[Drug Interactions in Pain Therapy]

Overview

Journal Schmerz

Date 2015 Jul 4

PMID 26137862

Authors

K M J Syhr

B G Oertel

G Geisslinger

Affiliations

Soon will be listed here.

Abstract

Background: Pain is one of the most common reasons for consulting a physician. Chronic pain patients often suffer from a variety of comorbidities, such as depression and anxiety and they are therefore often simultaneously treated with more than one drug. The probability of drug interactions increases with every additional drug.

Material And Methods: A systematic internet and literature search up to February 2015 was carried out. Systematic lists were included. In addition, the drug prescription information sheets were used and an internet search via Pubmed and google.com was carried out for drugs alone and in combination in order to find substance-specific interactions.

Results: A differentiation is made between pharmaceutical, pharmacodynamic and pharmacokinetic drug interactions. Pharmaceutical interactions are caused by chemical, physical or physicochemical incompatibility of drugs or adjuvants used. These can even occur outside the body and during concomitant administration via the same route. A pharmacodynamic interaction in pain management is for example the additive sedative effect of opioids and benzodiazepines when taken together. Pharmacokinetic interactions occur during the absorption, distribution, metabolism and in the elimination phases.

Conclusion: Many drug interactions can be avoided by careful and continuous evaluation of pharmacotherapy and if necessary its adaptation; however, a sound knowledge of the underlying pharmacological mechanisms and the properties of currently used analgesics is necessary.

References

Oneta C, Lieber C, Li J, Ruttimann S, Schmid B, Lattmann J . Dynamics of cytochrome P4502E1 activity in man: induction by ethanol and disappearance during withdrawal phase. J Hepatol. 2002; 36(1):47-52. DOI: 10.1016/s0168-8278(01)00223-9. View

McClements B, Hyland M, Callender M, BLAIR T . Management of paracetamol poisoning complicated by enzyme induction due to alcohol or drugs. Lancet. 1990; 335(8704):1526. DOI: 10.1016/0140-6736(90)93063-u. View

Khan A, Warner H, Brown W . Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: an analysis of the Food and Drug Administration database. Arch Gen Psychiatry. 2000; 57(4):311-7. DOI: 10.1001/archpsyc.57.4.311. View

Dart R, Green J, Kuffner E, Heard K, Sproule B, Brands B . The effects of paracetamol (acetaminophen) on hepatic tests in patients who chronically abuse alcohol - a randomized study. Aliment Pharmacol Ther. 2010; 32(3):478-86. DOI: 10.1111/j.1365-2036.2010.04364.x. View

Potter W, Thorgeirsson S, JOLLOW D, Mitchell J . Acetaminophen-induced hepatic necrosis. V. Correlation of hepatic necrosis, covalent binding and glutathione depletion in hamsters. Pharmacology. 1974; 12(3):129-43. DOI: 10.1159/000136531. View

Isbister G, Dawson A, Whyte I, Prior F, Clancy C, Smith A . Neonatal paroxetine withdrawal syndrome or actually serotonin syndrome?. Arch Dis Child Fetal Neonatal Ed. 2001; 85(2):F147-8. PMC: 1721292. DOI: 10.1136/fn.85.2.f145g. View

Alvan G, Bechtel P, Iselius L, Gundert-Remy U . Hydroxylation polymorphisms of debrisoquine and mephenytoin in European populations. Eur J Clin Pharmacol. 1990; 39(6):533-7. DOI: 10.1007/BF00316090. View

Heiskanen T, Backman J, Neuvonen M, Kontinen V, Neuvonen P, Kalso E . Itraconazole, a potent inhibitor of P-glycoprotein, moderately increases plasma concentrations of oral morphine. Acta Anaesthesiol Scand. 2008; 52(10):1319-26. DOI: 10.1111/j.1399-6576.2008.01739.x. View

Gijtenbeek J, van den Bent M, Vecht C . Cyclosporine neurotoxicity: a review. J Neurol. 1999; 246(5):339-46. DOI: 10.1007/s004150050360. View

10.

Rosskopf D, Kroemer H, Siegmund W . [Pharmacokinetic problems in clinical practice: role of drug transporters]. Dtsch Med Wochenschr. 2009; 134(8):345-56. DOI: 10.1055/s-0028-1124005. View

11.

Pearson E, Woosley R . QT prolongation and torsades de pointes among methadone users: reports to the FDA spontaneous reporting system. Pharmacoepidemiol Drug Saf. 2005; 14(11):747-53. DOI: 10.1002/pds.1112. View

12.

Whitcomb D, Block G . Association of acetaminophen hepatotoxicity with fasting and ethanol use. JAMA. 1994; 272(23):1845-50. DOI: 10.1001/jama.1994.03520230055038. View

13.

Benson G, Koff R, Tolman K . The therapeutic use of acetaminophen in patients with liver disease. Am J Ther. 2005; 12(2):133-41. DOI: 10.1097/01.mjt.0000140216.40700.95. View

14.

Cascorbi I . Drug interactions--principles, examples and clinical consequences. Dtsch Arztebl Int. 2012; 109(33-34):546-55. PMC: 3444856. DOI: 10.3238/arztebl.2012.0546. View

15.

Larson A, Polson J, Fontana R, Davern T, Lalani E, Hynan L . Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology. 2005; 42(6):1364-72. DOI: 10.1002/hep.20948. View

16.

Hammad T, Laughren T, Racoosin J . Suicide rates in short-term randomized controlled trials of newer antidepressants. J Clin Psychopharmacol. 2006; 26(2):203-7. DOI: 10.1097/01.jcp.0000203198.11453.95. View

17.

Zhao L, Pickering G . Paracetamol metabolism and related genetic differences. Drug Metab Rev. 2010; 43(1):41-52. DOI: 10.3109/03602532.2010.527984. View

18.

Bertilsson L, Dahl M, Dalen P, Al-Shurbaji A . Molecular genetics of CYP2D6: clinical relevance with focus on psychotropic drugs. Br J Clin Pharmacol. 2002; 53(2):111-22. PMC: 1874287. DOI: 10.1046/j.0306-5251.2001.01548.x. View

19.

Read R, Tredger J, Williams R . Analysis of factors responsible for continuing mortality after paracetamol overdose. Hum Toxicol. 1986; 5(3):201-6. DOI: 10.1177/096032718600500309. View

20.

Grun B, Merkel U, Riedel K, Weiss J, Mikus G . Contribution of CYP2C19 and CYP3A4 to the formation of the active nortilidine from the prodrug tilidine. Br J Clin Pharmacol. 2012; 74(5):854-63. PMC: 3495150. DOI: 10.1111/j.1365-2125.2012.04261.x. View