Objectives:

Systematize and contribute to a better understanding of the pharmacokinetic and pharmacodynamic characteristics of opioid drugs available in Portugal for non-oncological pain and contribute to a more informed and adapted choice for the patient, which will enhance the efficiency and reduce the incidence of adverse effects.

Methods:

A narrative review of the bibliography on this theme was done using the terms Medical Subject Headings (MeSH) ‘Analgesics, Opioid’ and ‘Pharmacology, Clinical’. The Summary of Product Characteristics of all opioids available in Portugal was also used, as well as the pharmacokinetic and pharmacodynamic characteristics of these drugs registered in the DrugBank.

Results:

Twenty-two articles were selected for reading, of which 14 are literature reviews, four reference manuals, and four clinical guidelines, in addition to the use of INFARMED and DrugBank databases. In aging, there is a decrease of about 50% in the renal function from 40 to 70 years old, forcing dose reductions and special care in the use of drugs eliminated by this route. Hydromorphone and buprenorphine are the only opioids that don’t have renal elimination. Central obesity and an increase in acid α1-glycoprotein are also more frequent, increasing the volume of distribution of fat-soluble drugs and bases, such as opioids. Morphine and hydromorphine are the only ones that are not fat-soluble opioids. Regarding metabolism, in addition to a decrease in phase 1 metabolism, polypharmacy in the elderly is more frequent, so opioids with phase 2 metabolism, such as tapentadol, hydromorphone, and morphine, may be preferable.

Conclusions:

The recognition of the individual characteristics of each elderly patient, associated with knowledge of the basic pharmacology of each opioid available in Portugal, may ensure greater safety and safeguard greater adherence to therapy.

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