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Ou LB, Azoulay L, Reynier P, Platt RW, Yoon S, Grad R, Filion KB. Tramadol versus codeine and the short-term risk of cardiovascular events in patients with non-cancer pain: A population-based cohort study. Br J Clin Pharmacol 2021; 88:1824-1834. [PMID: 34599613 DOI: 10.1111/bcp.15099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/30/2021] [Accepted: 09/13/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS The effect of tramadol on the cardiovascular system is largely unknown. There is concern that, with its multimodal mechanism of action to increase serotonin and norepinephrine levels in the body, it could increase the risk of arterial ischaemia and cardiovascular events. We aimed to compare the short-term risk of cardiovascular events with the use of tramadol to that of codeine among patients with non-cancer pain. METHODS We conducted a retrospective population-based cohort study using data from the Clinical Practice Research Datalink (CPRD) with new users of tramadol or codeine from April 1998 to March 2017. Exposure was defined using an approach analogous to an intention-to-treat, with a maximum follow-up of 30 days. The primary endpoint was myocardial infarction, and secondary endpoints were unstable angina, ischaemic stroke, coronary revascularization, cardiovascular death and all-cause mortality. Hazard ratios (HRs) were estimated using Cox proportional hazards models, adjusted for high-dimensional propensity score. RESULTS The final cohort included 123 394 tramadol users and 914 333 codeine users. When tramadol was compared to codeine, the adjusted hazard ratio (HR) of myocardial infarction was 1.00 (95% CI 0.81-1.24). There was also no evidence of elevated risks of unstable angina (0.92; 95% CI 0.67-1.27), ischaemic stroke (0.98; 95% CI 0.82-1.17), coronary revascularization (0.97; 95% CI 0.69-1.38), cardiovascular death (1.07; 95% CI 0.93-1.23) or all-cause mortality (1.03; 95% CI 0.94-1.14) when tramadol was compared to codeine. CONCLUSIONS Short-term use of tramadol, compared with codeine, was not associated with an increased risk of cardiac events among patients with non-cancer pain.
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Affiliation(s)
- Linda B Ou
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Centre of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Laurent Azoulay
- Centre of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada
| | - Pauline Reynier
- Centre of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Robert W Platt
- Centre of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Sarah Yoon
- Centre of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Kristian B Filion
- Centre of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
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2
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De Canecaude C, Rousseau V, Sommet A, Montastruc JL. Tramadol-induced hypoglycemia: A pharmacovigilance study. Fundam Clin Pharmacol 2021; 35:933-936. [PMID: 33511683 DOI: 10.1111/fcp.12655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 12/01/2022]
Abstract
Several papers have reported that tramadol can induce hypoglycemia. However, in some reports, confounding factors can be found, like coadministration of hypoglycemic drugs. We used the WHO pharmacovigilance database (VigiBase®) to investigate whether tramadol alone could be associated with hypoglycemia. All 2010–2019 ICSRs (Individual Case Safety Reports) with the PT term “hypoglycemia” and tramadol were included. Two disproportionality analyses were performed: 1/after inclusion of all reports, 2/after exclusion of concomitant hypoglycemic drugs. Results are expressed as Reporting Odds Ratios (ROR; 95% CI). Among 10 038 436 ICSRs, 97 639 were included. In comparison with codeine, a significant association was found between tramadol use and reports of hypoglycemia before [ROR = 1.54 (1.43–1.66)] or after [ROR = 1.43 (1.31–1.56)] exclusion of hypoglycemic drugs. Tramadol use is associated with a higher risk of hypoglycemia reports than codeine, the other step 2 analgesic, in the presence as well as in the absence of other hypoglycemic drugs. We concluded that hypoglycemia is an adverse drug reaction of tramadol, which can be observed in diabetic as well as in non-diabetic patients.
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Affiliation(s)
- Claire De Canecaude
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM 1436, Faculté de Médecine, Centre Hospitalier Universitaire, Toulouse, France
| | - Vanessa Rousseau
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM 1436, Faculté de Médecine, Centre Hospitalier Universitaire, Toulouse, France
| | - Agnès Sommet
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM 1436, Faculté de Médecine, Centre Hospitalier Universitaire, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM 1436, Faculté de Médecine, Centre Hospitalier Universitaire, Toulouse, France
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3
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Juba KM, van Manen RP, Fellows SE. A Review of the Food and Drug Administration Adverse Event Reporting System for Tramadol-Related Hypoglycemia. Ann Pharmacother 2019; 54:247-253. [PMID: 31648533 DOI: 10.1177/1060028019885643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Hypoglycemia is a rare adverse effect of tramadol that is described in the medical literature and package insert. Objective: The purpose of this study was to review reports of tramadol and hypoglycemia in the Food and Drug Administration Adverse Event Reporting System (FAERS) database to determine a potential association. Methods: Disproportionality analysis with Bayesian correction was used to compare tramadol and hypoglycemia with other medications in FAERS. The results were considered significant if the fifth percentile of the Empirical Bayesian geometric mean distribution (EB05) >2. Logistic regression odds ratios was used to determine if age, diabetes medications, and renal insufficiency masked the disproportionality of hypoglycemia, with the fifth percentile of the logistic regression odds ratio (LR05) >2 indicating a potential signal. The Interaction Signal Score (INTSS) was computed to determine the influence of predisposing risk factors on the signal. Results: A total of 605 cases of tramadol-associated hypoglycemia were reported, but our results were not significant (EB05: 1.590). Tramadol-associated hypoglycemia was significant in patients who did not take diabetes medications (EB05: 2.256; LR05: 2.2104). Renal insufficiency was not found to increase the risk of tramadol-associated hypoglycemia (INTSS: 0.865). There was a significant signal for tramadol-associated hypoglycemia in patients aged 0 to 1 year (LR05: 3.0240) and 2 to 4 years (LR05: 2.6853). Conclusion and Relevance: Results of our analysis suggest a potential signal between hypoglycemia and tramadol use in patients not taking diabetes medications. Our results do not support a predisposition for tramadol-associated hypoglycemia in patients with renal insufficiency, increasing age, and/or diabetes as noted in the tramadol package insert.
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Samper Bernal D, Alvarado Bonilla A, Cánovas L, Carregal A, Fernández Sánchez SP, González Mesa JM, Guillén Astete C, Loscos López A, Lozano Martínez AJ, Pérez-Castejón JM, Romero-Cullerés G, Salido de Andrés E. [Consensus statement on the use of acetaminophen/tramadol in patients with moderate-severe pain]. Semergen 2019; 45:52-62. [PMID: 30686297 DOI: 10.1016/j.semerg.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/03/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To present recommendations on the use of the paracetamol/tramadol (P/T) combination in patients with moderate-intense pain based on best evidence and experience. METHODS The method of nominal groups and Delphi was followed, and supported by a systematic literature review (SLR). A multidisciplinary panel of 12 experts in pain management was selected. In the first nominal group meeting, the aim, scope, users, and sections of the consensus document, were defined, along with the preliminary general recommendations. For the SLR, the inclusion and exclusion criteria, as well as the search strategies, were defined. Two reviewers selected and analysed the articles. This evidence was discussed in a second nominal group meeting, and definitive recommendations were developed. For each recommendation, the evidence levels and grade of recommendation grades were classified according to the Oxford model, and the grade according to the Delphi technique. It was defined as an agreement if at least 70% of the participants scored ≥7 for each recommendation (1=total disagreement to 10=total agreement). RESULTS A total of 20 recommendations were produced, which covered general aspects, such as the assessment of pain, and those specific to P/T management. These latter included the indications of the P/T combination (patient profile, dosing, prescription, formulations), risk management (contraindications, precautions, interactions, concomitant use with other medications, follow-up, special situations), and patient education. CONCLUSIONS These recommendations attempt to resolve any of the routine clinical questions, and help in the making of decisions on the use of the P/T combination in patients with moderate-intense pain.
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Affiliation(s)
- D Samper Bernal
- Servicio Anestesia, Clínica del Dolor, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
| | - A Alvarado Bonilla
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Jerez de la Frontera, Jerez de la Frontera, Cádiz, España
| | - L Cánovas
- Unidad del Dolor, Servicio de Anestesia, Complexo Hospitalario Universitario de Ourense, Orense, España
| | - A Carregal
- Unidad del Dolor, Servicio de Anestesia, Complexo Hospitalario Universitario de Vigo, Vigo, España
| | | | - J M González Mesa
- Unidad del Dolor, Hospital Clínico Virgen de la Victoria, Málaga, España
| | - C Guillén Astete
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A Loscos López
- Servicio de Urgencias, Hospital Arnau de Vilanova, Valencia, España
| | - A J Lozano Martínez
- Servicio de Oncología Radioterápica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - J M Pérez-Castejón
- Servicio de Geriatría y Cuidados Paliativos de Badalona Servicios Asistenciales (BSA). Centro Sociosanitario El Carme, Badalona, Barcelona, España
| | - G Romero-Cullerés
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Fundación Althaia. Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC) y Universitat Internacional de Catalunya (UIC), Manresa, Barcelona, España
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Combier A, Bon L, Van Ganse E, Aubrun F, Letrilliart L. Perceptions of French general practitioners and patients regarding dextropropoxyphene withdrawal: a qualitative study. BMJ Open 2018; 8:e021582. [PMID: 30244207 PMCID: PMC6157533 DOI: 10.1136/bmjopen-2018-021582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Dextropropoxyphene (DXP), a step 2 analgesic commonly prescribed in France, was withdrawn from the French market in 2011 following a European decision due to its poor risk-benefit ratio. The purpose of this study was to explore the perceptions of French general practitioners (GPs) and patients regarding DXP withdrawal. DESIGN Qualitative study based on 26 individual semi-structured interviews. SETTING Rhône-Alpes region of France. PARTICIPANTS Thirteen patients and 13 GPs. METHODS Interviews were conducted to collect data concerning the status of DXP, its efficacy and safety, the conditions of DXP's withdrawal and its potential impact. The transcripts were analysed using NVivo software. RESULTS DXP was a very popular drug among both patients and GPs. Its withdrawal was a bad experience for patients and many GPs; these misunderstood the reasons for its withdrawal and several contested them. They generally recognised more benefits than risks of DXP and considered alternative drugs unsatisfactory. In the same period, a French court case regarding another drug led to distrust towards the pharmaceutical industry and healthcare institutions, which contributed to the negative feelings reported. However, the experience was positive for the GPs who had been alerted to the poor DXP risk-benefit ratio well before its withdrawal. CONCLUSIONS Apart from physicians who were previously informed of its poor risk-benefit ratio, DXP withdrawal was not a good experience for patients and GPs. Better anticipation by the health authorities, in terms of pharmacoepidemiological surveillance and communication to healthcare professionals as well as the general public, should provide better acceptance of such a decision in the future.
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Affiliation(s)
- Aurélie Combier
- Collège universitaire de médecine générale, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
| | - Lucile Bon
- Collège universitaire de médecine générale, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
| | - Eric Van Ganse
- Faculté d’odontologie, Université Claude-Bernard-Lyon 1, UMR CNRS 5558, Lyon, France
- Groupe hospitalier Nord-hôpital de la Croix-Rousse, service de pneumologie, Hospices Civils de Lyon, CHU de Lyon, Lyon, France
- HESPER EA 7425, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
| | - Frédéric Aubrun
- Groupe hospitalier Nord-hôpital de la Croix-Rousse, service de pneumologie, Hospices Civils de Lyon, CHU de Lyon, Lyon, France
- HESPER EA 7425, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
- Department of Anesthesiology and Critical Care, Hospices Civils de Lyon, Lyon, France
| | - Laurent Letrilliart
- Collège universitaire de médecine générale, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
- HESPER EA 7425, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
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Van Ganse E, Belhassen M, Ginoux M, Chrétien E, Cornu C, Ecoffey C, Aubrun F. Use of analgesics in France, following dextropropoxyphene withdrawal. BMC Health Serv Res 2018; 18:231. [PMID: 29609613 PMCID: PMC5880096 DOI: 10.1186/s12913-018-3058-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 03/23/2018] [Indexed: 12/05/2022] Open
Abstract
Background In 2009, the European Medicines Agency recommended withdrawal of dextropropoxyphene (DXP); in March 2011 it was withdrawn from the market in France. Up until that time the combination dextropropoxyphene-paracetamol (DXP/PC) was widely used for analgesia. At withdrawal, French regulators recommended that DXP/PC be replaced by other step 2 analgesics, i.e. tramadol, codeine, or opium-containing drugs, or by PC for a weak level of pain. To investigate prescribing behaviours after DXP/PC withdrawal, dispensations of analgesics before and after withdrawal were analysed. Methods Aggregated dispensation data of analgesics prescribed between January 2009 and December 2012 in the Rhône-Alpes region were obtained from the general health insurance claims data; changes in analgesic dispensation over time were analysed with the ATC/DDD methodology. Pre (Jan-June 2009) and post-withdrawal (Jan-June 2012) changes of DDDs where computed for each analgesic step. Results The dispensations of DXP/PC experienced a two-step decrease until 2011. Over the withdrawal period 2009-2012, there was a 14% decrease in the overall use of analgesic (from 109 to 94 DDDs), while the use of step 2 analgesics declined by 46% (− 22 DDDs, from 47 to 25 DDDs). This latter decline included a cessation of use of DXP/PC (29 DDDs in 2009) that were only in part (+ 7 DDDs, from 18 to 25 DDDs) compensated by increased use of codeine, tramadol and opium, in monotherapy or combined with PC. For step 1 analgesics, use increased with 9%, mostly PC (+ 8 DDDs, from 31 to 39 DDDs). Step 3 analgesics dispensations remained largely unchanged over this period (around 3 DDDs). Conclusions In the Rhône-Alpes region, DXP/PC withdrawal was accompanied in part by an increased use of same level analgesics, and in part by an increased use of PC in monotherapy. The extent of DXP/PC use before withdrawal, and the increased use of PC after DXP withdrawal, underline the complexity of pain management.
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Affiliation(s)
- E Van Ganse
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France. .,PELyon, PharmacoEpidemiologie Lyon, Lyon, France. .,Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.
| | - M Belhassen
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,PELyon, PharmacoEpidemiologie Lyon, Lyon, France
| | - M Ginoux
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,PELyon, PharmacoEpidemiologie Lyon, Lyon, France
| | - E Chrétien
- Department of Anesthesiology and Critical Care, Croix Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - C Cornu
- UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Claude Bernard University, CNRS, Lyon, France.,Louis Pradel Hospital, Lyon University, Lyon, France INSERM Clinical Investigation Centre (CIC1407), Lyon, France
| | - C Ecoffey
- Department of Anaesthesiology and Critical Care, Ponchaillou University Hospital, CIC Inserm, Rennes, France
| | - F Aubrun
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,Department of Anesthesiology and Critical Care, Croix Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
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Svendsen K, Halvorsen KH, Vorren S, Samdal H, Garcia B. Adverse drug reaction reporting: how can drug consumption information add to analyses using spontaneous reports? Eur J Clin Pharmacol 2017; 74:497-504. [DOI: 10.1007/s00228-017-2396-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
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8
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Bounes V, Charriton-Dadone B, Levraut J, Delangue C, Carpentier F, Mary-Chalon S, Houze-Cerfon V, Sommet A, Houze-Cerfon CH, Ganetsky M. Predicting morphine related side effects in the ED: An international cohort study. Am J Emerg Med 2016; 35:531-535. [PMID: 28117179 DOI: 10.1016/j.ajem.2016.11.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/25/2016] [Accepted: 11/28/2016] [Indexed: 11/18/2022] Open
Abstract
STUDY OBJECTIVES Morphine is the reference treatment for severe acute pain in an emergency department. The purpose of this study was to describe and analyse opioid-related ADRs (adverse drug reactions) in a large cohort of emergency department patients, and to identify predictive factors for those ADRs. METHODS In this prospective, observational, pharmaco-epidemiological international cohort study, all patients aged 18years or older who were treated with morphine were enrolled. The study was done in 23 emergency departments in the US and France. Baseline numerical rating scale score and initial and total doses of morphine titration were recorded. Logistic regression analysis was used to study the effects of demographic, clinical and medical history covariates on the occurrence of opioid-induced ADRs within 6h after treatment. RESULTS A total of 1128 patients were included over 10months. Median baseline initial pain scores were 8/10 (7-10) versus 3/10 (1-4) after morphine administration. Median titration duration was 10min (IQR, 1-30). The occurrence of opioid-induced ADRs was 25% and 2% were serious. Patients experienced mainly nausea and drowsiness. Medical history of travel sickness (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.01-2.86) and history of nausea or vomiting post morphine (OR, 3.86; 95% CI, 2.29-6.51) were independent predictors of morphine related ADRs. CONCLUSION Serious morphine related ADRs are rare and unpredictable. Prophylactic antiemetic therapy could be proposed to patients with history of travel sickness and history of nausea or vomiting in a postoperative setting or after morphine administration.
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Affiliation(s)
- Vincent Bounes
- Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059 Cedex 9, France; INSERM UMR 1027, Université Paul Sabatier, Toulouse 31000, France.
| | | | - Jacques Levraut
- Pôle Médecine d'Urgence, Hôpital Universitaire de Nice, Nice 06000, France
| | - Cyril Delangue
- Service d'Accueil des Urgences, Centre Hospitalier de Dunkerque, Dunkerque 59385, France
| | - Françoise Carpentier
- Pôle Urgences Médecine Aigüe, Hôpital Universitaire des Alpes, Grenoble 38043 Cedex 9, France
| | - Stéphanie Mary-Chalon
- Pôle Médecine d'Urgence, Centre Hospitalier Comminges Pyrénées, Saint-Gaudens 31806, France
| | - Vanessa Houze-Cerfon
- Pôle Médecine d'Urgence, Hôpitaux Universitaires de Toulouse, Toulouse 31059 Cedex 9, France
| | - Agnès Sommet
- Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmaco-épidémiologie et d'Informations sur e médicament, Hôpital Universitaire de Toulouse, Toulouse 31059 Cedex 9, France
| | | | - Michael Ganetsky
- Department of Emergency Medicine Administrative Offices, West CC-2, Beth Israel Deaconess Medical Center, 1 Deaconess Place, Boston, MA 02215, USA
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Becquemont L, Delespierre T, Bauduceau B, Benattar-Zibi L, Berrut G, Corruble E, Danchin N, Derumeaux G, Doucet J, Falissard B, Forette F, Hanon O, Pasquier F, Pinget M, Ourabah R, Bucher S, Lazkani A, Piedvache C, Bertin P. Consequences of dextropropoxyphene market withdrawal in elderly patients with chronic pain. Eur J Clin Pharmacol 2014; 70:1237-42. [DOI: 10.1007/s00228-014-1722-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022]
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10
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Fuzier R, Serres I, Bourrel R, Palmaro A, Montastruc JL, Lapeyre-Mestre M. Analgesic drug consumption increases after knee arthroplasty: A pharmacoepidemiological study investigating postoperative pain. Pain 2014; 155:1339-1345. [DOI: 10.1016/j.pain.2014.04.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 04/04/2014] [Accepted: 04/07/2014] [Indexed: 11/30/2022]
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Karahan S, Karagöz H, Erden A, Avcı D, Esmeray K. Codeine-induced syndrome of inappropriate antidiuretic hormone: case report. Balkan Med J 2014; 31:107-9. [PMID: 25207179 DOI: 10.5152/balkanmedj.2013.9424] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/26/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The syndrome of inappropriate antidiuretic hormone was first described in 1957 by Schwartz, and is characterised by hyponatraemia, inappropriately increased urine osmolality and urine sodium, and decreased serum osmolality in a euvolemic patient without edema. A patient with the syndrome of inappropriate antidiuretic hormone should have normal cardiac, renal, adrenal, hepatic, and thyroid functions and should not take any diuretics. CASE REPORT We present a case of the syndrome of inappropriate antidiuretic hormone caused by codeine and associated with reduced urine volume, increased urine sodium, and decreased serum sodium concentration. CONCLUSION The syndrome of inappropriate antidiuretic hormone is a disease that can lead to morbidity and even mortality. Clinicians should measure serum electrolytes intermittently in order to avoid missing the diagnosis of the syndrome of inappropriate antidiuretic hormone in patients using opioid.
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Affiliation(s)
- Samet Karahan
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Hatice Karagöz
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Abdulsamet Erden
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Deniz Avcı
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Kübra Esmeray
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
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Klose J, Fröhling S, Kroth E, Dobmeyer T, Nolting A. Safety Information From Spontaneous and Literature Adverse Reaction Reports: A Comparison. Ther Innov Regul Sci 2013; 47:248-255. [PMID: 30227524 DOI: 10.1177/0092861512463920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Marketing authorization holders should report adverse drug reactions (ADRs) derived from spontaneous case reports and literature for their medicinal products to competent authorities. Yet the difference in quality of data from both sources has never been analyzed. To this end, YES Pharmaceutical Development Services in cooperation with the German Medicines Manufacturers Association has conducted an analysis examining more than 25,100 spontaneous and literature cases that occurred between 2007 and 2008. Reporting rates of ADRs for specific drug substances (DSs), expectedness, and the system organ class (SOC) referred to were examined. It was found that the distribution of ADRs to specific SOCs differs between both groups for selected DSs. For more than 37% of the DSs being evaluated, a difference of 10% or more regarding reporting rates of unexpected ADRs was observed between both groups. These findings underline the substantial importance of regular literature reviews in addition to the spontaneous reporting system for a sufficient safety assessment of medicinal products.
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Affiliation(s)
- Janine Klose
- 1 YES Pharmaceutical Development Services GmbH, Friedrichsdorf, Germany
| | - Simone Fröhling
- 1 YES Pharmaceutical Development Services GmbH, Friedrichsdorf, Germany
| | - Elmar Kroth
- 2 Bundesverband der Arzneimittel-Hersteller e.V., Bonn, Germany
| | - Thomas Dobmeyer
- 1 YES Pharmaceutical Development Services GmbH, Friedrichsdorf, Germany
| | - Axel Nolting
- 1 YES Pharmaceutical Development Services GmbH, Friedrichsdorf, Germany
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Cudennec T, Goëau-Brissonnière O, Coscas R, Capdevila C, Moulias S, Coggia M, Teillet L. Delirium in elderly vascular surgery patients. Ann Vasc Surg 2013; 28:781-6. [PMID: 24216404 DOI: 10.1016/j.avsg.2013.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 11/28/2022]
Abstract
The elderly represent a large percentage of patients seen in departments of vascular surgery. Delirium is a frequent perioperative complication in this population and contributes to increased morbidity and mortality. Prevention of problems associated with mental confusion rests in identifying comorbidities, their severity, and the risk factors associated with delirium syndrome. The aging of our population implies management of increasing numbers of older patients who often have concomitant pathologies and, consequently, polypharmacy. Optimization of their management rests on collaboration between surgeons, anesthetists, and geriatrists.
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Affiliation(s)
- Tristan Cudennec
- Department of Geriatrics, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt (92), and Versailles Saint-Quentin en Yvelines University, Versailles, France.
| | - Olivier Goëau-Brissonnière
- Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt (92), and Versailles Saint-Quentin en Yvelines University, Versailles, France
| | - Raphaël Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt (92), and Versailles Saint-Quentin en Yvelines University, Versailles, France
| | - Clément Capdevila
- Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt (92), and Versailles Saint-Quentin en Yvelines University, Versailles, France
| | - Sophi Moulias
- Department of Geriatrics, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt (92), and Versailles Saint-Quentin en Yvelines University, Versailles, France
| | - Marc Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt (92), and Versailles Saint-Quentin en Yvelines University, Versailles, France
| | - Laurent Teillet
- Department of Geriatrics, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt (92), and Versailles Saint-Quentin en Yvelines University, Versailles, France
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Bourne C, Gouraud A, Daveluy A, Grandvuillemin A, Auriche P, Descotes J, Vial T. Tramadol and hypoglycaemia: comparison with other step 2 analgesic drugs. Br J Clin Pharmacol 2013; 75:1063-7. [PMID: 22943675 DOI: 10.1111/j.1365-2125.2012.04451.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/28/2012] [Indexed: 12/23/2022] Open
Abstract
AIMS The risk of hypoglycaemia with tramadol (TRM) is not well described. Our aim was to analyze spontaneous reports of hypoglycaemia registered in the French Pharmacovigilance database and to compare these data with two other step-2 analgesic drugs. METHODS Cases of hypoglycaemia associated with TRM, dextropropoxyphene (DXP) and codeine (COD) recorded between 1997 and November 2010 in the French pharmacovigilance database were compared. RESULTS Seventy-two cases of hypoglycaemia associated with DXP and 43 with TRM were retained for evaluation (the single case reported with COD was not further considered). Most patients were elderly people with no significant difference in age between DXP- and TRM-treated patients (71.2 ± 21 vs. 69.4 ± 22.5 years). Hypoglycaemia occurred after a median of 4 and 5 days with DXP and TRM treatment, respectively. The mean lowest serum glucose concentration was 2.1 ± 0.9 mmol l(-1) in the DXP group compared with 2.5 ± 1 mmol l(-1) in the TRM group (P = 0.072). At least, one risk factor of hypoglycaemia was found in most patients, with no significant difference between groups (58.3% in the DXP group and 58.1% in the TRM group). In particular, 31.9% patients from the DXP group had diabetes compared with 41.8 % from the TRM group (P = 0.28) and 18% of DXP patients had renal insufficiency compared with 16.3% of TRM patients (P = 0.8). CONCLUSIONS Our study confirms that TRM is associated with the occurrence of hypoglycaemia in elderly or predisposed patients, with characteristics similar to those previously reported with DXP.
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Abadie D, Durrieu G, Roussin A, Montastruc JL. ["Serious" adverse drug reactions with tramadol: a 2010-2011 pharmacovigilance survey in France]. Therapie 2013; 68:77-84. [PMID: 23773348 DOI: 10.2515/therapie/2013021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/15/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Tramadol is a weak opioid used as a step 2 analgesic, approved in France for moderate to severe pain. After dextropropoxyphene withdrawal, a national pharmacovigilance follow-up of tramadol was decided by the French Drug Agency. METHODS All Serious Adverse Drug Reactions (SADR) notified with tramadol to the French PharmacoVigilance Centres (CRPV) and pharmaceutical companies between August 1(st), 2010 and July 31(th), 2011 were analyzed. RESULTS During the study period, 296 cases of SADR were notified to CRPV and 59 to pharmaceutical companies. Apart from opiate-related SADR, tramadol induced serotoninergic SADR, including seizures or serotoninergic syndromes. Several « unlabelled » SADR were also identified: some of them, like hyponatremia or hypoglycemia, are poorly known by health professionals. Other were never published: peripheral edema or pancreatitis. CONCLUSION This study shows that besides well-known opioid or serotoninergic ADR, tramadol can also induce 2 other relatively unknown ADR: hypoglycemia and hyponatremia.
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Affiliation(s)
- Delphine Abadie
- Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, et Centre Midi-Pyrénées d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance, Université de Toulouse, Faculté de Médecine, Centre hospitalier universitaire, Toulouse, France.
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Fuzier R, Serres I, Guitton E, Lapeyre-Mestre M, Montastruc JL. Adverse drug reactions to gabapentin and pregabalin: a review of the French pharmacovigilance database. Drug Saf 2013; 36:55-62. [PMID: 23315296 DOI: 10.1007/s40264-012-0006-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gabapentin and pregabalin are widely used as antineuropathic pain drugs. Their use is also associated with the development of adverse drug reactions (ADRs), mainly neuropsychiatric. OBJECTIVE The aim of this work was to study 'serious' and/or 'unexpected' adverse reactions associated with pregabalin and gabapentin. STUDY DESIGN We studied ADRs reported to the French Pharmacovigilance System occurring between 1995 and 2009. MAIN OUTCOME MEASURE For each ADR associated with gabapentin or pregabalin, we noted year, patient age and sex, type of adverse reaction, as well as the imputability score. Reporting rate of serious ADRs for gabapentin and pregabalin was estimated with regard to data of use (obtained from the French National Health Insurance Fund) using the defined daily dose. A global and descriptive analysis of the adverse reactions for each drug is presented. Secondly, details of deaths and ADRs with an imputability score of at least 'probable' or 'likely' were presented. RESULTS Overall, 1333 cases were recorded (725 related to gabapentin, 608 related to pregabalin), mainly neuropsychiatric ADRs. Among the 22 deaths recorded, 8 were related to gabapentin in obstetrical situations. Other less well-documented ADRs were identified, such as hepatitis associated with gabapentin and haematological ADRs associated with pregabalin. CONCLUSION This study confirmed the prevalence of neuropsychiatric ADRs associated with gabapentin or pregabalin. A high rate of death occurred with gabapentin in an obstetrical context. New adverse reactions have been noted, such as haematological or hepatic adverse reactions associated with pregabalin and gabapentin, respectively.
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Affiliation(s)
- Régis Fuzier
- Pharmacoepidemiology Research Unit, INSERM 1027, University of Toulouse, and Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.
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Drugs associated with restless legs syndrome: a case/noncase study in the French Pharmacovigilance Database. J Clin Psychopharmacol 2012; 32:824-7. [PMID: 23131889 DOI: 10.1097/jcp.0b013e318272cdd8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several case reports have suggested that drugs could induce restless legs syndrome. However, no systematic review of this adverse drug reaction (ADR) in a pharmacovigilance database has been published. OBJECTIVE To assess the frequency of restless legs syndrome in the French Pharmacovigilance Database. METHODS We selected all ADR reports from January 1, 1984 to December 31, 2009 coded as restless legs syndrome. Restless legs syndrome diagnosis was validated from case descriptions. Using a case/noncase approach, reporting odds ratio and 95% confidence interval were calculated for "suspected'' drugs with 2 or more observations. RESULTS Twenty-six ADR reports were found. Four cases were excluded because of alternative diagnosis. Fourteen cases were women (64%). Median age was 57. Most frequently suspected drugs were antidepressants (reporting odds ratio, 15.9 [6.4-39.7]; amitriptyline, escitalopram, mianserine, mirtazapine, duloxetine), neuroleptics (17.8 [6.1-51.7]; thioridazine, loxapine, risperidone, aripiprazole) or tramadol (18.2 [6.3-52.8]). CONCLUSIONS Restless legs syndrome is a very rare ADR that was more frequently reported in association with antidepressants, neuroleptics, or tramadol.
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Bismuth S, Leng EL, Oustric S, Montastruc JL, Lapeyre-Mestre M. Quel(s) antalgique(s) après le retrait du dextropropoxyphène ? Enquête auprès de médecins généralistes de la région Midi-Pyrénées. Therapie 2011; 66:25-8. [DOI: 10.2515/therapie/2011004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 12/13/2010] [Indexed: 11/20/2022]
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Perez-Lloret S, Bondon-Guitton E, Rascol O, Montastruc JL. Adverse drug reactions to dopamine agonists: A comparative study in the french pharmacovigilance database. Mov Disord 2010; 25:1876-80. [DOI: 10.1002/mds.23204] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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