Opioid peptides and primary biliary cirrhosis
Open accessAbstract
Patients with liver disease have increased plasma concentrations of the endogenous opioid peptides methionine enkephalin and leucine enkephalin. As an initial investigation to determine whether opioid peptides contribute to any of the clinical manifestations of hepatic disease nalmefene, a specific opioid antagonist devoid of agonist activity, was given to 11 patients with cirrhosis. They all experienced a severe opioid withdrawal reaction on starting the drug. In the nine patients with primary biliary cirrhosis pruritus was greatly alleviated, fatigue seemed to improve, and plasma bilirubin concentration, which had been rising, showed a modest fall in all except one patient. These results indicate that blocking opioid receptors has an effect on some of the metabolic abnormalities of liver disease.
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Patients with high opioidergic tone may experience an opiate withdrawal-like reaction to opioid antagonists, characterized by abdominal pain, high blood pressure, tachycardia, goose bumps, nightmares, and depersonalization.
“Patients with high opioidergic tone may experience an opiate withdrawal-like reaction to opioid antagonists, characterized by abdominal pain, high blood pressure, tachycardia, goose bumps, nightmares, and depersonalization.(201)(202)(203)(204)”
From Primary Biliary Cholangitis: 2018 Practice Guidance from the American Association for the Study of Liver Diseases (2019) · cites this paper as [202]
The Discussion (p. 1502) describes an apparent withdrawal reaction after opioid antagonism in patients with raised opioid-peptide concentrations, including abdominal pain and increased arterial pressure. It explicitly says these patients had relative bradycardia, not tachycardia. The Results (p. 1502) do not report goose bumps, nightmares, or depersonalization. (LLM, conf=0.89)
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- Authors
- Thornton, J. R., & Losowsky, M. S.
- Affiliations
- St James's University Hospital (GB)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1988-12-10
- Volume
- 297
- Issue
- 6662
- Pages
- 1501-1504
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1835218
- OpenAlex
- W1983148582
- Cited by
- 300
- References
- 31
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 3 · 2019: 7 · 2018: 5 · 2017: 6 · 2016: 5 · 2015: 7 · 2014: 6 · 2013: 7 · 2012: 6
- FWCI
- 3.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuropeptides and Animal Physiology
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- opioid peptides, primary biliary cirrhosis, met-enkephalin, leu-enkephalin, nalmefene, opioid antagonism, opioid withdrawal, pruritus, fatigue, hyperbilirubinemia, liver disease
- MeSH terms
- Adult, Aged, Bilirubin, Fatigue, Female, Humans, Liver Cirrhosis, Biliary, Male, Middle Aged, Naltrexone, Narcotic Antagonists, Pruritus, Substance Withdrawal Syndrome
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