Secondary Logo

Institutional members access full text with Ovid®

Opioid Pharmacology

Developmental Effects on Opioid Metabolism

Kopecky, Ernest A., PhD, ScD, MBA

The Clinical Journal of Pain: June 2019 - Volume 35 - Issue 6 - p 481–486
doi: 10.1097/AJP.0000000000000710
Special Topic Series on Opioid Therapeutics and Concerns in Pediatrics

Aims/Objectives/Background: Children represent a patient demographic composed of multiple, unique subpopulations differentiated by rapidly changing age-related physiology, which includes the means of metabolizing opioids. Opioids are an important part of the pharmacological treatment of both acute and chronic pain. In both clinical medicine and clinical research, it is necessary to understand the differences in drug handling by age cohort in order to appropriately dose children to effect, and to avoid exacerbating deleterious adverse events with potentially grave sequelae.

Methods: Topical review using data from a targeted PubMed literature search.

Results: Protein binding, tissue solubility, weight, size (body mass, surface area), blood flow, drug metabolism, and renal function are key determinants of dosing across the different pediatric age cohorts. Each variable functions to elicit a change in drug exposure and therefore varying clinical effect.

Conclusions: Understanding how these variables change the pharmacokinetics and pharmacodynamics of each opioid is critical to the successful and safe management of pain in children.

From the TEVA Branded Pharmaceutical Products R&D Inc., Frazer, PA.

No funding was received for this work. E.A.K. is a salaried employee of TEVA Branded Pharmaceutical Products R&D Inc. (Frazer, PA).

Reprints: Ernest A. Kopecky, PhD, ScD, MBA, TEVA Branded Pharmaceutical Products R&D Inc., 41 Moores Road, Suite 3E-164, Frazer, PA 19355 (e-mail:

Received February 25, 2019

Accepted February 28, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.