MS Contin with Cirrhosis

[ghost dog]

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Hey folks,

Wondering what peeps experiences are in regards to using MS Contin with end stage liver disease / Cirrhosis / elevated LFTs.

A journal article ( http://pain-topics.org/pdf/Opioids-R...ysfunction.pdf ) suggests increasing the dosing interval (i.e. once daily dosing instead of BID).

Has anyone tried this, and if so, what has the outcome been? Do you just end up dosing as per usual?

Curious.

 

[lobelsteve]

Hey folks,

Wondering what peeps experiences are in regards to using MS Contin with end stage liver disease / Cirrhosis / elevated LFTs.

A journal article ( http://pain-topics.org/pdf/Opioids-R...ysfunction.pdf ) suggests increasing the dosing interval (i.e. once daily dosing instead of BID).

Has anyone tried this, and if so, what has the outcome been? Do you just end up dosing as per usual?

Curious.

TID to bid is as good as its gotten with liver mets. But then pain got worse and went back to tid.

 

[drf]

That's the same review I've used as a resource!

It seems to imply methadone being a reasonable choice for renal dz and fentanyl being the safest for liver disease in terms of LAO. In practice I start low and go slow, relying on prns until some sort of steady state is achieved then transition to LAO.

I have definitely seen OD/intoxication with LAO regimens when something medical happened to acutely worsen organ function or when new meds were added that inhibited metabolism.