorphone tablets in healthy Japanese subjects without co-administration of an opioid antagonist under fasting and fed conditions. Plasma and urinary concentrations of hydromorphone and metabolites were measured by liquid-chromatography tandem mass-spectroscopy. Following administration of the ER tablet, plasma concentrations of hydromorphone slowly increased with a median tmax of 5.0 h and the Cmax decreased to 37% of the IR tablet, while the AUC0-inf was comparable with that of the IR tablet when administered at the same dose. The degree of fluctuation in the plasma concentration for the ER tablet was much lower than that of the IR tablet and certain levels of plasma concentrations were maintained after 24 h of ER dosing. The AUC0-inf and Cmax increased with food for both IR and ER tablets. The AUC0-inf of hydromorphone-3-glucoside was one-tenth of that of hydromorphone-3-glucuronide. A single oral administration of the hydromorphone tablets would be well-tolerated in healthy Japanese subjects despite a lack of co-administration of an opioid antagonist and the newly developed ER hydromorphone tablets may have the appropriate PK characteristics for once-daily dosing.

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“…[22][23][24] Oxycodone, hydrocodone and buprenorphine are synthetic opioids that are synthesised from the (non-narcotic) alkaloid thebaine found in opium (Table 1). [23][24][25][26][27] Other known synthetic opioids are heroin (diacetylmorphine or diamorphine) and oxymorphone (Table 1). [22,26] Heroin is metabolised in human bodies into 6-monoacetylmorphine and morphine among others [23,28] (Table 1).…”

Section: Opioidsmentioning

confidence: 99%

“…[23][24][25][26][27] Other known synthetic opioids are heroin (diacetylmorphine or diamorphine) and oxymorphone (Table 1). [22,26] Heroin is metabolised in human bodies into 6-monoacetylmorphine and morphine among others [23,28] (Table 1). Morphine, the major constituent of opium, can also be derived from codeine, heroin and 6-monoacetylmorphine.…”

Section: Opioidsmentioning

confidence: 99%

“…High concentrations, at hundreds of nanograms to micrograms per litre, of cocaine and benzoylecgonine have been reported in wastewaters (Table 13). [26] A meta-analysis of all reported concentrations (for all countries) for cocaine and benzoylecgonine showed that they are generally found in the highest concentrations out of all illicit drugs in wastewaters. The overall abundance of cocaine derivatives in wastewaters was in the following order: benzoylecgonine .…”

Section: Cocaine and Metabolitesmentioning

confidence: 99%

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Neuropsychiatric pharmaceuticals and illicit drugs in wastewater treatment plants: a review

Asimakopoulos

Kannan

2016

Environ. Chem.

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Environmental context. Neuropsychiatric pharmaceuticals and illicit drugs in wastewaters are of increasing environmental concern. We compile the recent literature and evaluate the concentrations and profiles of various drugs and their removal efficiencies in wastewater treatment plants. The sewage epidemiology approach, used in the estimation of drug usage in communities, is discussed, and we make recommendations for future research in this area.Abstract. Neuropsychiatric pharmaceuticals and illicit drugs encompass a broad range of compounds including opioids, amphetamine-type stimulants, cannabinoids, benzodiazepines, barbiturates, antipsychotics, anaesthetics, anti-epileptics and mood stabilisers, lysergic compounds, sympathomimetic amines and cocaine derivatives. In this article, we review studies on the occurrence and fate of these drugs in wastewater treatment plants. In general, among various drugs studied, the concentrations and detection frequencies of opioids and cocaine derivatives were the highest in wastewaters. The forensic analysis of wastewaters suggests that cocaine and opioids usage has increased. Given the fact that data on drug usage can be used for making regulatory decisions and policies, this review focuses on understanding the sources and environmental dynamics of neuropsychiatric and illicit drugs. There is a pressing need for more research on the magnitude and extent of illicit drug consumption. The 'sewage epidemiology' approach, currently applied in the estimation of illicit drug consumption in communities, is reviewed. The field of wastewater research has been advancing in multipronged paths, incorporating concepts in analytical chemistry, organic chemistry, environmental chemistry, biochemistry, sewage engineering, drug epidemiology and statistics. Future prospects with regard to the occurrence and environmental fate of illicit and psychoactive drugs are recommended.

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Hydromorphone: Evolving to Meet the Challenges of Today’s Health Care Environment

Cited by 17 publications

References 74 publications

Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine

Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine

Single‐dose evaluation of safety, tolerability and pharmacokinetics of newly formulated hydromorphone immediate‐release and hydrophilic matrix extended‐release tablets in healthy Japanese subjects without co‐administration of an opioid antagonist

Neuropsychiatric pharmaceuticals and illicit drugs in wastewater treatment plants: a review

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