How is hydromorphone metabolized and excreted?

How is hydromorphone metabolized and excreted?

• A. Metabolized in the liver to an active metabolite and excreted renally.
• B. Primarily eliminated unchanged by the kidneys.
• C. Metabolized in the liver via CYP system to hydromorphone-3-glucuronide (inactive) and excreted by the kidneys.
• D. Excreted primarily via the biliary system.

Answer: (C)

Hydromorphone is cleared mainly by hepatic conjugation to a glucuronide and then excreted by the kidneys. The liver attaches glucuronic acid to form hydromorphone-3-glucuronide, an inactive metabolite, which is predominantly eliminated in the urine. This renal excretion of the glucuronide (and some of the parent drug) is the primary route, with biliary excretion not being the main pathway. Therefore, the major point is hepatic glucuronidation to an inactive metabolite followed by renal excretion. The other statements don’t fit this pattern: no unchanged drug is the primary renal excretion route, biliary excretion isn’t the main route, and metabolism to an active metabolite isn’t the characteristic pathway for hydromorphone.

Hydromorphone is cleared mainly by hepatic conjugation to a glucuronide and then excreted by the kidneys. The liver attaches glucuronic acid to form hydromorphone-3-glucuronide, an inactive metabolite, which is predominantly eliminated in the urine. This renal excretion of the glucuronide (and some of the parent drug) is the primary route, with biliary excretion not being the main pathway. Therefore, the major point is hepatic glucuronidation to an inactive metabolite followed by renal excretion. The other statements don’t fit this pattern: no unchanged drug is the primary renal excretion route, biliary excretion isn’t the main route, and metabolism to an active metabolite isn’t the characteristic pathway for hydromorphone.