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Journal of veterinary pharmacology and therapeutics2023; 46(5); 311-325; doi: 10.1111/jvp.13126

Pharmacokinetics and effects of codeine in combination with acetaminophen on thermal nociception in horses.

Abstract: Codeine and acetaminophen in combination have proven to be an effective analgesic treatment for moderate-to-severe and postoperative pain in humans. Studies have demonstrated that codeine and acetaminophen, when administered as sole agents, are well tolerated by horses. In the current study, we hypothesized that administration of the combination of codeine and acetaminophen would result in a significant thermal antinociceptive effect compared with administration of either alone. Six horses were administered oral doses of codeine (1.2 mg/kg), acetaminophen (20 mg/kg), and codeine plus acetaminophen (1.2 mg/kg codeine and 6-6.4 mg/kg acetaminophen) in a three-way balanced crossover design. Plasma samples were collected, concentrations of drug and metabolites determined via liquid chromatography-mass spectrometry, and pharmacokinetic analyses were performed. Pharmacodynamic outcomes, including effect on thermal thresholds, were assessed. Codeine C and AUC were significantly different between the codeine and combination group. There was considerable inter-individual variation in the pharmacokinetic parameters for codeine, acetaminophen, and their metabolites in horses. All treatments were well tolerated with minimal significant adverse effects. An increase in the thermal threshold was noted at 1.5 and 2 h, from 15 min through 6 h and 0.5, 1, 1.5, and 3 h in the codeine, acetaminophen, and combination groups, respectively.
Publication Date: 2023-04-06 PubMed ID: 37021661DOI: 10.1111/jvp.13126Google Scholar: Lookup
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  • Journal Article

Summary

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The research investigates the impact of combined codeine and acetaminophen administration on thermal pain response in horses, comparing it to the administration of either drug individually. The findings suggest that the combination of codeine and acetaminophen has potential as an effective pain reliever in horses.

Research Design and Methodology

  • The research was conducted on six horses, and it adopted a three-way balanced crossover design.
  • The horses were administered oral doses of codeine (1.2 mg/kg), acetaminophen (20 mg/kg), and a combination of codeine and acetaminophen (1.2 mg/kg codeine and 6-6.4 mg/kg acetaminophen).
  • Plasma samples were taken, and the concentration levels of administered drugs and their metabolites were determined using liquid chromatography-mass spectrometry.

Pharmacokinetic and Pharmacodynamics Analysis

  • The researchers carried out pharmacokinetic analyses to understand how the horses’ bodies absorbed, distributed, metabolized, and excreted the drugs.
  • Pharmacodynamic outcomes were also assessed. Pharmacodynamics refers to the effects and mechanisms of action of a drug within the body.
  • Particularly, the effects of the drugs on thermal thresholds were monitored. This involved understanding the thermal pain responses of the horses.

Results and Findings

  • Results showed that significant differences in the concentration of codeine and the area under the drug concentration-time curve (codeine C and AUC) between the horses administered with codeine only and those given the drug combination.
  • Significant variation was observed in how different horses metabolized codeine, acetaminophen, and their metabolites. This inter-individual variation reveals the different metabolic responses of the horses to the same drugs.
  • No significant adverse effects were reported in all the treatments, indicating that both drugs and their combination were well tolerated by the horses.
  • The thermal pain response increased at varying time intervals in horses administered with codeine, acetaminophen, and their combination. The combination group showed increased thermal threshold at 1, 1.5, and 3 hours after drug administration.

The implications of this research may extend to developing effective analgesic treatments for moderate-to-severe and postoperative pain in horses, utilizing the combination of codeine and acetaminophen.

Cite This Article

APA
Tueshaus T, McKemie DS, Kanarr K, Kass PH, Knych HK. (2023). Pharmacokinetics and effects of codeine in combination with acetaminophen on thermal nociception in horses. J Vet Pharmacol Ther, 46(5), 311-325. https://doi.org/10.1111/jvp.13126

Publication

ISSN: 1365-2885
NlmUniqueID: 7910920
Country: England
Language: English
Volume: 46
Issue: 5
Pages: 311-325

Researcher Affiliations

Tueshaus, Tisa
  • K.L Maddy Equine Analytical Pharmacology Laboratory, University of California Davis, School of Veterinary Medicine, Davis, California, USA.
McKemie, Daniel S
  • K.L Maddy Equine Analytical Pharmacology Laboratory, University of California Davis, School of Veterinary Medicine, Davis, California, USA.
Kanarr, Kirsten
  • K.L Maddy Equine Analytical Pharmacology Laboratory, University of California Davis, School of Veterinary Medicine, Davis, California, USA.
Kass, Philip H
  • Department of Medicine and Epidemiology, University of California Davis, School of Veterinary Medicine, Davis, California, USA.
Knych, Heather K
  • K.L Maddy Equine Analytical Pharmacology Laboratory, University of California Davis, School of Veterinary Medicine, Davis, California, USA.
  • Department of Molecular Biosciences, University of California Davis, School of Veterinary Medicine, Davis, California, USA.

MeSH Terms

  • Humans
  • Horses
  • Animals
  • Acetaminophen / therapeutic use
  • Nociception
  • Drug Therapy, Combination / veterinary
  • Codeine / therapeutic use
  • Codeine / adverse effects
  • Analgesics / therapeutic use
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / veterinary
  • Drug Combinations
  • Double-Blind Method
  • Horse Diseases / drug therapy

References

This article includes 36 references
  1. Bennett RC, Steffey EP. Use of opioids for pain and anesthetic management in horses. The Veterinary Clinics of North America Equine Practice 2002;18(1):47-60.
  2. Coffman BL, King CD, Rios GR, Tephly TR. The glucuronidation of opioids, other xenobiotics, and androgens by human UGT2B7Y(268) and UGT2B7H(268). Drug Metabolism and Disposition: The Biological Fate of Chemicals 1998;26(1):73-77.
  3. Combie J, Shults T, Nugent EC, Dougherty J, Tobin T. Pharmacology of narcotic analgesics in the horse: Selective blockade of narcotic-induced locomotor activity. American Journal of Veterinary Research 1981;42(5):716-721.
  4. Court MH, Freytsis M, Wang X, Peter I, Guillemette C, Hazarika S, Duan SX, Greenblatt DJ, Lee WM, Acute Liver Failure Study Group. The UDP-glucuronosyltransferase (UGT) 1A polymorphism c.2042C>G (rs8330) is associated with increased human liver acetaminophen glucuronidation, increased UGT1A exon 5a/5b splice variant mRNA ratio, and decreased risk of unintentional acetaminophen-induced acute liver failure. The Journal of Pharmacology and Experimental Therapeutics 2013;345(2):297-307.
    doi: 10.1124/jpet.112.202010google scholar: lookup
  5. Court MH, Krishnaswamy S, Hao Q, Duan SX, Patten CJ, Von Moltke LL, Greenblatt DJ. Evaluation of 3′-azido-3′-deoxythymidine, morphine, and codeine as probe substrates for UDP-glucuronosyltransferase 2B7 (UGT2B7) in human liver microsomes: Specificity and influence of the UGT2B7*2 polymorphism. Drug Metabolism and Disposition: The Biological Fate of Chemicals 2003;31(9):1125-1133.
    doi: 10.1124/dmd.31.9.1125google scholar: lookup
  6. Dean L, Kane M. Codeine therapy and CYP2D6 genotype. Medical genetics summaries 2012.
  7. Dönselmann Im Sande P, Hopster K, Kästner S. Effects of morphine, butorphanol and levomethadone in different doses on thermal nociceptive thresholds in horses. Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere 2017;45(2):98-106.
    doi: 10.15653/tpg-160655google scholar: lookup
  8. Fda, Cder. Bioanalytical Method Validation Guidance for Industry Biopharmaceutics Bioanalytical Method Validation Guidance for Industry Biopharmaceutics Contains Nonbinding Recommendations. .
  9. Figueiredo JP, Muir WW, Sams R. Cardiorespiratory, gastrointestinal, and analgesic effects of morphine sulfate in conscious healthy horses. American Journal of Veterinary Research 2012;73(6):799-808.
    doi: 10.2460/ajvr.73.6.799google scholar: lookup
  10. Foreman J, Foreman CB. Medical alternatives to conventional cyclo-oxygenase inhibitors for treatment of acute foot pain in a reversiblelameness model in horses. ACVIM Forum 2015.
  11. Gretler SR, Finno CJ, Kass PH, Knych HK. Functional phenotyping of the CYP2D6 probe drug codeine in the horse. BMC Veterinary Research 2021;17(1):77.
  12. Gretler SR, Finno CJ, McKemie DS, Kass PH, Knych HK. Metabolism, pharmacokinetics and selected pharmacodynamic effects of codeine following a single oral administration to horses. Veterinary Anaesthesia and Analgesia 2020;47(5):694-704.
    doi: 10.1016/j.vaa.2020.04.004google scholar: lookup
  13. Hamamoto-Hardman BD, Steffey EP, Weiner D, McKemie DS, Kass P, Knych HK. Pharmacokinetics and selected pharmacodynamics of morphine and its active metabolites in horses after intravenous administration of four doses. Journal of Veterinary Pharmacology and Therapeutics 2019;42(4):401-410.
    doi: 10.1111/jvp.12759google scholar: lookup
  14. Kirchheiner J, Nickchen K, Bauer M, Wong M-L, Licinio J, Roots I, Brockmöller J. Pharmacogenetics of antidepressants and antipsychotics: The contribution of allelic variations to the phenotype of drug response. Molecular Psychiatry 2004;9(5):442-473.
    doi: 10.1038/sj.mp.4001494google scholar: lookup
  15. Klimas R, Mikus G. Morphine-6-glucuronide is responsible for the analgesic effect after morphine administration: A quantitative review of morphine, morphine-6-glucuronide, and morphine-3-glucuronide. British Journal of Anaesthesia 2014;113(6):935-944.
    doi: 10.1093/bja/aeu186google scholar: lookup
  16. Knych HK, Kanarr K, Fang Y, McKemie DS, Kass PH. Characterization of the pharmacokinetics, behavioral effects and effects on thermal nociception of morphine 6-glucuronide and morphine 3-glucuronide in horses. Veterinary Anaesthesia and Analgesia 2022;49:634-644.
  17. Knych HK, Steffey EP, McKemie DS. Preliminary pharmacokinetics of morphine and its major metabolites following intravenous administration of four doses to horses. Journal of Veterinary Pharmacology and Therapeutics 2014;37(4):374-381.
    doi: 10.1111/jvp.12098google scholar: lookup
  18. Knych HK, Stucker K, Gretler SR, Kass PH, McKemie DS. Pharmacokinetics, adverse effects and effects on thermal nociception following administration of three doses of codeine to horses. BMC Veterinary Research 2022;18(1):196.
  19. Krishnaswamy S, Hao Q, Al-Rohaimi A, Hesse LM, von Moltke LL, Greenblatt DJ, Court MH. UDP glucuronosyltransferase (UGT) 1A6 pharmacogenetics: II. Functional impact of the three most common nonsynonymous UGT1A6 polymorphisms (S7A, T181A, and R184S). The Journal of Pharmacology and Experimental Therapeutics 2005;313(3):1340-1346.
    doi: 10.1124/jpet.104.081968google scholar: lookup
  20. KuKanich B. Pharmacokinetics of acetaminophen, codeine, and the codeine metabolites morphine and codeine-6-glucuronide in healthy greyhound dogs. Journal of Veterinary Pharmacology and Therapeutics 2010;33(1):15-21.
  21. KuKanich B. Pharmacokinetics and pharmacodynamics of oral acetaminophen in combination with codeine in healthy greyhound dogs. Journal of Veterinary Pharmacology and Therapeutics 2016;39(5):514-517.
    doi: 10.1111/jvp.12299google scholar: lookup
  22. Lampe JW, Bigler J, Bush AC, Potter JD. Prevalence of polymorphisms in the human UDP-glucuronosyltransferase 2B family: UGT2B4(D458E), UGT2B7(H268Y), and UGT2B15(D85Y). Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology 2000;9(3):329-333.
  23. Lévesque E, Beaulieu M, Hum DW, Bélanger A. Characterization and substrate specificity of UGT2B4 (E458): A UDP-glucuronosyltransferase encoded by a polymorphic gene. Pharmacogenetics 1999;9(2):207-216.
  24. Love EJ, Murrell J, Whay HR. Thermal and mechanical nociceptive threshold testing in horses: A review. Veterinary Anaesthesia and Analgesia 2011;38(1):3-14.
  25. Mazaleuskaya LL, Sangkuhl K, Thorn CF, FitzGerald GA, Altman RB, Klein TE. PharmGKB summary: Pathways of acetaminophen metabolism at the therapeutic versus toxic doses. Pharmacogenetics and Genomics 2015;25(8):416-426.
  26. McGraw J, Gerhardt A, Morris TC. Opportunities and obstacles in genotypic prediction of cytochrome P450 phenotypes. Expert Opinion on Drug Metabolism & Toxicology 2018;14(7):659-661.
  27. Mercer MA, McKenzie HC, Byron CR, Pleasant RS, Bogers SH, Council-Troche RM, Werre SR, Burns T, Davis JL. Pharmacokinetics and clinical efficacy of acetaminophen (paracetamol) in adult horses with mechanically induced lameness. Equine Veterinary Journal 2022.
    doi: 10.1111/evj.13601google scholar: lookup
  28. Mercer MA, McKenzie HC, Davis JL, Wilson KE, Hodgson DR, Cecere TE, McIntosh BJ. Pharmacokinetics and safety of repeated oral dosing of acetaminophen in adult horses. Equine Veterinary Journal 2020;52(1):120-125.
    doi: 10.1111/evj.13112google scholar: lookup
  29. Moore RA, Derry S, Wiffen PJ, Straube S. Effects of food on pharmacokinetics of immediate release oral formulations of aspirin, dipyrone, paracetamol and NSAIDs-A systematic review. British Journal of Clinical Pharmacology 2015;80(3):381-388.
    doi: 10.1111/bcp.12628google scholar: lookup
  30. Reed R, Barletta M, Mitchell K, Hanafi A, Bullington A, Knych H, Quandt J, Ryan C, Giguère S. The pharmacokinetics and pharmacodynamics of intravenous hydromorphone in horses. Veterinary Anaesthesia and Analgesia 2019;46(3):395-404.
    doi: 10.1016/j.vaa.2018.11.001google scholar: lookup
  31. Romberg R, van Dorp E, Hollander J, Kruit M, Binning A, Smith T, Dahan A. A randomized, double-blind, placebo-controlled pilot study of IV morphine-6-glucuronide for postoperative pain relief after knee replacement surgery. The Clinical Journal of Pain 2007;23(3):197-203.
  32. Söbbeler FJ, Kästner SB. Effects of transdermal lidocaine or lidocaine with prilocaine or tetracaine on mechanical superficial sensation and nociceptive thermal thresholds in horses. Veterinary Anaesthesia and Analgesia 2018;45(2):227-233.
    doi: 10.1016/j.vaa.2017.10.003google scholar: lookup
  33. Stain F, Barjavel MJ, Sandouk P, Plotkine M, Scherrmann JM, Bhargava HN. Analgesic response and plasma and brain extracellular fluid pharmacokinetics of morphine and morphine-6-beta-D-glucuronide in the rat. Journal of Pharmacology and Experimental Therapeutics 1995;274(2):852-857.
  34. Tavanaeimanesh H, Azarnoosh A, Ashar FS, Dehghan MM, Mohebbi Z, Akbarinejad V, Corley K. Comparison of analgesic effects of a constant rate infusion of both tramadol and acetaminophen versus those of infusions of each individual drug in horses. Journal of Equine Veterinary Science 2018;64:101-106.
  35. van Dorp ELA, Romberg R, Sarton E, Bovill JG, Dahan A. Morphine-6-glucuronide: Morphine's successor for postoperative pain relief?. Anesthesia and Analgesia 2006;102(6):1789-1797.
  36. Zhao L, Pickering G. Paracetamol metabolism and related genetic differences. Drug Metabolism Reviews 2011;43(1):41-52.

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