Summary: Hepatitis C is a type of liver disease that can effect the types and quantity of medications you can take. Morphine is one of them. While there are dangers to using it with Hepatitis C, often times the reward outweighs the risk.
Dear Curtis: My Dad has Hepatitis C and poor liver function. His doctor has said he wants to put him on Morphine to help with, what he called, breakthrough pain. Is this safe to take with his liver condition?
The short answer is: no. It’s not necessarily ‘safe’. But, it can be done and is done almost every day. But let me explain the details which should help put your mind at ease.
There are generally two types of morphine products that are given to patients. Immediate release and extended release. Because you’ve already indicated that your doctor intends to prescribe the morphine for ‘breakthrough’ pain that means your Dad will be getting the immediate release formulation of morphine sulfate.
As the name implies, breakthrough pain is the type of pain that ‘breaks through’. It’s not a constant worry, but you want to have drugs that work quickly to control those times when it does happen. Hence the reason for giving him immediate release morphine.
One of the most important things you have to consider when you take ANY drug is how it is metabolized, or broken down, in the body as well as how our body eliminates the drug or any of it’s metabolites. In regards to Morphine, either immediate release or extended release, it is metabolized in the liver. When it’s broken down in the liver it also produces metabolites. Finally, the morphine and the metabolites are then excreted primarily through the kidneys.
Here’s what this means for your Dad …
Because he has Hepatitis C there is a high likelihood that he has poor, or decreased, liver function. This will primarily be identified in his LFT’s (Liver Function Tests). Because of that morphine will likely NOT be broken down into it’s inactive metabolites as well. In studies, researchers found that the amount of morphine in the blood increased in comparison to the inactive metabolites.
So, it’s likely that your doctor will start at a lower dose first, and then take a ‘watch and wait’ attitude to see how your Dad responds to the adjusted dose. Also, as long as he has good kidney function, he will be able to eliminate the morphine from his system. That shouldn’t be a concern.
Morphine Is a Prototype
While having to adjust your Dad’s dose of morphine because of his decreased ability to break it down may be worrying, this type of situation arises daily for doctors, pharmacist and patients. And that’s because morphine is the prototypical opiate pain killer. Basically all our other potent pain killers act in a similar fashion.
So, for practical purposes, if you need a big gun for pain control you are almost forced into using this class of drugs. Secondly, immediate release morphine is available as a generic and is fairly cheap. A lot cheaper than other painkillers in it’s class.
So, technically it can be dangerous to take morphine with liver disease. However, for practical purposes, most doctors are fine with it as long as there isn’t really bad kidney disease too. The dose will be lowered and they’ll likely monitor your Dad and adjust his dose as needed.