A review of factors explaining variability in fentanyl pharmacokinetics; focus on implications for cancer patients

Fentanyl is a strong opioid that is available for various administration routes, and which is widely used to treat cancer‐related pain. Many factors influence the fentanyl pharmacokinetics leading to a wide inter‐ and intrapatient variability. This systematic review summarizes multiple studied facto...

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Bibliographic Details
Published in:British journal of clinical pharmacology 2017-02, Vol.83 (2), p.294-313
Main Authors: Kuip, Evelien J. M., Zandvliet, Maarten L., Koolen, Stijn L. W., Mathijssen, Ron H. J., Rijt, Carin C. D.
Format: Article
Language:English
Subjects:
Aged
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - pharmacokinetics
Cancer Pain - drug therapy
Confounding Factors, Epidemiologic
Dose-Response Relationship, Drug
Female
fentanyl
Fentanyl - administration & dosage
Fentanyl - pharmacokinetics
Humans
Male
Neoplasms - complications
Neoplasms - drug therapy
Pharmacogenetics
pharmacokinetics
Research Design
Review
Reviews
Sex Factors
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Summary:Fentanyl is a strong opioid that is available for various administration routes, and which is widely used to treat cancer‐related pain. Many factors influence the fentanyl pharmacokinetics leading to a wide inter‐ and intrapatient variability. This systematic review summarizes multiple studied factors that potentially influence fentanyl pharmacokinetics with a focus on implications for cancer patients. The use of CYP3A4 inhibitors and inducers, impaired liver function, and heating of the patch potentially influence fentanyl pharmacokinetics in a clinically relevant way. In elderly patients, current data suggest that we should carefully dose fentanyl due to alterations in absorption and metabolism. The influence of BMI and gender on fentanyl pharmacokinetics is questionable, most probably due to a large heterogeneity in the published studies. Pharmacogenetics, e.g. the CYP3A5*3 gene polymorphism, may influence fentanyl pharmacokinetics as well, although further study is warranted. Several other factors have been studied but did not show significant and clinically relevant effects on fentanyl pharmacokinetics. Unfortunately, most of the published papers that studied factors influencing fentanyl pharmacokinetics describe healthy volunteers instead of cancer patients. Results from the studies in volunteers may not be simply extrapolated to cancer patients because of multiple confounding factors. To handle fentanyl treatment in a population of cancer patients, it is essential that physicians recognize factors that influence fentanyl pharmacokinetics, thereby preventing potential side‐effects and increasing its efficacy.
ISSN:0306-5251
1365-2125
DOI:10.1111/bcp.13129