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Opioid는 척수나 신경의 수용체에 결합하여 작용을 한다.
4 types opioid receptor – delta, kappa, mu (3 classic ones) + nociceptin (구조적 상동성)
① mu-1 : supraspinal analgesia
② mu-2 : 행복감, 축동, 호흡 억제, 장 운동 억제
③ Delta : mu-1 보다는 약한 진통, 항우울 효과
④ Keppa : 불쾌감, 해리, 섬망, 이뇨작용
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Opioid는 효과를 나타내기 위해서 titration 해야 한다.
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Opioid 과민반응은 흔치 않으며 allergy 반응 또한 매우 드물다.
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환자가 Opioid 과민 반응을 나타낸다면 다른 class의 Opioid로 바꾸는 것은 신중을 기해야 한다.
Drug [Origin, Class] | Typical Initial Adult Dose | Pharmacokinetics | Comments |
Morphin | 2-6 mgIV
10 mg IM/SC
10-30 mg PO IR tablet | Onset: 1-2 min IV, 10-15 min IM/SC, and 30 min PO IR tablet
Peak effect: 3-5 min IV, 15-30 min IM/SC, and 1 h PO IR tablet
Duration: 1-2 h IV, 3-4 h IM/SC, and 3-5 h PO IR tablet | Histamine release may produce transient hypotension or nausea and emesis; neither requires routine adjunctive treatment. |
Hydromorphon | 0.5-2 mg IV
1-2 mg IM | Onset: 5-15 min IV
Peak effect: 10-20 min IV
Duration: 2-4 h IV | More euphoria inducing than morphine. |
Fentanyl | 50-100 mg IV | Onset: <1 min IV
Peak effect: 2-5 min IV
Duration: 30-60 min IV | Less cardiovascular depression than morphine. |
100-mcg nasal spray in 1 nostril | High doses (>5 micrograms/kg IV) can cause chest wall rigidity. | ||
100-mcg buccal mucosa tablet | Used for breakthrough pain in opioid-tolerant cancer patients.
Wait >2 h before treating another episode.
May increase dose by 100 micrograms per episode. | ||
Used for breakthrough pain in opioid-tolerant cancer patients. | |||
May repeat after 30 min. | |||
Wait >4 h before treating another episode. | |||
May increase dose by 100 micrograms per episode. | |||
Available transmucosal forms not bioequivalent. | |||
Meperidine | 25-50 mg IV
50-150 mg IM/SC | Onset: 5 min IV
Peak effect: 5-10 min IV
Duration: 2-3 h IV | Contraindicated when patient has taken a monoamine oxidase inhibitor within the past 14 d to avoid precipitating serotonin syndrome.
Neurotoxicity may occur when multiple doses are given for >48 h or with a total daily dose >600 milligrams, especially in the presence of renal failure. |
Oxycodone | 5-10 mg PO | Onset: 10-15 min PO
Duration: 3-6 h PO | Lower incidence of nausea than other opioids.
Possible inadvertent acetaminophen overdose with combination agents. |
Codine | 30~60 mg PO
30~100 mg IM | onset: 30~60 min PO and 10~30 min IM
Duration : 4~6 hours PO and IM | GI S/E 발생률 높음 |
Tramadol | 50~100 mg PO | Onset: 1h PO
Duration: 4~6 hours PO | CNS S/E 가 흔함 |
상품명(영문/한글) | 주요 성분 | 1정/캡슐/엘릭시르 용량 | 비고 |
옥시콘틴서방정 | 옥시코돈 | 5, 10, 20, 40, 80mg | 서방정, 12시간마다 |
오코돈서방정 | 옥시코돈 | 10, 20, 40mg | 서방정 |
모르핀서방정/속효성정 | 모르핀 | 10, 30, 60, 100, 200mg | 각 제형 |
타펜 | 트라마돌 | 50, 75, 100mg | 약한 마약성 진통제 |
울트라셋/트라스트 | 트라마돌+아세트아미노펜 | 37.5mg+325mg | 복합제, 약한 마약성 |
코데인정/코데인포스 | 코데인 | 10, 20, 30mg | 약한 마약성 |
하이드로코돈–아세트아미노펜 엘릭시르 | 하이드로코돈+아세트아미노펜 | 0.5mg+33.4mg/mL 등 | 소아는 제한적 |
타진서방정 (Targin) | 옥시코돈+날록손 | 5/2.5mg, 10/5mg, 20/10mg | 서방정, 변비예방 복합 |
