What to watch for when patients take opioids with other medications

Chronic pain is common in the U.S. population and one of main reasons patients seek medical care. Between 10% to 60% adults 18 years older report experiencing chronic or persistent lasting at least three six months, according a November 2021 study by Michaud colleagues published Journal Personalized Medicine. According study, more than 65% who take an opioid for also other medication concomitantly, increasing likelihood that will experience drug–drug interactions (DDIs). Mark Garofoli, PharmD, MBA, BCGP, CPE, clinical assistant professor WVU School Pharmacy, said he usually classifies into these categories: metabolic (CYP-450/Transporters), QTc interval prolongation, serotonergic, sedatives, pharmacogenomics, gender, age. Opioids like codeine, hydrocodone, oxycodone, tramadol are metabolized body cytochrome P450 (CYP) enzymatic system, specifically CYP2D6 isoenzyme, activate prodrug (inactive substrate) resulting relief from active metabolites morphine, hydromorphone, oxymorphone, O-desmethyl-tramadol, respectively. Issues arise when coadministered drugs interact inhibit have greater affinity thereby interfering with activation process opioids. “When it comes pharmacogenomic interactions, CYP3A4 players,” was not involved study. He therapy selection dosage changes most regard (e.g., codeine). Since DDIs associated decreased concentrations metabolites, which results inadequate analgesic effects, variable effectiveness, safety concerns, conducted retrospective, observational cohort analysis examining drug claims data investigate effects use on health care costs. They found took opioids interacting tended be higher risk adverse events, overall yearly costs, had average daily intake no drugs. To identify evaluate opioid-related issues data, research team used decision support software Tabula Rasa HealthCare called MedWise Science. Patients taking sedative properties benzodiazepines respiratory depression, cognitive impairment, even death overdose. “If you’re licensed professional pulse, you obviously know major concern benzodiazepine interactions. “The question, however, what do about each every patient,” Garofoli. CDC recommends clinicians avoid prescribing concurrently whenever possible prevent potential dangers. Pharmacists should recommend naloxone hand case accidental NIH, signs overdose include unconsciousness, very small pupils, slow shallow breathing, vomiting, inability speak, faint heartbeat, limp arms legs, pale skin, purple lips fingernails. Many medications serotonergic can management opioids, such as methadone, meperidine, levorphanol, tramadol, yet how pharmacists explain goes long way, advise wait contact their provider if they feel ill, said. advises direct, conversational manner approach topic. “Approaching while striving safe effective often driving highway side stating right lane closes 1 mile another sign reading left 2 miles; we’re wondering lane, treatment option utilize,”