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Veterinary Anaesthesia and Analgesia, 2006, 33, 266–273 doi:10.1111/j.1467-2995.2005.00266.

RESEARCH PAPER

Pharmacokinetics of fentanyl after single intravenous


injection and constant rate infusion in dogs

Tadashi Sano* DVM, PhD, Ryohei Nishimura* DVM, PhD Hideko Kanazawa  PD, Eri Igarashi  PD, Yoshiko Nagata 
PD, Manabu Mochizuki* DVM, PhD & Nobuo Sasaki* DVM, PhD
*Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo,
Japan
 Laboratory of Physical Pharmaceutical Chemistry, Kyoritsu College of Pharmacy, Tokyo, Japan

Correspondence: Tadashi Sano, Laboratory of Veterinary Radiology and Radiation Biology, Department of Veterinary Medicine, Kitasato
University School of Veterinary Medicine, Higashi 23 Bancho 35-1, Towada, Aomori 034-8628, Japan. E-mail: tsano@vmas.kitasato-u.ac.jp

Sciences (Kyoto University) in Visual Basic (VBA)


Abstract
on Excel (Microsoft Corporation).
Objective To determine the plasma concentration
and define the pharmacokinetic characteristics of Results Plasma fentanyl concentration decreased
fentanyl (10 lg kg)1) administered as a single rapidly after single IV injection: the plasma concen-
intravenous (IV) injection followed by: (a) no tration–time curve best fitted a two-compartment
further drug; or (b) a constant rate infusion (CRI) model. Pharmacokinetic variables for IV injection
of fentanyl 10 lg kg)1 hour)1 lasting 1, 3 or were characterized by a short distribution half-time
4 hours in dogs. (t1/2a was 4.5 minutes), a relatively long elimination
half time (t1/2b was 45.7 minutes), a large volume of
Animals Fourteen healthy adult beagles (seven distribution (approximately 5 L kg)1) and high total
males and seven females). body clearance (77.9 mL minute)1 kg)1). Stable
plasma fentanyl levels were obtained in all CRI
Experimental design Randomized cross-over design. groups although pharmacokinetic variables were
influenced by the duration of administration.
Materials and methods Dogs were randomly
assigned to four treatment groups. Drugs were Conclusions and clinical relevance While this study
administered to each dog in a randomized cross- clarified the pharmacokinetic features of rapid IV
over design with at least a 14-day washout fentanyl injection and CRI in dogs, the plasma concen-
interval between experiments. All dogs received tration achieving analgesia was not and so further
an IV loading dose of fentanyl (10 lg kg)1). One research is needed. Further studies on the effects of
group received no further fentanyl. In others, the other sedatives and/or anaesthetics on fentanyl’s
loading dose was followed by a CRI of fentanyl disposition are also required as the drug is commonly
(10 lg kg)1 hour)1) for 1, 3 or 4 hours. Blood used with other agents.
samples were collected and plasma fentanyl con-
Keywords constant rate infusion, dogs, fentanyl,
centrations determined using high-performance
pharmacokinetics.
liquid chromatography–mass spectrometry. Plasma
pharmacokinetic estimates were obtained by plot-
ting plasma concentrations versus time data and by
Introduction
fitting the change in concentration to a pharma-
cokinetic model, using a purpose-built program Nociceptive stimulation by surgery may still induce
written by the Graduate School of Pharmaceutical autonomic nervous system responses during

266
Pharmacokinetics of fentanyl after single IV injection T Sano et al.

general anaesthesia with volatile or injectable thy (based on physical and haematological exam-
anaesthetics (Pascoe 2000) in which case additional ination) 1- to 2-year-old beagles (seven males and
analgesia is required. Additional analgesia is also seven females; mean 1.3 year) with a body mass of
required during total intravenous (IV) anaesthesia 6.4–14.0 kg (mean 8.9 kg) were studied. They were
because injectable anaesthetics like propofol have housed in individual cages maintained at constant
weak or no analgesic effects (Smith et al. 1994). temperature and humidity. They were given food
Opioids are widely used to improve analgesia during once daily and were allowed free access to water.
general anaesthesia. Food was withheld for at least 12 hours before each
Fentanyl citrate (N-phenylethyl-N-[1,2-phenyl- experiment.
ethyl 4-piperidyl] propanamide) has a high affinity The dogs were randomly assigned to four treat-
and intrinsic action at the opioid receptor (Villiger ment groups of six dogs each. Each dog was used in
et al. 1983; Boas & Villiger 1985). The drug’s one or two experiments in different treatment
characteristics include a rapid onset and short groups. The interval between successive experi-
duration of action with a relative analgesic potency ments on the same dog was at least 14 days.
of 75–100 times that of morphine (Yaksh et al.
1986). It has fewer adverse side effects, e.g. respir-
Administration of fentanyl
atory depression, overt sedation, and dysphoria
when compared with morphine in dogs (Freye et al. The four experimental groups were based on a
1991). A single injection of fentanyl is commonly loading fentanyl dose, followed by: (a) no further
used to produce short-duration analgesia during drug; or (b) one of three CRIs lasting 1, 3 or
anaesthesia. To prolong this effect, the drug must be 4 hours. The CRI was determined as in previous
repeatedly injected at regular intervals – which may studies (Murphy et al. 1979, 1983, ). Group A dogs
cause respiratory depression (Yaksh et al. 1986; received a single IV injection of 10 lg kg)1 fentanyl
Freye et al. 1991; Duke et al. 1994a,b) – or be (Fentanest; Sankyo Co. Ltd, Tokyo, Japan) via a
continuously infused. Pharmacokinetic information catheter placed in the cephalic vein. Blood samples
is desirable because it allows the optimal dose for (2.5 mL) were collected from the catheter before
obtaining adequate and stable plasma levels to be and 2.5, 5.0, 7.5, 10.0, 12.5, 15.0, 17.5, 20, 30,
determined. The pharmacokinetic characteristics of 45, 60, 90, 120, 180 and 240 minutes after fent-
fentanyl after single injections and/or infusions anyl administration. In the other groups, fentanyl,
have been studied in humans (McClain & Hug 10 lg kg)1 IV, was followed by a CRI at
1980; Shafer & Varvel 1991). Fentanyl accumula- 10 lg kg)1 hour)1 maintained for 1 (group B), 3
tion after constant rate infusion (CRI) exceeding (group C) or 4 (group D) hours. The combination of
2 hours has also been reported in humans (Hughes a 10 lg kg)1 loading dose and a CRI of
et al. 1992). Although pharmacokinetic studies of 10 lg kg)1 hour)1 investigated in this study was
fentanyl after a single injection indicate that the based upon pharmacokinetic variables reported by
pharmacokinetic characteristics are dose independ- Holley & van Steennis (1988) previously. The blood-
ent in dogs (Murphy et al. 1983), the pharmaco- sampling interval in dogs receiving CRIs depended
kinetics during and after CRI in dogs remain unclear. on the infusion time. In group A, 2.5 mL blood was
This study was conducted to determine serial collected before the loading dose, 1, 5, 10, 20, 40
blood fentanyl concentrations in dogs and to define and 60 minutes after the start of infusion, and 2, 5,
the drug’s pharmacokinetic characteristics after 10, 30, 45, 60, 120, 240, 360 and 480 minutes
single injection alone or after single injection after the end of infusion. In the 3-hour infusion
followed by CRIs applied for 1, 3 or 4 hours. group, blood was collected at 80, 100, 120, 150
and 180 minutes after the start of infusion in
addition to those times listed for group B. In group
Materials and methods
D, blood was also collected 210 and 240 minutes
after the start of infusion in addition to those times
Animals
listed for group C.
This study was conducted in accordance with the Blood samples were collected into heparinized
guidelines provided by the Animal Care Committee tubes and centrifuged at 1560 g for 10 minutes.
of the Graduate School of Agricultural and Life Plasma was harvested, placed in cryogenic storage
Sciences at the University of Tokyo. Fourteen heal- vials and frozen at )80 C until analysis.

 2006 Association of Veterinary Anaesthetists, 33, 266–273 267


Pharmacokinetics of fentanyl after single IV injection T Sano et al.

Fentanyl assay Statistical analysis

Plasma fentanyl concentration was analysed using Values are expressed as the mean ± standard devi-
high-performance liquid chromatography–mass ation. One-way factorial analysis of variance (one-
spectrometry (HPLC/MS). Each plasma sample factor ANOVA) was performed for comparison of
(400 lL) was applied to an Extraction Disk C18 pharmacokinetic variables among the infusion
cartridge (Empore; 3M Co. Ltd, Tokyo, Japan) pre- groups. When a statistically significant difference
treated with methanol, water and 20 mM ammo- was detected, these variables were analysed using
nium acetate (pH 4.8). After washing the column the Bonferroni’s/Dunn method. Values of p < 0.05
with 3 mL of 20 mM ammonium acetate, fentanyl were considered statistically significant.
was eluted with 1 mL of methanol and the elute
was evaporated under reduced pressure. The Results
residue was dissolved in 40 lL of mobile phase
and then 5 lL of this solution was injected into Bolus administration
the HPLC system. In this study an HPLC system
(L-8000 Hitachi, Tokyo, Japan) connected to a Plasma fentanyl concentrations of 5.0 ng mL)1
mass spectrometer computer system (M-7000 Hi- which were achieved approximately 2.5 minutes
tachi, Tokyo, Japan) through the SSI interface after IV injection, rapidly decreased for the first
(L-8000 Hitachi; Tokyo, Japan) was used. The 20 minutes and more slowly thereafter. The plasma
chromatographic separation was carried out on concentration–time curve was derived from two
an ODS column of hydrosphere (YMC-Pack Pro exponential functions (Fig. 1). The data were best
semi micro column; 150 · 146 mm ID, Kyoto, fitted to a two-compartment open model using the
Japan) using methanol:20 mM ammonium acetate formula:
(60:40) as the mobile phase. The system was t t
Ct ¼ Aea þ Beb
operated at ambient temperature at a flow of
0.2 mL minute)1. The drift voltage of SSI was where Ct is the plasma concentration at time t, A the
60 V, and the shield temperature and sampling intercept, a the rate constant for the initial steep
aperture were 200 and 110 C respectively. The (disposition) portion of the curve, B the intercept
lowest limit of this assay system for detection of and b the rate constant for the terminal (elimin-
fentanyl was 50 pg mL)1. ation) portion of the curve. The pharmacokinetic
variables of a single fentanyl injection (10 lg kg)1)
are shown in Table 1. The decrease in plasma
Pharmacokinetic analysis
fentanyl concentration was rapid, with a distribu-
Plasma pharmacokinetic estimates were obtained tion half-time (t1/2a) of 1.9–6.2 minutes (mean
by plotting plasma concentrations versus time data 4.5 minutes) and an elimination half-time (t1/2b)
and by fitting the change in concentration to a of 30.6–55.2 minutes (mean 45.7 minutes). The
pharmacokinetic model. Curve fitting was per- distribution volumes expressed as V1 (volume of
formed with an interactive least–squares approach, distribution at central compartment) and Vdb
using the computer program MULTI (free software (volume of distribution at elimination phase) were
based on the Microsoft Excel; provided by Graduate 870–1940 mL kg)1 (mean 1500 mL kg)1) and
school of Pharmaceutical Sciences, Faculty of 3835–6186 mL kg)1 (mean 4939 mL kg)1)
Pharmaceutical Sciences, Kyoto University, Kyoto, respectively. Total body clearance (TBCL)
Japan) (Yamaoka et al. 1981). Area under the was 48.1–110.3 mL minute)1 kg)1 (mean
curve (AUC) was calculated using the log-trapezoi- 77.9 mL minute)1 kg)1).
dal method and adding the estimated terminal
portion of the curve. Clearance, distribution volume
Constant rate infusion
and microdistribution rate constants were calcula-
ted on the basis of the AUC and the variables for the Changes in plasma fentanyl concentration are
aforementioned equation. shown in Figs 2–4 and the pharmacokinetic varia-
In the CRI groups, clearance and volume of bles in the CRI group are shown in Table 2. In
distribution were calculated by moment-analysis group D, the IV administration of fentanyl caused
using MULTI. an initial rise in plasma concentration after which

268  2006 Association of Veterinary Anaesthetists, 33, 266–273


Pharmacokinetics of fentanyl after single IV injection T Sano et al.

10

log fentanyl concentration (ng ml–1)


1

0.1

Figure 1 Plasma fentanyl concentra- 0.01


0 20 40 60 80 100 120 140 160 180 200 220 240
tion changes after rapid IV injection
of 10 lg kg)1 in conscious dogs. Time after administation (minutes)

Table 1 Pharmacokinetic parameters of fentanyl after cantly different in any CRI group, but TBCL was
rapid intravenous injection (10 lg kg)1) in conscious dogs significantly higher in group B compared with those
in groups C and D.
A (ng mL)1) zero-time intercept of distribution 5.6 ± 2.2
phase adjusted by method of residuals
B (ng mL)1) zero-time intercept of elimination 1.5 ± 0.2
Discussion
phase
In this study, plasma fentanyl concentrations
a (minute)1) distribution phase rate-constant 0.18 ± 0.09
b (minute)1) elimination phase rate-constant 0.02 ± 0.004
decreased rapidly for approximately 20 minutes
V1 (mL kg)1) apparent volume of the central 1500.0 ± 400 after IV administration and then more gradually.
compartment Plasma fentanyl concentrations best fitted a two-
Vdb (mL kg)1) apparent volume of distribution 4939.2 ± 859 compartment open model consisting of two lines, in
at the b phase
which the initial rapid decrease in plasma concen-
AUC (ng mL)1 minute)1) area under the blood 137.9 ± 41.9
concentration versus time curve
tration is caused mainly by drug redistribution from
t1/2a (minutes) half-life of distribution phase 4.5 ± 1.5 the central to the peripheral compartment, with
t1/2b (minutes) half-life of elimination phase 45. ± 8.6 subsequent changes resulting from drug redistri-
TBCL (mL minute)1 kg)1) total body clearance 77.9 ± 22.3 bution and elimination from the body. It has been
of fentanyl
reported elsewhere that the pharmacokinetics of
k12 0.09 ± 0.026
k21 0.05 ± 0.007
fentanyl are best fitted to two-compartment models
kel 0.05 ± 0.029 in rats and three-compartment models in humans,
dogs and cats (Murphy et al. 1979; McClain & Hug
Values are given as mean ± SD. 1980; Hug & Murphy 1981, Shafer & Varvel 1991,
Kxy (minute)1) microrate constant (rate of drug transfer from Lee et al. 2000). However, the number of com-
compartment x to y). partments involved also depends on the frequency
of blood sampling (Adam et al. 1980). The distri-
the level decreased until 60 minutes after the start bution volume (Vd) of fentanyl in group A was
of infusion. The concentration then remained rel- relatively large and similar to that reported else-
atively stable, increasing slightly for 3 hours until where in dogs (Murphy et al. 1979, 1983, ). This
the end of infusion. During that period, plasma large value indicates that fentanyl diffuses rapidly
fentanyl concentration remained between 0.8 and throughout body tissues or binds to tissues other
1.5 ng mL)1 (mean 1.0–1.3 ng mL)1). In groups B than plasma. Distribution half-time (t1/2a) in group
and C, the changes in plasma fentanyl concentra- A was short and similar to times previously repor-
tions were similar to those in group D until the end ted in dogs (Murphy et al. 1979, 1983), humans
of infusion, when the fentanyl concentration de- (Bovill & Sebel 1980) and rats (Hug & Murphy
creased rapidly for a short while before decreasing at 1981). The short t1/2a indicates that fentanyl dis-
a more gradual rate in all the CRI groups. Compared appears rapidly from the effect site after rapid IV
with group A, t1/2a, t1/2b and Vdss were not signifi- injection.

 2006 Association of Veterinary Anaesthetists, 33, 266–273 269


Pharmacokinetics of fentanyl after single IV injection T Sano et al.

10
log fentanyl concentration (ng ml )
–1

0.1

Fentanyl
Figure 2 Plasma fentanyl concentra-
infusion tion changes in conscious dogs
after rapid intravenous injection of
0.01
0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 320 340 360 380 400 420 440 460 480 500 520 540 10 lg kg)1 followed by infusion
Time after administration (minutes) (10 lg kg)1 hour)1) for 1 hour.

10
log fentanyl concentration (ng ml–1)

0.1

Figure 3 Plasma fentanyl concentra-


Fentanyl infusion tion changes in conscious dogs
0.01 after rapid intravenous injection of
0 40 80 120 160 200 240 280 320 360 400 440 480 520 560 600 640 10 lg kg)1 followed by infusion
Time after administration (minutes) (10 lg kg)1 hour)1) for 3 hours.

10
log fentanyl concentration (ng ml–1)

0.1

Figure 4 Plasma fentanyl concentra-


Fentanyl infusion
tion changes in conscious dogs
0.01
after rapid intravenous injection of
0 40 80 120 160 200 240 280 320 360 400 440 480 520 560 600 640 680 720 10 lg kg)1 followed by infusion
Time after administration (minutes) (10 lg kg)1 hour)1) for 4 hours.

Total body clearance is an important pharmaco- (10 mL kg)1 minute)1) in dogs. This indicates that
kinetic parameter that represents the body’s ability fentanyl may be metabolized in extra hepatic sites
for drug elimination. In this study, fentanyl TBCL in and eliminated by extra renal routes in addition to
group A was approximately 80 mL kg)1 minute)1, hepatic metabolism through N-dealkylation and
which exceeds the sum total of hepatic hydroxylation (Clotz & Nahata 1991; Rajan et al.
(40 mL kg)1 minute)1) and renal blood flow 1998). A first pass by pulmonary uptake (approxi-

270  2006 Association of Veterinary Anaesthetists, 33, 266–273


Pharmacokinetics of fentanyl after single IV injection T Sano et al.

Table 2 Pharmacokinetic properties


of fentanyl in conscious dogs receiv- Group A Group B Group C Group D
ing single fentanyl injection
(10 lg kg)1 IV) (group A) followed t1/2a (minutes) 4.5 ± 1.5 30.5 ± 24.3 51.6 ± 35.5* 41.1 ± 32.2*
by a controlled rate infusion t1/2b (minutes) 45.7 ± 8.6 151.1 ± 61.0* 182.1 ± 68.1* 157.1 ± 87.5*
(10 lg kg)1 hour)1) for 1 (group Total body clearance 77.9 ± 22.3 61.9 ± 4.6 46.9 ± 7.5† 47.9 ± 16.4†
B), 3 (group C) or 4 hours (group D) (mL minute)1 kg)1)
End-infusion plasma 1.01 ± 0.7 1.11 ± 0.4 1.25 ± 0.7
fentanyl concentration
(ng mL)1).
Vdss (mL kg)1) 4774.0 ± 253.8 4382.5 ± 385.5 4040.4 ± 260.3

Values are given as mean ± SD.


*Statistical significance (p < 0.05) was observed compared with group A; †Statistical
significance (p < 0.05) was observed compared with group B.

mately 75% of administered fentanyl) has been are less sensitive to opioid analgesics than humans
reported in humans. A small amount of unchanged (Murphy et al. 1979). In addition, the analgesic
fentanyl is eliminated in the urine and faeces in rats plasma concentration required depends on the
(Hug & Murphy 1981; Mather 1983; Roerig et al. surgery to be performed. Further investigations
1987). including the pharmacokinetic changes caused by
The elimination half-time (t1/2b) in group A was drugs given concomitantly are required to deter-
relatively short and similar to times previously mine the optimal dose of fentanyl in dogs under-
reported in dogs (Murphy et al. 1979, 1983), going surgery.
humans (Bovill & Sebel 1980) and rats (Hug & In this study, the plasma fentanyl concentration
Murphy 1981). The t1/2b is related to drug remained relatively stable during CRI for the first
elimination from the body and is mainly influenced 4 hours. It has been reported that plasma fentanyl
by the rate of elimination or TBCL. The result concentration increases rapidly after CRI exceeding
obtained here suggests that fentanyl is excreted in a 3 hours in humans, even at low infusion rates
comparatively short time after IV administration in (Hughes et al. 1992). Fentanyl accumulation is
dogs. thought to account for this (Hughes et al. 1992). In
In group B, plasma fentanyl concentrations did contrast, plasma fentanyl concentration remained
not reach stable levels, while in groups C and D, stable and Vdss did not change significantly even
they were relatively stable and remained between after CRI for 4 hours in this study. Fentanyl is
0.2 and 1.8 ng mL)1 (mean 0.9–1.3 ng mL)1) widely distributed to peripheral tissues even after
from about 80 minutes after the start of CRI until prolonged infusions in dogs, although concentra-
the end of infusion. The optimal plasma fentanyl tions increased gradually, even in this study.
concentration for analgesia has been reported to be Target-controlled infusion using a computer system
0.9–2.0 ng mL)1 in humans and dogs (Holley & (Saijo et al. 2001) may be a more suitable way
van Steennis 1988; Varvel et al. 1989; Robinson of obtaining more stable plasma fentanyl levels
et al. 1999). The combination of a 10 lg kg)1 rapidly.
loading dose followed by a CRI of 10 lg kg)1 After the cessation of CRI in groups B, C and D,
investigated in this study might be a guideline for values for t1/2a were greater than that in group A.
a CRI dose of fentanyl during general anaesthesia to The t1/2a indicates the rate of fentanyl disappear-
provide analgesia in dogs. Because of its large ance from the effect site and depends on clearance
distribution volume, loading doses of fentanyl are and distribution volume. In this study, the volume
necessary for establishing early effective and stable of distribution did not change statistically in any
plasma levels. The loading dose used in this study CRI group, but the TBCL changed in the 3- and
was much greater than that used in humans (Holley 4-hour CRI groups. This indicates that analgesia
& van Steennis 1988). The optimal fentanyl level may be sustained for longer periods after CRI
described above in humans was established by using discontinuation when infusion doses of
loading doses of 1.0–4.0 lg kg)1 followed by CRIs 10 lg kg)1 hour)1 are administered for more than
of 1.0 lg kg)1 hour)1. One study showed that dogs 3 hours.

 2006 Association of Veterinary Anaesthetists, 33, 266–273 271


Pharmacokinetics of fentanyl after single IV injection T Sano et al.

Total body clearance in the 3- and 4-hour CRI research is needed to determine how these levels
groups was significantly lower than that found in may be achieved and the influence of other varia-
Groups A and B. Hepatic metabolism, which is the bles, e.g. co-administered drugs.
principal determinant of clearance, depends on
hepatic blood flow and hepatic enzyme activity
Acknowledgements
(Clotz & Nahata 1991; Rajan et al. 1998). However,
extra hepatic factors contribute to falling plasma The authors thank professor N. Sasaki and associate
concentrations. Reduced hepatic blood flow occurs professor R. Nishimura and co-workers in Labora-
during cumulative administration of fentanyl in tory of Veterinary Surgery, Graduate School of
dogs (Hayashi 1998). In this study, hepatic blood Agricultural and Life Sciences, the University of
flow may have been reduced during 3 and 4 hours Tokyo and associate professor H. Kanazawa and
of infusion. Values for TBCL obtained in this assistant Y. Nagata and co-workers in Laboratory
study were larger than those reported previously of Physical Pharmaceutical Chemistry, Kyoritsu
in dogs (Murphy et al. 1979) even in group D. The College of Pharmacy.
pharmacokinetic data reported previously were
obtained under general anaesthesia with enflurane,
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