Abstract
Chronic clinical pain remains poorly treated. Despite attempts to develop novel analgesic agents, opioids remain the standard analgesics of choice in the clinical management of chronic and severe pain. However, mu opioid analgesics have undesired side effects including, but not limited to, respiratory depression, physical dependence and tolerance. A growing body of evidence suggests that P-glycoprotein (P-gp), an efflux transporter, may contribute a systems-level approach to the development of opioid tolerance. Herein, we describe current in vitro and in vivo methodology available to analyze interactions between opioids and P-gp and critically analyze P-gp data associated with six commonly used mu opioids to include morphine, methadone, loperamide, meperidine, oxycodone, and fentanyl. Recent studies focused on the development of opioids lacking P-gp substrate activity are explored, concentrating on structure-activity relationships to develop an optimal opioid analgesic lacking this systems-level contribution to tolerance development. Continued work in this area will potentially allow for delineation of the mechanism responsible for opioid-related P-gp up-regulation and provide further support for evidence based medicine supporting clinical opioid rotation.
Keywords: Opioids, analgesics, P-glycoprotein, efflux transporters, tolerance, dependence, chronic and severe pain, respiratory depression, opioid tolerance, clinical opioid rotation, analgesia, agonists
Current Topics in Medicinal Chemistry
Title: Opioid Analgesics and P-Glycoprotein Efflux Transporters: A Potential Systems-Level Contribution to Analgesic Tolerance
Volume: 11 Issue: 9
Author(s): Susan L. Mercer and Andrew Coop
Affiliation:
Keywords: Opioids, analgesics, P-glycoprotein, efflux transporters, tolerance, dependence, chronic and severe pain, respiratory depression, opioid tolerance, clinical opioid rotation, analgesia, agonists
Abstract: Chronic clinical pain remains poorly treated. Despite attempts to develop novel analgesic agents, opioids remain the standard analgesics of choice in the clinical management of chronic and severe pain. However, mu opioid analgesics have undesired side effects including, but not limited to, respiratory depression, physical dependence and tolerance. A growing body of evidence suggests that P-glycoprotein (P-gp), an efflux transporter, may contribute a systems-level approach to the development of opioid tolerance. Herein, we describe current in vitro and in vivo methodology available to analyze interactions between opioids and P-gp and critically analyze P-gp data associated with six commonly used mu opioids to include morphine, methadone, loperamide, meperidine, oxycodone, and fentanyl. Recent studies focused on the development of opioids lacking P-gp substrate activity are explored, concentrating on structure-activity relationships to develop an optimal opioid analgesic lacking this systems-level contribution to tolerance development. Continued work in this area will potentially allow for delineation of the mechanism responsible for opioid-related P-gp up-regulation and provide further support for evidence based medicine supporting clinical opioid rotation.
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Cite this article as:
L. Mercer Susan and Coop Andrew, Opioid Analgesics and P-Glycoprotein Efflux Transporters: A Potential Systems-Level Contribution to Analgesic Tolerance, Current Topics in Medicinal Chemistry 2011; 11 (9) . https://dx.doi.org/10.2174/156802611795371288
DOI https://dx.doi.org/10.2174/156802611795371288 |
Print ISSN 1568-0266 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4294 |
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