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Chu F, Yao Y, Gao B, Huang M, Kong L. Incidence and risk factors for potential drug-drug interactions in outpatients receiving opioid analgesics. Expert Opin Drug Saf 2024:1-9. [PMID: 38641999 DOI: 10.1080/14740338.2024.2346101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/19/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Opioids are the most frequently used drugs to treat pain in cancer patients. However opioid analgesics can cause adverse effects and potential drug-drug interaction. RESEARCH DESIGN AND METHODS This cross-sectional retrospective study analyzed pDDI in 1839 patients with opioid analgesics in a large comprehensive hospital in China from January 1 to 31 December 2022. Three drug interaction databases were used to screen for pDDI including Drugs (U.S.A.), Medscape (U.S.A.), and Drug Assistant of Dingxiangyuan (China). RESULTS The prevalence of pDDIs among 1839 patients was around 41.27% of 759 patients, and 564 patients (74.31%) with pDDIs were diagnosed with tumor. Further, the total of 275 various pDDIs combinations were identified. The combination of oxycodone with morphine had the most frequent occurrence of 229 times, and its adverse effects mainly related to exacerbate central respiratory depression. While, gender, tumor, number of diagnoses, and the variety of opioid analgesics used were independent risk factors for pDDIs. CONCLUSIONS Outpatients taking opioid analgesics had a higher incidence of pDDIs. As consequently, optimized monitoring and management of patients taking opioid analgesics is recommended in order to ensure patient medication safety.
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Affiliation(s)
- Fei Chu
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical University, Bengbu, China
- School of Pharmacy, Bengbu Medical University, Bengbu, China
- Anhui Engineering Technology Research Center of Biochemical Pharmaceutical, Bengbu Medical University, Bengbu, Anhui, China
| | - Yang Yao
- School Hospital, Bengbu Medical University, Bengbu, China
| | - Bei Gao
- School of Pharmacy, Bengbu Medical University, Bengbu, China
| | - Mingzhi Huang
- Department of Quality Control, the First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Lingti Kong
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical University, Bengbu, China
- School of Pharmacy, Bengbu Medical University, Bengbu, China
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Park S, Lee GH, Kim S, Kim S, Kim Y, Choi SA. Risk Factors for Respiratory Depression Associated with Tramadol Based on the Global Pharmacovigilance Database (VigiBase). Pharmaceuticals (Basel) 2024; 17:205. [PMID: 38399420 PMCID: PMC10893455 DOI: 10.3390/ph17020205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Tramadol, a weak μ-opioid receptor agonist, has been used worldwide for pain management. It is considered to have a favorable safety profile without serious adverse events; however, safety issues of respiratory depression were proposed by regulatory governments. We aimed to examine the risk and contributing factors associated with tramadol-related respiratory depression using a real-world database, VigiBase. Disproportionality analysis of tramadol and tramadol/paracetamol was performed using proportional reporting ratios, reporting odds ratios, and information components for all drugs and opioids. Factors related to respiratory depression, including sex, age, presence of abuse, death, and various concomitant medications, were evaluated. Among 140,721 tramadol reports, respiratory depression was reported in 1126 cases, 81.3% of which were deemed serious. Five adverse events were detected as signals of tramadol-related acute central respiratory depression (ACRD) in 882 reports. A higher proportion of ACRD cases in children and adolescents was observed than all adverse events cases of tramadol. Concomitant users of CYP2D6 inhibitors, opioids, benzodiazepines, and anti-depressant drugs showed a higher proportion in ACRD cases than non-ACRD cases. ACRD was related to drug abuse and death. This pharmacovigilance study, using VigiBase, confirmed a high risk of respiratory depression (a serious, potentially fatal adverse event) secondary to the use of tramadol, especially in pediatric patients, drug abusers, or during concomitant use of opioids, benzodiazepines, or antidepressants.
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Affiliation(s)
- Sunny Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Korea University, Sejong 30019, Republic of Korea;
| | - Geon-Ho Lee
- College of Pharmacy, Korea University, Sejong 30019, Republic of Korea
| | - Soyun Kim
- College of Pharmacy, Korea University, Sejong 30019, Republic of Korea
| | - Solee Kim
- College of Pharmacy, Korea University, Sejong 30019, Republic of Korea
| | - Yeju Kim
- College of Pharmacy, Korea University, Sejong 30019, Republic of Korea
| | - Soo-An Choi
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Korea University, Sejong 30019, Republic of Korea;
- College of Pharmacy, Korea University, Sejong 30019, Republic of Korea
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D'Aiuto C, Lunghi C, Guénette L, Berbiche D, Pitrou I, Bertrand K, Vasiliadis HM. Factors associated with potentially inappropriate opioid use in community-living older adults consulting in primary care. Int J Geriatr Psychiatry 2022; 37. [PMID: 35795908 DOI: 10.1002/gps.5780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the factors associated with opioid use and potentially inappropriate opioid use (PIOU) in primary care older adults with non-cancer pain referring to the conceptual framework developed by the American Agency for Healthcare Research and Quality. METHODS This is a secondary analysis of health survey and medico-administrative data from Québec, Canada. Individuals aged ≥65 were recruited between 2011 and 2013 in primary care clinics to participate in face-to-face interviews. The sample included 945 older adults without a malignant tumor over the study period or any tumor in the 2 years surrounding opioid use. Opioid use within a 3 year follow-up period was identified from the public drug plan database. Potentially inappropriate opioid use (PIOU) was defined using the American Geriatrics Society Beers 2019 list. Multinomial regression analyses were performed to study the factors (patient, pain, substance use, provider, healthcare system) associated with opioid use and PIOU. RESULTS In this sample of older adults, 26.2% used an opioid and 18.4% were categorized as PIOU. Factors associated with PIOU compared to opioid use included female sex, higher psychological distress, number of emergency department visits, and recruitment type of healthcare practice. Factors associated with PIOU compared to no use included female sex, country of origin, presence of a trauma, physical/psychiatric multimorbidity, number of outpatient consultations, pain severity/type, and number of prescribers. CONCLUSIONS Mental health and health system factors were associated with PIOU. Results highlights the importance of a multidisciplinary approach for pain management, and the urgent need for implementing organizational efforts to optimize opioid use in primary care.
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Affiliation(s)
- Carina D'Aiuto
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Charles-Le Moyne Research Center (CR-CLM), Longueuil, Quebec, Canada
| | - Carlotta Lunghi
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, Canada.,Population Health and Optimal Health Practices Research Axes, CHU de Québec Research Center, Quebec City, Quebec, Canada
| | - Line Guénette
- Population Health and Optimal Health Practices Research Axes, CHU de Québec Research Center, Quebec City, Quebec, Canada.,Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
| | - Djamal Berbiche
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Charles-Le Moyne Research Center (CR-CLM), Longueuil, Quebec, Canada
| | - Isabelle Pitrou
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Charles-Le Moyne Research Center (CR-CLM), Longueuil, Quebec, Canada
| | - Karine Bertrand
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Charles-Le Moyne Research Center (CR-CLM), Longueuil, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Charles-Le Moyne Research Center (CR-CLM), Longueuil, Quebec, Canada
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Galimberti F, Casula M, Scotti L, Olmastroni E, Ferrante D, Ucciero A, Tragni E, Catapano AL, Barone-Adesi F. Potentially Inappropriate Prescribing among Elderly Outpatients: Evaluation of Temporal Trends 2012-2018 in Piedmont, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063612. [PMID: 35329299 PMCID: PMC8953164 DOI: 10.3390/ijerph19063612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/24/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022]
Abstract
Pharmacological intervention is one of the cornerstones in the treatment and prevention of disease in modern healthcare. However, a large number of drugs are often prescribed and used inappropriately, especially in elderly patients. We aimed at investigating the annual prevalence of potentially inappropriate prescriptions (PIPs) among older outpatients using administrative healthcare databases of the Piedmont Region (Italy) over a seven-year period (2012–2018). We included all Piedmont outpatients aged 65 years or older with at least one drug prescription per year. Polypharmacy and the prevalence of PIPs according to the ERD list explicit tool were measured on an annual basis. A range between 976,398 (in 2012) and 1,066,389 (in 2018) elderly were evaluated. Among them, the number of subjects with at least one PIP decreased from 418,537 in 2012 to 339,764 in 2018; the prevalence significantly reduced by ~25% over the study period. The stratified analyses by age groups and sex also confirmed the downward trend and identified several differences in the most prevalent inappropriately prescribed drugs. Overall, despite a reduction in PIP prevalence, one out of three older outpatients was still exposed to inappropriateness, highlighting the extensive need for intervention to improve prescribing.
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Affiliation(s)
| | - Manuela Casula
- IRCCS MultiMedica, Sesto S. Giovanni, 20099 Milan, Italy; (F.G.); (A.L.C.)
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (E.O.); (E.T.)
- Correspondence:
| | - Lorenza Scotti
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.S.); (D.F.); (A.U.); (F.B.-A.)
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (E.O.); (E.T.)
| | - Daniela Ferrante
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.S.); (D.F.); (A.U.); (F.B.-A.)
| | - Andrealuna Ucciero
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.S.); (D.F.); (A.U.); (F.B.-A.)
| | - Elena Tragni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (E.O.); (E.T.)
| | - Alberico Luigi Catapano
- IRCCS MultiMedica, Sesto S. Giovanni, 20099 Milan, Italy; (F.G.); (A.L.C.)
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (E.O.); (E.T.)
| | - Francesco Barone-Adesi
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.S.); (D.F.); (A.U.); (F.B.-A.)
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Chen Q, Che Y, Xiao Y, Jiang F, Chen Y, Zhou J, Yang T. Impact of Multimorbidity Subgroups on the Health Care Use and Clinical Outcomes of Patients With Tuberculosis: A Population-Based Cohort Analysis. Front Public Health 2021; 9:756717. [PMID: 34692632 PMCID: PMC8531479 DOI: 10.3389/fpubh.2021.756717] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Multimorbidity is defined as the existence of two or more chronic health conditions in the same individual. While patients with tuberculosis commonly have multiple conditions at diagnosis, such as HIV, diabetes, and depression, to the authors' knowledge, there is limited information on the patterns of multimorbidity, and how the types and combinations of conditions could impact the healthcare utilization, expenditure, and TB outcomes. Methods: An observational cohort study of adult patients diagnosed with tuberculosis was conducted using the Chinese Center for Disease Control and Prevention (CDC)'s National TB Information System (NTBIS) linked to the Ningbo Regional Health Care Database (NRHCD) (2015–2020). Latent class analysis was used to identify comorbidity groups among the subset with ≥2 conditions including TB. Group-level health care use, expenditure, and treatment outcomes were compared with patients without chronic conditions using multivariate regression models. Results: A total of 9,651 patients with TB were identified, of whom approximately 61.4% had no chronic conditions, 17.4% had 1 chronic condition, and 21.3% had ≥2 chronic conditions. Among those with ≥1 chronic condition other than TB, 4 groups emerged: (1) general morbidity (54.4%); (2) cardiovascular morbidity without complications (34.7%); (3) cardiovascular morbidity with complications (5.0%); (4) respiratory morbidity (5.9%). The respiratory morbidity group experienced the highest expenditures, at 16,360 CNY more overall (95% CI, CNY 12,615–21,215) after adjustment compared with TB patients without chronic conditions. The respiratory morbidity and cardiovascular morbidity with complications group also had the lowest odds of favorable TB outcomes [adjusted odds ratio (aOR), 0.68; 95% CI, 0.49–0.93] and (aOR 0.59, 95% CI 0.42–0.83), respectively. The cardiovascular morbidity without complications group had the highest odds of successful TB treatment (aOR, 1.40; 95% CI, 1.15–1.71). Conclusions: Multimorbidity is common among patients with TB. The current study identified four distinct comorbidity subgroups, all of which experienced high, yet differential, rates of health care use. These findings highlight the need for urgent reforms to transform current fragmented TB care delivery and improve access to other specialists and financial assistance.
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Affiliation(s)
- Qin Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Yang Che
- Ningbo Municipal Center for Disease Control and Prevention, Institute of Tuberculosis Prevention and Control, Ningbo, China
| | - Yue Xiao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Feng Jiang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yanfei Chen
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Tianchi Yang
- Ningbo Municipal Center for Disease Control and Prevention, Institute of Tuberculosis Prevention and Control, Ningbo, China
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