1
|
Teker C, Aslan R, İpekçi C, Tokdemir M, Akgür SA. Pregabalin Qualitative Detection in Turkish Forensic Cases Between 2017 to 2018. J Psychoactive Drugs 2024; 56:380-386. [PMID: 37343948 DOI: 10.1080/02791072.2023.2226138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/22/2023] [Indexed: 06/23/2023]
Abstract
Pregabalin (PGB) has been commonly subjected to diversion, from being a prescription drug to a recreational drug. In this study, pregabalin use (which is one of the substances subject to control in Turkey) and the concomitant use of other substances in cases admitted to the Izmir Forensic Medicine Institute was evaluated. Samples from 15,259 cases were screened, between June 2017 and December 2018, for the presence of PGB, and PGB positive cases were further analyzed. Of all cases screened, PGB was detected in 3.2% (n = 487). The mean age of PGB positive cases was 29.24 ± 10.34 years old (min: 14, max: 84), and 94% of them were male. Cannabis metabolite THC-COOH was the most common substance detected in the blood samples following PGB. Overall, 8 other substances were commonly used along with PGB. These substances were cannabis, morphine, hydromorphone, codeine, hydrocodone, heroin, paracetamol, and naproxen. Finally, we observed similar results in urine analysis. This research provides systematic data for PGB use in forensic cases in Turkey. The study findings indicate that PGB and multiple drug use increased over time, and providers should be particularly careful when prescribing PGB.
Collapse
Affiliation(s)
- Ceyda Teker
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
| | - Rukiye Aslan
- Ege University, Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Izmir, Turkey
| | - Cahit İpekçi
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
| | - Mehmet Tokdemir
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
- Department of Forensic Medicine, Izmir Katip Çelebi University, Izmir, Turkey
| | - Serap Annette Akgür
- Ege University, Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Izmir, Turkey
| |
Collapse
|
2
|
Alshahrani SM, Orayj K, Alqahtani AM, Algahtany MA. Community Pharmacists' Perceptions towards the Misuse and Abuse of Pregabalin: A Cross-Sectional Study from Aseer Region, Saudi Arabia. Healthcare (Basel) 2021; 9:healthcare9101281. [PMID: 34682961 PMCID: PMC8535499 DOI: 10.3390/healthcare9101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/15/2021] [Accepted: 09/25/2021] [Indexed: 11/16/2022] Open
Abstract
Pregabalin is a first-line therapy for neuropathic pain and for chronic pain. It has abuse potential. This study was conducted to assess community pharmacists’ perceptions towards pregabalin abuse and misuse in the Aseer region, Saudi Arabia, and identify predictors and associated factors. A cross-sectional survey using a structured questionnaire following a self-administrative study was conducted across community pharmacies in the Aseer region (Abha, Khamis Mushait, Mahayel, Sarat Abeeda, Ahad-Rufaida, and Bishah). A total of 206 respondents from community pharmacists participated in the study. Over the last six months, 136 respondents (66.0%) suspected pregabalin abuse in community pharmacies; male dominance in pregabalin abusers was also recorded (n = 165, 80.1%). Additionally, 40 (19.4%) respondents stated that a prescription was not issued for pregabalin demands. Over half (61.7%) of community pharmacists recorded an increased change in pregabalin abuse compared to the previous year. This is the first study to explore pharmacists’ perceptions in the community of the Aseer region towards customers’ misuse and abuse of pregabalin. Further monitoring and regulations on the prescribing and procurement of pregabalin are needed to avoid abuse.
Collapse
Affiliation(s)
- Sultan M. Alshahrani
- Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha 61441, Saudi Arabia;
- Correspondence: ; Tel.: +96-650-874-7473
| | - Khalid Orayj
- Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha 61441, Saudi Arabia;
| | - Ali M. Alqahtani
- Pharmacology Department, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia;
| | - Mubarak A. Algahtany
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha 62512-2291, Saudi Arabia;
| |
Collapse
|
3
|
Obtention illégale de prégabaline comme proxy de l’usage non médical : analyse nationale multisource du Réseau Français d’Addictovigilance. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2020. [DOI: 10.1016/j.toxac.2020.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
4
|
Dufayet L, Monnet F, Laborde-Casterot H, Caré W, Lekens B, Langrand J, Mégarbane B, Vodovar D. Unintentional exposure to pregabalin in ≤6-year-old children: a nationwide French Poison Control Center study. Clin Toxicol (Phila) 2020; 59:433-439. [PMID: 33006482 DOI: 10.1080/15563650.2020.1822530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In France, pregabalin is widely prescribed in adults but still not approved for children. We aimed to investigate the incidence of pregabalin exposure in ≤6-year-old children, to describe the characteristics and outcome of ingestions involving pregabalin alone, and to estimate a clinically relevant toxic dose in this population. METHODS Retrospective analysis of pregabalin exposures in ≤6-year-old children, collected by the French Poison Control Centers in 2004-2019. The incidence was estimated using pregabalin prescription data from the Health Improvement Network database (the French version of THIN). The poison severity score (PSS) was used to grade severity. RESULTS We found 313 unintentional immediate-release pregabalin ingestions in ≤6-year-old children. The number of cases per 100,000 pregabalin-treated adults increased over time (p < 0.001). One hundred twenty-six cases involving pregabalin alone (age, 2 years [1.6-3.0] (median [25th-75th percentiles]); median ingested dose 6.4 mg/kg [3.6-10.9]) were analyzed. No child presented an underlying neurological/cardiac disease and/or took concomitant medications. Most of the children (77%) remained asymptomatic (PSS0) while 21% and 2% developed minor (PSS1) or moderate (PSS2) neurological symptoms, respectively. No severe complications/fatalities were reported. All symptomatic children recovered within 24 h. The ingested pregabalin dose was positively correlated with PSS (p < 0.0001). Using a ROC curve approach (area under the curve, 0.85; p < 0.001), ingestion of ≥19.4 mg/kg pregabalin was appropriate to recommend hospital referral (sensitivity, 39% [95% confidence interval (95% CI), 24-56], specificity, 100% [95% CI, 96-100], predictive positive value, 100% [95% CI, 64-100], and negative predictive value, 85% [95% CI, 82-89]). Symptomatic children who ingested <19.4 mg/kg pregabalin developed minor symptoms. CONCLUSION Despite increasing prescriptions in adults in France, unintentional pregabalin ingestions in ≤6-year-old children remain rare and cause minimal toxicity. Children with no underlying neurological/cardiac disease and concomitant medication ingesting <19.4 mg/kg immediate-release pregabalin alone can be safely observed at home.
Collapse
Affiliation(s)
- Laurène Dufayet
- Centre Antipoison de Paris - Fédération de Toxicologie (FeTox), Hôpital Fernand-Widal, APHP, Paris, France.,INSERM, UMRS-1144, Faculté de pharmacie, Paris, France.,Unité médico-judiciaire, Hôtel-Dieu, APHP, Paris, France
| | - Fleur Monnet
- GERSDATA, Gers SAS (Groupe Cegedim), Boulogne-Billancourt, France
| | - Hervé Laborde-Casterot
- Centre Antipoison de Paris - Fédération de Toxicologie (FeTox), Hôpital Fernand-Widal, APHP, Paris, France
| | - Weniko Caré
- Centre Antipoison de Paris - Fédération de Toxicologie (FeTox), Hôpital Fernand-Widal, APHP, Paris, France.,Département de médecine interne, hôpital d'instruction des armées Percy, Service de Santé des Armées, Clamart, France
| | - Béranger Lekens
- GERSDATA, Gers SAS (Groupe Cegedim), Boulogne-Billancourt, France
| | - Jérôme Langrand
- Centre Antipoison de Paris - Fédération de Toxicologie (FeTox), Hôpital Fernand-Widal, APHP, Paris, France.,INSERM, UMRS-1144, Faculté de pharmacie, Paris, France
| | | | - Bruno Mégarbane
- INSERM, UMRS-1144, Faculté de pharmacie, Paris, France.,Réanimation Médicale et Toxicologique - Fédération de toxicologie (FeTox), Hôpital Lariboisière, APHP, Paris, France.,UFR de médecine, Université de Paris, Paris, France
| | - Dominique Vodovar
- Centre Antipoison de Paris - Fédération de Toxicologie (FeTox), Hôpital Fernand-Widal, APHP, Paris, France.,INSERM, UMRS-1144, Faculté de pharmacie, Paris, France.,UFR de médecine, Université de Paris, Paris, France
| |
Collapse
|
5
|
Lapeyre-Mestre M, Boucher A, Daveluy A, Gibaja V, Jouanjus E, Mallaret M, Peyrière H, Micallef J. Addictovigilance contribution during COVID-19 epidemic and lockdown in France. Therapie 2020; 75:343-354. [PMID: 32660776 PMCID: PMC7309935 DOI: 10.1016/j.therap.2020.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 01/16/2023]
Abstract
Addictovigilance is a safety monitoring targeted at substances with potential for abuse and dependence. This vigilance was involved during the period of COVID-19 epidemic due to the significant changes in access to drugs and psychological disruption caused by the pandemic and lockdown. This article aims to present the different steps implemented by the French Addictovigilance network in collaboration with the French Health authorities from March to May 2020, including monitoring of potential harmful events, and scientific communication. The first events were identified through the continuity of the networking between the French addictovigilance centres and their partners: community pharmacies, general practitioners, specialized structures and emergency wards. As soon as the lockdown began, first cases of overdoses (lethal or not) were reported with opioids, mainly with methadone, and other opioids (heroin, oxycodone, tramadol or antitussive codeine). Lockdown-related noteworthy events consisted in clinical cases or other relevant information for which lockdown clearly played an important role: among the many substances identified at least once, pregabalin, benzodiazepines, cannabis, cocaine and nitrous oxide were the most significant in terms of prevalence, seriousness or particularly specific to the lockdown context. Despite significant decrease in the activity and travel limited to vital needs, community pharmacies continued to identify falsified prescriptions in this period, highlighting an increase in suspicious requests for pregabalin, codeine and tramadol. In parallel, the French addictovigilance network continued its communications efforts in the period, issuing a newsletter on tramadol, a press release on methadone and naloxone, and participating in the COVID-19 frequently asked questions (FAQs) of the French Society of Pharmacology and Therapeutic website (https://sfpt-fr.org/covid19). COVID-19 epidemic has been an important challenge for addictovigilance, and has proved that this monitoring is highly essential for alerting health professionals and health authorities to points of vigilance in the field of psychoactive substances.
Collapse
|
6
|
Micallef J, Jouanjus É, Mallaret M, Lapeyre Mestre M. [Safety signal detection by the French Addictovigilance Network: Innovative methods of investigation, examples and usefulness for public health]. Therapie 2019; 74:579-590. [PMID: 31694770 DOI: 10.1016/j.therap.2019.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 10/25/2022]
Abstract
The French Addictovigilance Network aims to monitor all psychoactive substances with abuse potential including prescription drugs and other legal and illegal substances such as new psychoactive substances (NPS) and its consequences in humans. Created in 1990 through a network of regional addictovigilance centres covering the entire country, these pharmacologists with expertise in addictovigilance have developed interface with different partners (physicians, toxicologists, network of community pharmacies, addictology care centers…) and implemented several original tools of pharmacosurveillance (such as DRAMES [death related to the abuse of medicines] in strong collaboration with toxicologists or such OPPIDUM [observation of illegal products and misuse of psychotropic medications]), complementary to the spontaneous reporting. A such multidimensional approach including proactive surveillance by these tools and also among several heterogenous data sources (such as data from hospitals or claims database) is able to detect early addictovigilance signals and warnings as illustrated with three following examples: cannabis use and acute serious cardiovascular disorders, new synthetic opioids (ocfentanil, carfentanil) and severe opiate overdose or deaths, the diverted use of psychoactive drugs (codeine analgesics or sedative H1 antihistamines called purple drank) by adolescents and young adults. The choice of a broad strategy and the multifaceted system implemented by the French Addictovigilance Network using elements of pharmacology (fundamental, clinical, pharmacoepidemiology) expertise is an innovative method to detect early addictovigilance signals, and to describe its characteristics in order to increase awareness of psychoactive substances by patients, users and health professionals.
Collapse
Affiliation(s)
- Joëlle Micallef
- UMR 1106, Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Marseille, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, Aix-Marseille université, 13005 Marseille, France.
| | - Émilie Jouanjus
- UMR 1027 Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Toulouse, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, université Paul-Sabatier, 31000 Toulouse, France
| | - Michel Mallaret
- Centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, centre hospitalo-universitaire de Grenoble, 38043 Grenoble, France
| | - Maryse Lapeyre Mestre
- UMR 1027 Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Toulouse, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, université Paul-Sabatier, 31000 Toulouse, France
| |
Collapse
|
7
|
Driot D, Jouanjus E, Oustric S, Dupouy J, Lapeyre-Mestre M. Patterns of gabapentin and pregabalin use and misuse: Results of a population-based cohort study in France. Br J Clin Pharmacol 2019; 85:1260-1269. [PMID: 30737829 DOI: 10.1111/bcp.13892] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/06/2019] [Accepted: 02/01/2019] [Indexed: 12/25/2022] Open
Abstract
AIMS The aim of this study was to assess the use and factors associated with the misuse of gabapentin and pregabalin in the general French population, through a cohort study in the EGB (General Sample of Beneficiaries), a national representative sample of the French general population. METHODS New users of gabapentin and pregabalin were identified from June 2006 to December 2014, and new users of duloxetine served as control group. Misuse was defined as a use of higher daily doses than recommended. Cox proportional hazard regression models were performed to identify associated factors of misuse. RESULTS Misuse was more frequent in the 8692 new users of pregabalin (12.8%) than in the 1963 gabapentin (6.6%) or the 3214 duloxetine new users (9.7%) (P < 0.001). Factors associated with misuse were pregabalin (hazard ratio [HR] 1.48; 95% confidence interval [CI] [1.29-1.69]), age (HR[18-45] versus > 70 years 1.98 [1.70-2.31] and HR[58-70] versus > 70 years 1.25 [1.06-1.47]), multiple prescribers (HR2 or 3 versus 1 prescriber 1.29 [1.15-1.45]; HR4 or more versus 1 prescriber 1.54 [1.30-1.83]), cancer (1.28 [1.11-1.47]), multiple sclerosis (1.53 [1.07-2.18]), neuropathy (1.85 [1.19-2.89]), depression (1.26 [1.07-1.49]) and methadone (2.61 [1.16-5.84]). After this first episode of drug misuse, 11.6% of gabapentin and 10.7% of pregabalin misusers developed a primary addiction. CONCLUSION In a cohort of new users, misuse is more likely to occur in new users of pregabalin, with different associated factors of misuse compared to gabapentin and duloxetine. Health professionals and prescribers must be aware of this misuse potential, which could lead to abuse and dependence.
Collapse
Affiliation(s)
- Damien Driot
- Département universitaire de médecine générale, Faculté de Médecine, Université de Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France
| | - Emilie Jouanjus
- Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France.,Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP), Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, France
| | - Stéphane Oustric
- Département universitaire de médecine générale, Faculté de Médecine, Université de Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France
| | - Julie Dupouy
- Département universitaire de médecine générale, Faculté de Médecine, Université de Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France
| | - Maryse Lapeyre-Mestre
- Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France.,Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP), Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, France.,Centre d'Investigation Clinique, 1436 Inserm CHU, CHU de Toulouse, France
| |
Collapse
|
8
|
Lafaurie M, Pochard L, Lotiron C, Molinier L, Lapeyre-Mestre M, Jouanjus E. Identification of Somatic Disorders Related to Psychoactive Drug Use from an Inpatient Database in a French University Hospital. Clin Drug Investig 2018; 38:977-982. [DOI: 10.1007/s40261-018-0679-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
9
|
Frauger E, Pochard L, Boucherie Q, Giocanti A, Chevallier C, Daveluy A, Gibaja V, Caous AS, Eiden C, Authier N, Le Boisselier R, Guerlais M, Jouanjus É, Lepelley M, Pizzoglio V, Pain S, Richard N, Micallef J. Dispositif pharmacoépidémiologique de surveillance des substances psychoactives : intérêts du programme national OPPIDUM du Réseau français d’addictovigilance. Therapie 2017; 72:491-501. [DOI: 10.1016/j.therap.2017.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/16/2017] [Accepted: 02/14/2017] [Indexed: 11/30/2022]
|
10
|
Wertli MM, Reich O, Signorell A, Burgstaller JM, Steurer J, Held U. Changes over time in prescription practices of pain medications in Switzerland between 2006 and 2013: an analysis of insurance claims. BMC Health Serv Res 2017; 17:167. [PMID: 28241764 PMCID: PMC5327558 DOI: 10.1186/s12913-017-2086-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Europe, scant information is available about prescription practices for pain medications. The aim of this research was to assess changes in prescription rates of non-opioid, weak opioid, and strong opioid medications between 2006 and 2013 in the Swiss population. METHODS Using insurance claims data covering one-sixth of the Swiss population, we analyzed the numbers of reimbursed pain medications, the number of reimbursements per persons, and the cumulative dose in milligrams. For opioids, the morphine equivalent dose and treatment days were calculated. Data were extrapolated to the dose per day per 100'000 population stratified by age, gender, and canton. RESULTS In total, 4'746'942 paracetamol, 2'156'620 NSAIDs or Coxibs, 931'129 metamizole, 1'322'272 weak opioid, and 807'835 strong opioid claims were analyzed. Between 2006 and 2013, the increase in claims per 100'000 persons was 32% for paracetamol, 242% for metamizole, 107% for NSAIDS, 86% for Coxibs, 13% for weak opioids, and 121% for strong opioids. For strong opioids the total MED in mg /100'000 increased by 117%, the treatment days /100'000 by 101%. For strong opioids, fentanyl was most frequently used (increase between 2006 and 2013 by 91% for MED/100'000 persons and 94% treatment days / 100'000) followed by buprenorphine and oxycodone. The highest proportional increase in MED / 100'000 was observed for methadone (+1414%) and oxycodone (+313%). Marked geographical variation was detected in the use of metamizole, paracetamole, and strong opioids in different cantons. CONCLUSION The analysis of insurance claims data provides evidence that the prescription rates for pain medications increased in Switzerland within the last ten years, in particular for metamizole and strong opioids. Furthermore, the prescription rates for metamizole, paracetamol, and strong opioids varied substantially between different cantons in Switzerland.
Collapse
Affiliation(s)
- Maria M Wertli
- Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland. .,Department of General Internal Medicine, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland.
| | - Oliver Reich
- Department of Health Sciences, Helsana, Zürichstrasse 130, CH-8600, Dübendorf, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana, Zürichstrasse 130, CH-8600, Dübendorf, Switzerland
| | - Jakob M Burgstaller
- Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland
| | - Johann Steurer
- Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland
| | - Ulrike Held
- Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland
| |
Collapse
|
11
|
Comment on: "Social Media Mining for Toxicovigilance: Automatic Monitoring of Prescription Medication Abuse from Twitter". Drug Saf 2017; 40:183-185. [DOI: 10.1007/s40264-016-0497-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
12
|
Bossard JB, Ponté C, Dupouy J, Lapeyre-Mestre M, Jouanjus E. Disproportionality Analysis for the Assessment of Abuse and Dependence Potential of Pregabalin in the French Pharmacovigilance Database. Clin Drug Investig 2017; 36:735-742. [PMID: 27300651 DOI: 10.1007/s40261-016-0421-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Pregabalin abuse and dependence has been increasingly described; however, it is not described in France. Our study aimed to investigate the abuse and dependence potential of pregabalin by a disproportionality analysis, in the French Pharmacovigilance Database (FPVD), in comparison with amitriptyline and clonazepam. METHODS We performed a case/noncase study in the FPVD. Between January, 1 2010 and December, 31 2015, we identified cases of abuse and or dependence (excluding isolated withdrawal syndromes) using MedDRA (Medical Dictionary for Regular Activities) terms. Exposure to pregabalin was defined as the mention of pregabalin in the report. Clonazepam was used as positive control and amitriptyline as negative control. RESULTS Among the 184,310 reports in the database, 521 were abuse or dependence cases. Exposure to pregabalin was found in eight (1.5 %) of them. We did not find any significant association between exposure to pregabalin and drug abuse or dependence: reporting odds ratio (ROR) = 1.1 95 % confidence interval (CI) (0.6-2.3). ROR for clonazepam was 5.7 95 % CI (3.5-9.2). No case of an amitriptyline-related abuse or dependence was recorded in the FPVD. CONCLUSIONS The first cases of pregabalin-related abuse or dependence reported in France occurred later than in other European countries, since none had been described before 2010. This analysis in the FPVD did not find a higher proportion of abuse/dependence with pregabalin in comparison with other drugs. Considering evidence of pregabalin abuse worldwide, this analysis underlines the limitations of spontaneous reporting system in the field of addictovigilance.
Collapse
Affiliation(s)
- Jean-Baptiste Bossard
- Equipe de Pharmacoepidemiologie, UMR1027-Université Paul Sabatier Toulouse III, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Camille Ponté
- CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Julie Dupouy
- Equipe de Pharmacoepidemiologie, UMR1027-Université Paul Sabatier Toulouse III, 37 allées Jules Guesde, 31000, Toulouse, France.,Département Universitaire de Médecine Générale, Université Paul Sabatier Toulouse III, Faculté de Médecine, 133, route de Narbonne, Toulouse, 31062, France
| | - Maryse Lapeyre-Mestre
- Equipe de Pharmacoepidemiologie, UMR1027-Université Paul Sabatier Toulouse III, 37 allées Jules Guesde, 31000, Toulouse, France.,CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Emilie Jouanjus
- Equipe de Pharmacoepidemiologie, UMR1027-Université Paul Sabatier Toulouse III, 37 allées Jules Guesde, 31000, Toulouse, France. .,CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.
| |
Collapse
|
13
|
Sensitivity of Quantitative Signal Detection in Regards to Pharmacological Neuroenhancement. Int J Mol Sci 2017; 18:ijms18010101. [PMID: 28067776 PMCID: PMC5297735 DOI: 10.3390/ijms18010101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 11/16/2022] Open
Abstract
Pharmacological neuroenhancement (PNE) is a form of abuse and has not yet been addressed by methods of pharmacovigilance. In the present study, we tested if quantitative signal detection may be sensitive in regards to PNE. We evaluated the risk of drug abuse and dependence (DAAD) related to substances that are known to be used for PNE and divided this group into agents with (methylphenidate) and without a known abuse potential outside the field of PNE (atomoxetine, modafinil, acetylcholine esterase inhibitors, and memantine). Reporting odds ratios (RORs) were calculated using a case/non-case approach based on global and country-specific drug safety data from the Uppsala Monitoring Centre (UMC). Both control substances (diazepam and lorazepam) and methylphenidate were statistically associated with DAAD in all datasets (except methylphenidate in Italy). Modafinil was associated with DAAD in the total dataset (ROR, 2.7 (95% confidence interval (CI), 2.2-3.3)), Germany (ROR, 4.6 (95% CI, 1.8-11.5)), and the USA (ROR, 2.0 (95% CI, 1.6-2.5)). Atomoxetine was associated with DAAD in the total dataset (ROR, 1.3 (95% CI, 1.2-1.5)) and in the UK (ROR, 3.3 (95% CI, 1.8-6.1)). Apart from memantine, which was associated with DAAD in Germany (ROR, 1.8 (95% CI, 1.0-3.2)), no other antidementia drug was associated with DAAD. Quantitative signal detection is suitable to detect agents with a risk for DAAD. Its sensitivity regarding PNE is limited, although atomoxetine and modafinil, which do not have a known abuse potential outside PNE, and no antidementia drugs, whose use in PNE is presumably low, were associated with DAAD in our analysis.
Collapse
|
14
|
Passamonti L, Luijten M, Ziauddeen H, Coyle-Gilchrist ITS, Rittman T, Brain SAE, Regenthal R, Franken IHA, Sahakian BJ, Bullmore ET, Robbins TW, Ersche KD. Atomoxetine effects on attentional bias to drug-related cues in cocaine dependent individuals. Psychopharmacology (Berl) 2017; 234:2289-2297. [PMID: 28551713 PMCID: PMC5519645 DOI: 10.1007/s00213-017-4643-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 05/11/2017] [Indexed: 12/19/2022]
Abstract
RATIONALE Biased attention towards drug-related cues and reduced inhibitory control over the regulation of drug-intake characterize drug addiction. The noradrenaline system has been critically implicated in both attentional and response inhibitory processes and is directly affected by drugs such as cocaine. OBJECTIVES We examined the potentially beneficial effects of the noradrenaline reuptake inhibitor atomoxetine in improving cognitive control during two tasks that used cocaine- and non-cocaine-related stimuli. METHODS A double-blind, placebo-controlled, and cross-over psycho-pharmacological design was employed. A single oral dose of atomoxetine (40 mg) was administered to 28 cocaine-dependent individuals (CDIs) and 28 healthy controls. All participants performed a pictorial attentional bias task involving both cocaine- and non-cocaine-related pictures as well as a verbal go/no-go task composed of cocaine- and food-related words. RESULTS As expected, CDIs showed attentional bias to cocaine-related cues whilst controls did not. More importantly, however, atomoxetine, relative to placebo, significantly attenuated attentional bias in CDIs (F 26 = 6.73, P = 0.01). During the go/no-go task, there was a treatment × trial × group interaction, although this finding only showed a trend towards statistical significance (F 26 = 3.38, P = 0.07). CONCLUSIONS Our findings suggest that atomoxetine reduces attentional bias to drug-related cues in CDIs. This may result from atomoxetine's modulation of the balance between tonic/phasic activity in the locus coeruleus and the possibly parallel enhancement of noradrenergic neurotransmission within the prefrontal cortex. Studying how cognitive enhancers such as atomoxetine influence key neurocognitive indices in cocaine addiction may help to develop reliable biomarkers for patient stratification in future clinical trials.
Collapse
Affiliation(s)
- Luca Passamonti
- Departments of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK. .,Consiglio Nazionale delle Ricerche, Istituto di Bioimmagini e Fisiologia Molecolare, Catanzaro, Italy.
| | - M. Luijten
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - H. Ziauddeen
- Cambridgeshire and Peterborough Foundation Trust, Cambridge, UK
| | | | - T. Rittman
- Departments of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ UK
| | - S. A. E. Brain
- Departments of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ UK
| | - R. Regenthal
- Division of Clinical Pharmacology, Rudolf-Boehm-Institute of Pharmacology and Toxicology, University of Leipzig, Leipzig, Germany
| | - I. H. A. Franken
- Institute of Psychology, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - B. J. Sahakian
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - E. T. Bullmore
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK ,GlaxoSmithKline, Clinical Unit Cambridge, Cambridge, UK
| | - T. W. Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - K. D. Ersche
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| |
Collapse
|
15
|
Daveluy A, Frauger E, Peyrière H, Moracchini C, Haramburu F, Micallef J. Which psychoactive substances are used by patients seen in the healthcare system in French overseas territories? Results of the OPPIDUM survey. Fundam Clin Pharmacol 2016; 31:126-131. [DOI: 10.1111/fcp.12233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/21/2016] [Accepted: 08/30/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Amélie Daveluy
- CHU Bordeaux; Service de Pharmacologie médicale; Centre d'Addictovigilance; INSERM U1219; F-33000 Bordeaux France
| | - Elisabeth Frauger
- CNRS; INT, Institut de Neurosciences Timone; APHM; Service de Pharmacologie Clinique; Centre d'Addictovigilance Paca Corse; Aix Marseille Université; F-13005 Marseille France
| | - Hélène Peyrière
- Département de Pharmacologie médicale et Toxicologie; Centre d'Addictovigilance; CHRU Montpellier; F-34295 Montpellier France
| | - Christophe Moracchini
- CNRS; INT, Institut de Neurosciences Timone; APHM; Service de Pharmacologie Clinique; Centre d'Addictovigilance Paca Corse; Aix Marseille Université; F-13005 Marseille France
| | - Françoise Haramburu
- CHU Bordeaux; Service de Pharmacologie médicale; Centre d'Addictovigilance; INSERM U1219; F-33000 Bordeaux France
| | - Joëlle Micallef
- CNRS; INT, Institut de Neurosciences Timone; APHM; Service de Pharmacologie Clinique; Centre d'Addictovigilance Paca Corse; Aix Marseille Université; F-13005 Marseille France
| |
Collapse
|