heroin and Liver-Diseases

This article reviews the pharmacokinetics of heroin after intravenous, oral, intranasal, intramuscular and rectal application and after inhalation in humans, with a special focus on heroin maintenance therapy in heroin dependent patients. In heroin maintenance therapy high doses pharmaceutically prepared heroin (up to 1000 mg/day) are prescribed to chronic heroin dependents, who do not respond to conventional interventions such as methadone maintenance treatment. Possible drug-drug interactions with the hydrolysis of heroin into 6-monoacetylmorphine and morphine, the glucuronidation of morphine and interactions with drug transporting proteins are described. Since renal and hepatic impairment is common in the special population of heroin dependent patients, specific attention was paid on the impact of renal and hepatic impairment. Hepatic impairment did not seem to have a clinically relevant effect on the pharmacokinetics of heroin and its metabolites. However, some modest effects of renal impairment have been noted, and therefore control of the creatinine clearance during heroin-assisted treatment seems recommendable.

Topics: ATP Binding Cassette Transporter, Subfamily B, Member 1; Drug Interactions; Heroin; Humans; Kidney Diseases; Liver Diseases; Morphine; Morphine Derivatives

Topics: Adult; Aged; Blood Pressure; Body Temperature; Body Weight; Cardiovascular Diseases; Female; Gastrointestinal Diseases; Heroin; Humans; Liver Diseases; Lung Diseases; Lymphatic Diseases; Male; Middle Aged; Morphine Dependence; Pulse; Skin Diseases; Splenic Diseases; Substance-Related Disorders; Urologic Diseases

A double-blind study comparing placebo and haem arginate was conducted in 12 patients with acute intermittent porphyria. 2 days after admission in attack patients were randomised to receive intravenous haem arginate 3 mg/kg per 24 h for 4 days or placebo. 9 patients were readmitted with a further attack and were given the alternative treatment. Before randomisation the paired attacks were of similar severity with respect to urinary porphobilinogen (PBG) excretion and clinical manifestations. With haem arginate the median PBG excretion of the 9 patients with two attacks (normal range 0-16 mumol per 24 h) fell significantly from 332 mumol per 24 h (range 137-722) on admission to a median lowest level of 40 (range 22-105). On placebo, median PBG excretion was 382 (range 196-542) on admission, falling to 235 (range 128-427). Median duration of admission after the start of treatment was 11 days (range 2-28) for placebo and 8 days (3-26) for haem arginate. Median total analgesic requirement between the start of treatment and discharge was 8150 mg pethidine equivalents (range 0-17,650) with placebo versus 6425 (range 50-20,650) with haem arginate. Phlebitis occurred in 5 patients on haem arginate and in 2 on placebo. Haem arginate effectively reduces porphyrin precursor overproduction in the acute porphyric attack but this reduction is not accompanied by striking resolution of the clinical manifestations of the attack.

Topics: Acute Disease; Adolescent; Arginine; Clinical Trials as Topic; Double-Blind Method; Female; Heme; Heroin; Humans; Infusions, Intravenous; Injections, Intravenous; Liver Diseases; Male; Meperidine; Pain; Phlebitis; Porphyrias; Random Allocation; Recurrence; Severity of Illness Index

Topics: Acute Disease; Adult; Chronic Disease; Female; Hepatitis A; Heroin; Humans; Injections, Intravenous; Liver Diseases; Liver Diseases, Alcoholic; Male; Substance-Related Disorders

Topics: Adult; Autoantibodies; Bacterial Infections; Biopsy; Chemical and Drug Induced Liver Injury; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Diagnosis, Differential; Female; Halothane; Hepatitis; Hepatitis B Antibodies; Hepatitis B Surface Antigens; Hepatitis, Viral, Human; Heroin; Heroin Dependence; Humans; Hypergammaglobulinemia; Liver; Liver Diseases; Liver Function Tests; Male; Middle Aged

Topics: Adolescent; Adult; Chronic Disease; Heroin; Humans; Liver Diseases; Substance-Related Disorders

Liver function tests were performed in 500 young servicemen with a history of drug abuse. Serum glutamic oxaloacetic transaminase (SGOT) level was abnormal in 66% of 68 patients with a history of parenteral drug abuse. Forty-one percent of 432 patients with a history of only nonparenteral drug abuse also had elevated SGOT levels. A high incidence of liver disease in parenteral drug abusers is well established; however, to our knowledge, the magnitude of the problem in nonparenteral drug abusers has not been noted previously. Liver biopsy specimens in 34 of our patients showed either a classic viral hepatitis or a mild nonspecific hepatitis. Limited follow-up suggested a slowly resolving process. We conclude that hepatitis may be a common sequel to epidemic nonparenteral drug abuse.

Topics: Adolescent; Adult; Alkaline Phosphatase; Asia, Southeastern; Aspartate Aminotransferases; Cannabis; Chemical and Drug Induced Liver Injury; Clinical Enzyme Tests; Confidentiality; Hepatitis B Antigens; Heroin; Humans; Liver; Liver Diseases; Liver Function Tests; Male; Military Medicine; Phytotherapy; Substance-Related Disorders; United States

Topics: Adult; Heroin; Heroin Dependence; Humans; Immunodiffusion; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Immunoglobulins; Liver Diseases; Liver Function Tests; Substance-Related Disorders

Topics: Adult; Alcoholism; Child; Female; Hepatitis A; Heroin; Humans; Liver Cirrhosis; Liver Diseases; Lung Diseases; Male; Middle Aged; Oxygen Inhalation Therapy; Pneumonia; Respiratory Insufficiency; Syndrome

Topics: Adult; Female; Heroin; Humans; Immunoglobulin M; Liver Diseases; Male; Methadone; Substance-Related Disorders

Topics: Alcoholism; Chemical and Drug Induced Liver Injury; Hepatitis A; Hepatitis B; Heroin; Heroin Dependence; Humans; Liver Diseases; Substance-Related Disorders

Topics: Adolescent; Adult; Aged; Burns; Colon; Endotoxins; Female; Gastrointestinal Hemorrhage; Heroin; Humans; Intestinal Obstruction; Ischemia; Kidney Transplantation; Liver Cirrhosis; Liver Diseases; Lung Diseases, Parasitic; Male; Middle Aged; Mononuclear Phagocyte System; Morphine Dependence; Peritonitis; Sepsis; Shock, Septic; Transplantation, Homologous; Urinary Fistula; Urinary Tract Infections

Topics: Acute Disease; Antibodies; Antigens; Biopsy; Chronic Disease; Drug Synergism; Ethanol; Hepatitis B Antigens; Heroin; Humans; Liver Diseases; Liver Function Tests; Morphine Dependence; Radioimmunoassay

Topics: Acute Disease; Adolescent; Adult; Autopsy; Chemical and Drug Induced Liver Injury; Female; Hepatitis A; Hepatitis B; Heroin; Humans; Liver; Liver Diseases; Lymph Nodes; Male; Morphine Dependence; Necrosis; Pulmonary Edema

Topics: Carrier State; Hepatitis A; Heroin; Heroin Dependence; Humans; Liver Diseases; Substance-Related Disorders