scholarly journals Clinically significant drug–drug interactions involving opioid analgesics used for pain treatment in patients with cancer: a systematic review

2015 ◽  
pp. 5255 ◽  
Author(s):  
Aleksandra Kotlinska-Lemieszek ◽  
Pål Klepstad ◽  
Dagny Faksvåg Haugen
Keyword(s):  
Systematic Review ◽  
Drug Interactions ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Patients With Cancer ◽  
Clinically Significant

scholarly journals Potential Drug-Drug and Herb-Drug Interactions in Patients With Cancer: A Prospective Study of Medication Surveillance

2017 ◽  
Vol 13 (7) ◽  
pp. e613-e622 ◽  
Author(s):  
Allan Ramos-Esquivel ◽  
Álvaro Víquez-Jaikel ◽  
Cristina Fernández
Keyword(s):  
High Risk ◽  
Prospective Study ◽  
Drug Interactions ◽  
Anticancer Therapy ◽  
Herbal Supplement ◽  
Herbal Supplements ◽  
Patients With Cancer ◽  
Clinical Consequences ◽  
Clinically Significant ◽  
A Prospective Study

Purpose: Patients with cancer frequently use herbal supplements and concomitant medications along with antineoplastic agents. These patients are at high risk of herb-drug interactions (HDIs) and drug-drug interactions (DDIs). We aimed to determine clinically relevant DDIs and HDIs leading to pharmaceutical intervention. Methods: Patients starting a new anticancer therapy were asked to complete a questionnaire to identify concomitant use of any over-the-counter drug or herbal supplement. Potential DDIs and HDIs were identified using two different databases. If a potentially clinically relevant DDI was recognized by the clinical pharmacist, a notification was sent to the prescribing oncologist, who decided whether to carry out a suggested intervention. Regression analyses were performed to identify variables associated with clinically relevant DDIs. Results: A total of 149 patients were included in this study, with 36 potentially clinically relevant DDIs identified in 26 patients (17.4%; 95% CI, 11.3% to 23.5%), all of them leading to therapy modifications. In total, four patients (2.7%; 95% CI, 0.1% to 5.3%) had experienced clinical consequences from DDIs at the time of pharmacist notification. Additionally, 84 patients (56.4%; 95% CI, 48.4% to 64.4%) reported using concurrent herbal supplements, and 122 possible HDIs were detected. Concomitant use of two or more drugs was independently associated with high risk of a clinically significant DDI (odds ratio, 2.53; 95% CI, 1.08 to 5.91; P = .03). Conclusion: Potentially clinically relevant DDIs and possible HDIs were frequently detected in this prospective study. A multidisciplinary approach is required to identify and avoid potentially harmful combinations with anticancer therapy.

scholarly journals Individual variability in clinical effect and tolerability of opioid analgesics – Importance of drug interactions and pharmacogenetics

2017 ◽  
Vol 17 (1) ◽  
pp. 193-200 ◽  
Author(s):  
Vigdis Solhaug ◽  
Espen Molden
Keyword(s):  
Side Effects ◽  
Drug Interactions ◽  
Clinical Effect ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Individual Variability ◽  
Comorbid Condition ◽  
Variable Response ◽  
Increased Risk ◽  
Serotonergic Drugs

AbstractBackgroundAs pain is often a comorbid condition, many patients use opioid analgesics in combination with several other drugs. This implies a generally increased risk of drug interactions, which along with inherent pharmacogenetic variability and other factors may cause differences in therapeutic response of opioids.AimTo provide an overview of interactions and pharmacogenetic variability of relevance for individual differences in effect and tolerability of opioid analgesics, which physicians and other healthcare professionals should be aware of in clinical practice.MethodsThe article was based on unsystematic searches in PubMed to identify literature highlighting the clinical impact of drug interactions and pharmacogenetics as sources of variable response of opioid analgesics.ResultsCytochrome P450 (CYP)-mediated metabolism is an important process for both clinically relevant interactions and pharmacogenetic variability of several opioids. Concomitant use of CYP inhibitors (e.g. paroxetine, fluoxetine and bupropion) or inducers (e.g. carbamazepine, phenobarbital and phenytoin) could counteract the clinical effect or trigger side effects of analgesics in the same manner as genetically determined differences in CYP2D6-mediated metabolism of many opioids. Moreover, combination treatment with drugs that inhibit or induce P-glycoprotein (ABCB1), a blood-brain barrier efflux transporter, may alter the amount (‘dose’) of opioids distributed to the brain. At the pharmacodynamic level, it is crucial to be aware of the potential risk of interaction causing serotonergic syndrome when combining opioids and serotonergic drugs, in particular antidepressants inhibiting serotonin reuptake (SSRIs and SNRIs). Regarding pharmacogenetics at the receptor level of pain treatment, the knowledge is currently scarce, but an allelic variant of the μ1 opioid receptor (OPRM1) gene has been associated with higher dosage requirement to achieve analgesia.Conclusions and implicationsDrug interactions and pharmacogenetic differences may lead to therapeutic failure or serious side effects of opioid analgesics. Many interactions involve combinations with antidepressants and antiepileptics, which are highly relevant drugs in patients suffering from pain. To prevent unfavourable drug interactions it is important that clinicians pay close attention and use electronic drug interaction checkers when treatments are initiated or discontinued. For the management of issues related to pharmacogenetic differences, blood-based CYP genotyping is available as routine test at many laboratories, and provide a valuable tool for proper choice of drugs and doses for treatment of pain and other diseases.

scholarly journals Clinico-pharmacological characteristics of opioid drug-drug interactions in cancer patients with chronic pain syndrome

2019 ◽  
Vol 17 (6) ◽  
pp. 114-122
Author(s):  
O. P. Bobrova ◽  
N. A. Shnayder ◽  
S. K. Zyryanov ◽  
Yu. A. Dyhno ◽  
M. M. Petrova ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Cancer Patients ◽  
Pain Treatment ◽  
Pain Syndrome ◽  
Opioid Analgesics ◽  
Individual Choice ◽  
Analgesic Therapy ◽  
Co Morbidity ◽  
The Impact

The aimof the review was to analyze published studies on the impact of opioid drug-drug interactions on the choice of analgesic therapy regimens.Material and methods.A systematic literature search was conducted using PubMed, Scopus, Web of Science, and E-library databases.Results.The review showed a clinical significance of pharmacokinetic interactions of opioids with other drugs in cancer pain treatment. The problems of individual choice of analgesics from different groups under conditions of co-morbidity and concomitant medication were discussed to ensure the effectiveness/safety of the treatment strategy affecting the quality of life of cancer patients.Conclusion.A comprehensive assessment of factors in patients receiving opioid analgesics is a predictor of effective and safe analgesic therapy.

L-arginine effect on inflammatory mediators: A systematic review of randomized controlled clinical trials

2019 ◽  
pp. 1-9 ◽  
Author(s):  
Seyed Reza Mirhafez ◽  
Mitra Hariri
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Inflammatory Mediators ◽  
Randomized Clinical Trials ◽  
Randomized Controlled Clinical Trials ◽  
Patients With Cancer ◽  
Reactive Protein ◽  
Randomized Controlled ◽  
Human Adults ◽  
Factor Α

Abstract. L-arginine is an important factor in several physiological and biochemical processes. Recently, scientists studied L-arginine effect on inflammatory mediators such as C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). We conducted a systematic review on randomized controlled trials assessing L-arginine effect on inflammatory mediators. We searched data bases including Google scholar, ISI web of science, SCOPUS, and PubMed/Medline up to April 2019. Randomized clinical trials assessing the effect of L-arginine on inflammatory mediators in human adults were included. Our search retrieved eleven articles with 387 participants. Five articles were on patients with cancer and 6 articles were on adults without cancer. L-arginine was applied in enteral form in 5 articles and in oral form in 6 articles. Eight articles were on both genders, two articles were on women, and one article was on men. L-arginine could not reduce inflammatory mediators among patients with and without cancer except one article which indicated that taking L-arginine for 6 months decreased IL-6 among cardiopathic nondiabetic patients. Our results indicated that L-arginine might not be able to reduce selected inflammatory mediators, but for making a firm decision more studies are needed to be conducted with longer intervention duration, separately on male and female and with different doses of L-arginine.

Effect of Chemotherapy and Predictive Factors for Nausea or Vomiting in Patients with Cancer Receiving Opioid Analgesics for the First Time

2020 ◽  
Vol 15 (3) ◽  
pp. 213-220
Author(s):  
Masami Yamada ◽  
Chikako Matsumura ◽  
Yumi Jimaru ◽  
Rie Ueno ◽  
Sari Torii ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Opioid Analgesics ◽  
Patients With Cancer ◽  
First Time

Sending out Biased Signals: an Appropriate Proposition for Pain?

2019 ◽  
Vol 32 (2) ◽  
pp. 108-110 ◽  
Author(s):  
E. Besserer-Offroy ◽  
P. Sarret
Keyword(s):  
Side Effects ◽  
Acute Pain ◽  
Gold Standard ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Mu Opioid Receptor ◽  
Clinical Development ◽  
Mu Opioid ◽  
Development Stages ◽  
The Past

In the past few years, several biased ligands acting at the mu-opioid receptor were reported in the literature. These agonists are aimed at reducing pain while having fewer side effects than morphine, the gold standard of opioid analgesics. In this mini-review, we describe and discuss the recent advances in mu-biased ligands actually in preclinical and clinical development stages, including the latest U.S. Food and Drug Administration review of oliceridine, a biased mu-agonist for moderate to severe acute pain treatment developed by the company Trevena.

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