Methadone Pharmacokinetics in Geriatric Critically Ill Patients Following Intramuscular and Intravenous Administration: A Pilot Study

  • Safoura Beik Rassouli Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • Mohammad Reza Rouini 2Division of Biopharmaceutics and Pharmacokinetics, Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
  • Farhad Najmeddin Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran
  • Azin Gheimati Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran
  • Ali A Golabchifar Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
  • Kimia Tabib Department of Medical Chemistry, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
  • Arezoo Ahmadi Departments of Anesthesiology and Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
  • Kourosh Sadeghi Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran
  • Hooshyar Honarmand 3Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
  • Ali Mohammed Hadi Department of Clinical Pharmacy, College of Pharmacy, University of Basrah, Basrah, Iraq
  • Mojtaba Mojtahedzadeh Mail Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran
Keywords:
Methadone, Intensive Care Unit, Pharmacokinetics

Abstract

Background: Methadone is used for the pain management worldwide. Its special characteristics make it a potential alternative for pain management in critically ill and geriatric patients. Due to lack of studies in this population, we aimed to compare the pharmacokinetic behavior of Methadone following intramuscular and intravenous administration in geriatric ICU patients and with previously reports in healthy volunteers.

MethodsAccording to the limitations in ICU setting, we could include 11 patients over 65 years old, who required opioid for pain relief in this study. Patients were randomized to receive 5 mg of Methadone IM or IV injection every 8 hours for 6 days. The Methadone plasma level detected with LC-mass tandem mass spectrometry, and pharmacokinetics parameters were evaluated for each subject in both 1st and 6th days of treatment.

Results: Based on our results, bioavailability of intramuscular Methadone in geriatric ICU patients was low and less than 40% of the dose was absorbed within first 12 hours. The volume of distribution of Methadone in the first day was significantly lower than the previously reported values in healthy subjects and significantly increased during these 6 days. The Methadone half-life in this population also significantly increased through this period.

Conclusion: Pharmacokinetic behavior of Methadone in geriatric ICU patients is unpredictable. Reduced volume of distribution and half-life may be observed initially, following with an increase to the normal range. It seems that IM administration of Methadone in geriatric critically ill patients may not provide target analgesic Methadone serum levels.

Author Biographies

Safoura Beik Rassouli, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

Pharm. D, Hospital Pharmacists

Mohammad Reza Rouini, 2Division of Biopharmaceutics and Pharmacokinetics, Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Pharm. D, PhD of Pharmaceutics, Full Professor

Farhad Najmeddin, Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran

Pharm. D, Clinical Pharmacy Specialist, Fellowship in Critical Care Pharmacotherapy, Assistant Professor

Azin Gheimati, Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran

Pharm. D, Clinical Pharmacy Resident

Ali A Golabchifar, Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran

Pharm. D, PhD of Pharmaceutics, Assistant Professor

Kimia Tabib, Department of Medical Chemistry, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

Bachelor of Chemistry, Expert of Food, Drug & Health Laboratory

Arezoo Ahmadi, Departments of Anesthesiology and Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran

M.D, Anesthesiologist, Fellowship in Critical Care, Associate Professor

Kourosh Sadeghi, Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran

Pharm. D, Clinical Pharmacy Specialist, Assistant Professor

Ali Mohammed Hadi, Department of Clinical Pharmacy, College of Pharmacy, University of Basrah, Basrah, Iraq

Pharm. D, PhD of Clinical Pharmacy, Assistant Professor

Mojtaba Mojtahedzadeh, Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran

Pharm. D, Clinical Pharmacy Specialist, Fellowship in Critical Care Pharmacotherapy, Full Professor

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Published
2020-09-28
How to Cite
1.
Beik Rassouli S, Rouini MR, Najmeddin F, Gheimati A, Golabchifar AA, Tabib K, Ahmadi A, Sadeghi K, Honarmand H, Hadi AM, Mojtahedzadeh M. Methadone Pharmacokinetics in Geriatric Critically Ill Patients Following Intramuscular and Intravenous Administration: A Pilot Study. J Pharm Care. 8(3):99-109.
Section
Original Article(s)