Nonlinear blood-brain barrier transport and dosing strategies influence
receptor occupancy ratios of morphine and its metabolites in pain
matrix.
Abstract
Background & purpose Morphine is important for treatment of acute and
chronic pain. However, there is high interpatient variability and often
inadequate pain relief and adverse effects. To better understand
variability in the dose effect relationships of morphine, we
investigated the impact of its nonlinear blood-brain-barrier (BBB)
transport on mu-opioid receptor (μ-OR) occupancy in different CNS
locations, in conjunction with its main metabolites that bind to the
same receptor. Methods CNS exposure profiles for morphine, M3G and M6G
for clinically relevant dosing regimens based on intravenous, oral
immediate- and extended-release formulations were generated using a CNS
PBPK model which incorporated nonlinear BBB transport of morphine. The
simulated CNS exposure profiles were then used to derive corresponding
μ-OR occupancies at multiple CNS pain matrix locations. Results The
simulated CNS exposure profiles for morphine, M3G and M6G, associated
with nonlinear BBB transport of morphine resulted in varying μ-OR
occupancies between the different dose regimens, formulations, and CNS
locations. We find that at lower doses, the μ-OR occupancy of morphine
was relatively higher than at higher doses of morphine, due to the
relative contribution of M3G and M6G. At such higher doses, M6G showed
higher occupancy than morphine, whereas M3G occupancy was low throughout
the dose ranges. Conclusion and implications Nonlinear BBB transport of
morphine influences the μ-OR occupancy ratios of morphine and its
metabolites, depending on dose and route of administration, and CNS
location. This may impact the clinical effects of morphine treatment for
pain relief.