Pharmacokinetic Drug Interactions in Palliative Care: Focus On Opioids

Opioid analgesics are crucial for pain management in most patients receiving palliative care. Contemporary models advocate for the provision of palliative care services as early as possible in a course of illness, suggesting that many patients will receive palliative care services, and opioids, concurrent with complex disease-modifying therapies. This article reviews the metabolic pathways of commonly prescribed opioid analgesics and provides a survey of what is known about how disease-modifying therapies alter the pharmacokinetics and pharmacodynamics of opioids. Existing treatment guidelines are reviewed. Practical suggestions are offered.