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1.
J Opioid Manag ; 17(7): 179-182, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520040

RESUMO

This case report demonstrates using buprenorphine 32 mg to achieve adequate pain control after a total knee replacement. The patient stopped buprenorphine 48 hours before surgery. He was prescribed 150 tablets of oxycodone 5 mg. After finishing oxycodone, he experienced significant pain that was relieved by 32 mg of buprenorphine daily. Urine drug screens were negative perioperatively. Patients with opioid use disorder require careful discharge planning to avoid opioid relapses or misuses of pain medications. Buprenorphine offers many unique advantages in acute pain control, including lower risk of respiratory depression, abuse potential, and lower risk of nephrotoxicity.


Assuntos
Artroplastia do Joelho , Buprenorfina , Analgésicos Opioides/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Buprenorfina/efeitos adversos , Humanos , Masculino , Oxicodona/efeitos adversos , Dor
2.
PLoS One ; 16(9): e0257021, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34499688

RESUMO

OBJECTIVE: To compare the effectiveness and safety of prescribing ibuprofen and oxycodone for at-home management of children's fracture pain. METHODS: A prospective observational cohort was conducted at the Stollery Children's Hospital pediatric emergency department (June 2010-July 2014). Children aged 4-16 years with an isolated fracture discharged home with advice to use either ibuprofen or oxycodone were recruited. RESULTS: A cohort of 329 children (n = 217 ibuprofen, n = 112 oxycodone) were included. Mean age was 11.1 years (SD 3.5); 68% (223/329) were male. Fracture distribution included 80.5% (264/329) upper limb with 34.3% (113/329) requiring fracture reduction. The mean reduction in Faces Pain Score-Revised score (maximum pain-post-treatment pain) for Day 1 was 3.6 (SD 1.9) (ibuprofen) and 3.8 (SD 2.1) (oxycodone) (p = 0.50); Day 2 was 3.6 (SD 1.8) (ibuprofen) and 3.7 (SD 1.6) (oxycodone) (p = 0.56); Day 3 was 3.7 (SD 1.7) (ibuprofen) and 3.3 (SD 1.7) (oxycodone) (p = 0.24). Children prescribed ibuprofen (51.2%, 109/213) experienced less adverse events compared to those prescribed oxycodone (70.5% 79/112) on Day 1 (p = 0.001). Children prescribed ibuprofen (71.8%, 150/209) had their function (eat, play, school, sleep) affected less than those prescribed oxycodone (83.0%, 93/112) (p = 0.03) on Day 1. CONCLUSION: Children prescribed ibuprofen or oxycodone experienced similar analgesic effectiveness for at-home fracture pain. Oxycodone prescribing was associated with more adverse events and negatively impacted function. Oxycodone use does not appear to confer any benefit over ibuprofen for pain relief and has a negative adverse effect profile. Ibuprofen appears to be a safe option for fracture-related pain.


Assuntos
Analgésicos não Narcóticos/administração & dosagem , Fraturas Ósseas/tratamento farmacológico , Ibuprofeno/administração & dosagem , Oxicodona/administração & dosagem , Acetaminofen/administração & dosagem , Acetaminofen/efeitos adversos , Adolescente , Analgésicos não Narcóticos/efeitos adversos , Analgésicos Opioides , Criança , Pré-Escolar , Estudos de Coortes , Método Duplo-Cego , Serviço Hospitalar de Emergência , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/patologia , Humanos , Ibuprofeno/efeitos adversos , Masculino , Oxicodona/efeitos adversos , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/patologia
3.
eNeuro ; 8(4)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34312305

RESUMO

Opioid drugs are increasingly being prescribed to pregnant women. Such compounds can also bind and activate opioid receptors in the fetal brain, which could lead to long-term brain and behavioral disruptions. We hypothesized that maternal treatment with oxycodone (OXY), the primary opioid at the center of the current crisis, leads to later neurobehavioral disorders and gene expression changes in the hypothalamus and hippocampus of resulting offspring. Female mice were treated daily with 5 mg OXY/kg or saline solution (control; CTL) for two weeks before breeding and then throughout gestation. Male and female offspring from both groups were tested with a battery of behavioral and metabolic tests to measure cognition, exploratory-like, anxiety-like, voluntary physical activity, and socio-communication behaviors. qPCR analyses were performed for candidate gene expression patterns in the hypothalamus and hippocampus of OXY and CTL derived offspring. Developmental exposure to OXY caused socio-communication changes that persisted from weaning through adulthood. Such offspring also showed cognitive impairments, reduced voluntary physical activity, and weighed more than CTL counterparts. In the hippocampus, prenatal exposure to OXY caused sex-dependent differences in expression of genes encoding opioid receptors and those involved in serotonin signaling. OXY exposure induced changes in neuropeptide hormone expression and the epigenetic modulator, Dnmt3a, in the hypothalamus, which could result in epigenetic changes in this brain region. The findings suggest cause for concern that consumption of OXY by pregnant mothers may result in permanent neurobehavioral changes in their offspring. Further work is needed to determine the potential underpinning epigenetic mechanisms.


Assuntos
Oxicodona , Efeitos Tardios da Exposição Pré-Natal , Animais , Ansiedade , Epigênese Genética , Feminino , Hipocampo , Hipotálamo , Masculino , Camundongos , Oxicodona/efeitos adversos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/genética
4.
BMJ Open ; 11(6): e044157, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193479

RESUMO

OBJECTIVES: Sex as a biological variable affects response to opioids. However, few reports describe the prevalence of specific adverse reactions to commonly prescribed opioids in men and women separately. A large cohort was used to investigate sex differences in type and occurrence of adverse reactions associated with use of codeine, tramadol, oxycodone and hydrocodone. DESIGN: Retrospective cohort study. SETTING: Participants in the Right Drug, Right Dose, Right Time (RIGHT) Study. PARTICIPANTS: The medical records of 8457 participants in the RIGHT Study who received an opioid prescription between 1 January 2004 and 31 December 2017 were reviewed 61% women, 94% white, median age (Q1-Q3)=58 (47-66). PRIMARY AND SECONDARY OUTCOME MEASURES: Adverse reactions including gastrointestinal, skin, psychiatric and nervous system issues were collected from the allergy section of each patient's medical record. Sex differences in the risk of adverse reactions due to prescribed opioids were modelled using logistic regression adjusted for age, body mass index, race and ethnicity. RESULTS: From 8457 participants (of which 449 (5.3%) reported adverse reactions), more women (6.5%) than men (3.4%) reported adverse reactions to at least one opioid (OR (95% CI)=2.3 (1.8 to 2.8), p<0.001). Women were more likely to report adverse reactions to tramadol (OR (95% CI)=2.8 (1.8 to 4.4), p<0.001) and oxycodone (OR (95% CI)=2.2 (1.7 to 2.9), p<0.001). Women were more likely to report gastrointestinal (OR (95% CI)=3.1 (2.3 to 4.3), p<0.001), skin (OR (95% CI)=2.1 (1.4 to 3.3), p=0.001) and nervous system issues (OR (95% CI)=2.3 (1.3 to 4.2), p=0.004). CONCLUSIONS: These findings support the importance of sex as a biological variable to be factored into pain management studies.


Assuntos
Analgésicos Opioides , Caracteres Sexuais , Analgésicos Opioides/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Masculino , Oxicodona/efeitos adversos , Estudos Retrospectivos
5.
Nihon Yakurigaku Zasshi ; 156(3): 128-133, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33952838

RESUMO

In Japan, 14 opioids with a variety of dosage forms, such as oral preparation, injection, transdermal patch, transmucosal and suppository are clinically available as analgesics, and their use properly depends on the type and degree of pain and patient condition. Fundamentally, strong opioids are restricted to only treatment of cancer pain, while the indication of fentanyl transdermal patch and oxycodone tamper resistant tablet has been expanded for the treatment of non-cancer chronic pain. In US, the additional indication of opioids to chronic pain has led to prolongation and generalization of opioid use, which may contribute to "opioid crisis" in which opioid-related death strikingly increased due to opioid abuse and overdose-induced respiratory depression. Currently, opioid-related abuse and death have not been evident in Japan, while abuse of antitussive opioids (codeine and dihydrocodeine) are recently seen as a problem, which may suggest the sense of guilt to abuse legally-uncontrolled drugs (ex. weak opioids, antitussives or hypnotics) may be low in Japanese. In this review, I will summarize current status and issues in clinical use of opioid analgesics, and will talk about the necessity and expectation for development of novel analgesics without serious adverse reactions such as addiction and respiratory depression.


Assuntos
Analgésicos Opioides , Dor Crônica , Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Humanos , Japão , Oxicodona/efeitos adversos
6.
Pain Physician ; 24(3): E309-E315, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33988952

RESUMO

BACKGROUND: Tapentadol has relatively less effect on mu-opioid receptors compared with other opioids. This has the potential to reduce the occurrence of gastrointestinal (GI) adverse drug events (ADEs). OBJECTIVES: To compare the GI ADEs during hospitalization between tapentadol immediate release (IR) and oxycodone IR following orthopedic surgeries. STUDY DESIGN: Retrospective cohort study. SETTING: A major metropolitan tertiary referral hospital in Australia. METHODS: Data for adult orthopedic surgery patients receiving postoperative tapentadol IR or oxycodone IR during hospitalization between January 1, 2018 and June 30, 2019, were collected from electronic medical records. The primary outcome was the occurrence of postoperative GI ADEs occurring during hospitalization. This was defined as a composite of nausea, vomiting, or constipation. RESULTS: The study cohort included 199 patients. Of these, 99 patients received tapentadol IR and 100 patients received oxycodone IR for postoperative pain during hospitalization. The mean age was 66 ± 12 years, and 111 patients (56%) were women. There was no significant difference between groups on the occurrence of GI ADEs (53% in oxycodone group and 51% in tapentadol group, difference 2%, 95% confidence interval [CI], -11% to 16%; P = 0.777). After adjusting for potential confounders, the use of tapentadol IR was not associated with a significant reduction of GI ADEs (odds ratio, 0.62; 95% CI, 0.32-1.20; P = 0.154). LIMITATIONS: This was a single-center study and should be extrapolated with caution. As this was a retrospective study, the accuracy and availability of data were dependent on documentation in electronic medical records. CONCLUSIONS: Tapentadol IR is associated with similar GI ADE occurrence compared with oxycodone IR in patients with orthopedic postoperative pain during hospitalization.


Assuntos
Procedimentos Ortopédicos , Oxicodona , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Oxicodona/efeitos adversos , Fenóis/efeitos adversos , Estudos Retrospectivos , Tapentadol
7.
Biol Pharm Bull ; 44(4): 593-598, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33790110

RESUMO

Nausea is a typical adverse event associated with opioids. In this study, we performed logistic regression analysis with the aim of clarifying the risk factors for nausea induced by extended-release oxycodone (ER-OXY). Furthermore, we constructed a decision tree (DT) model, a typical data mining method, to estimate the risk of oxycodone-induced nausea by combining multiple factors. A retrospective study was conducted on patients who newly received ER-OXY for cancer pain during hospitalization at Hokkaido University Hospital in Japan from April 2015 to March 2018. In logistic regression and DT analyses, the dependent variable was the presence or absence of nausea. Independent variables were the potential risk factors. First, univariate analyses were performed to screen potential factors associated with oxycodone-induced nausea. Then, multivariate and DT analyses were performed using factors with p-values <0.1 in the univariate analysis. Of 267 cases included in this study, nausea was observed in 30.3% (81/267). In multivariate logistic regression analysis, only female sex was extracted as an independent factor affecting nausea (odds ratio, 1.98). In the DT analysis, we additionally revealed that an age <50 years was a risk factor for nausea in female patients. Thus, our DT model indicated that the risk of ER-OXY-induced nausea was highest in the subgroup comprising females <50 years of age (66.7%) and lowest in male patients (25.1%). The DT model suggested that the factor of young women may be an increased risk of ER-OXY-induced nausea.


Assuntos
Analgésicos Opioides/efeitos adversos , Árvores de Decisões , Modelos Teóricos , Náusea/induzido quimicamente , Oxicodona/efeitos adversos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dor do Câncer/tratamento farmacológico , Preparações de Ação Retardada/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Comprimidos , Adulto Jovem
8.
Drug Alcohol Depend ; 221: 108628, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33761428

RESUMO

BACKGROUND: The broad use/misuse of prescription opioids during pregnancy has resulted in a surge of infants with Neonatal Opioid Withdrawal Syndrome (NOWS). Short-term irritability and neurological complications are its hallmarks, but the long-term consequences are unknown. METHODS: A newly-developed preclinical model of oxycodone self-administration enables adult female rats to drink oxycodone (∼10/mg/kg/day) before and during pregnancy, and after delivery, and to maintain normal liquid intake, titrate dosing, and avoid withdrawal. RESULTS: Oxycodone was detected in the serum of mothers and pups. Growth parameters in dams and pups and litter mass and size were similar to controls. There were no differences in paw retraction latency to a thermal stimulus between Oxycodone and Control pups at postnatal (PN) 2 or PN14. Oxycodone and Control pups had similar motor coordination, cliff avoidance, righting time, pivoting, and olfactory spatial learning from PN3 through PN13. Separation-induced ultrasonic vocalizations at PN8 revealed higher call frequency in Oxycodone pups relative to Control pups (p<0.031; Cohen's d=1.026). Finally, Oxycodone pups displayed withdrawal behaviors (p's<0.029; Cohen's d's>0.806), and Oxycodone males only vocalized more than Control pups in the first minute of testing (p's<0.050; Cohen's d's>.866). Significant effects were corroborated by estimation plots. CONCLUSIONS: Our rat model of oral oxycodone self-administration in pregnancy shows exacerbated affect/social communication in pups in a sex-dependent manner but spared cognition and sensory-motor behaviors. This preclinical model reproduces selective aspects of human opioid use during pregnancy, enabling longitudinal analysis of how maternal oxycodone changes emotional behavior in the offspring.


Assuntos
Analgésicos Opioides/administração & dosagem , Comportamento Animal/efeitos dos fármacos , Síndrome de Abstinência Neonatal/psicologia , Oxicodona/administração & dosagem , Aprendizagem Espacial/efeitos dos fármacos , Administração Oral , Afeto/efeitos dos fármacos , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/sangue , Animais , Animais Recém-Nascidos , Comunicação , Modelos Animais de Doenças , Feminino , Masculino , Síndrome de Abstinência Neonatal/etiologia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Oxicodona/efeitos adversos , Oxicodona/sangue , Gravidez , Complicações na Gravidez/tratamento farmacológico , Ratos , Autoadministração , Síndrome de Abstinência a Substâncias/prevenção & controle
9.
J Opioid Manag ; 17(1): 79-96, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33735430

RESUMO

OBJECTIVE: To determine the incidence of addiction and dependence in persons with chronic noncancer pain (CNCP) who are treated with oxycodone. DESIGN: Systematic review following PRISMA guidelines. METHODS: PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Library were searched from inception to January 2020. Of 1,320 retrieved citations screened by two independent raters at title and abstract and full-text screening, six articles fulfilled the eligibility criteria for the systematic review. Data extraction and risk of bias assessment followed article screening. The Cochrane Collaboration tool and the Newcastle-Ottawa Scale (NOS) were used to assess the risk of bias in individual studies. RESULTS: Two of the six articles reported addiction and the remaining four reported dependence. The incidence rates of addiction were 2.91 percent and 1.72 percent, and the incidence rates of dependence were 0.00 percent, 0.44 percent, 0.45 percent, and 5.77 percent. In all articles, addiction and dependence were treated as secondary outcomes. Three randomized controlled trials (RCTs) had follow-up lengths of less than 31 days, which is insufficient to assess the incidence of addiction or dependence. CONCLUSIONS: The results of this systematic review show that oxycodone use leads to addiction and dependence in a small proportion of individuals with CNCP. However, one must exercise caution when drawing conclusions from the six included articles. Future studies in the area should examine addiction and dependence as primary outcomes using adequate follow-up periods.


Assuntos
Dor Crônica , Oxicodona , Analgésicos Opioides/efeitos adversos , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Humanos , Doença Iatrogênica , Oxicodona/efeitos adversos , Prescrições
10.
Eur J Anaesthesiol ; 38(9): 995-1002, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33428347

RESUMO

BACKGROUND: Tapentadol is an opioid, which acts as a µ-opioid receptor agonist and inhibits noradrenaline reuptake in the central nervous system. This dual mechanism of action results in synergistic analgesic effects and potentially less side effects. This has been shown in treatment of chronic pain but postoperative studies are sparse. OBJECTIVES: The main aim was to compare the analgesic effect of tapentadol with oxycodone after laparoscopic hysterectomy. Opioid side effects were recorded as secondary outcomes. DESIGN: Randomised, blinded trial. SETTING: Single-centre, Oslo University Hospital, Norway, December 2017 to February 2019. PATIENTS: Eighty-six opioid-naïve American Society of Anesthesiologists physical status 1 to 3 women undergoing laparoscopic hysterectomy for nonmalignant conditions. INTERVENTION: The patients received either oral tapentadol (group T) or oxycodone (group O) as part of multimodal pain treatment. Extended-release study medicine was administered 1 h preoperatively and after 12 h. Immediate-release study medicine was used as rescue analgesia. MAIN OUTCOME MEASURES: Pain scores, opioid consumption and opioid-induced side effects were evaluated during the first 24 h after surgery. RESULTS: The groups scored similarly for pain at rest using a numerical rating scale (NRS) 1 h postoperatively (group T 4.4, 95% CI, 3.8 to 5.0, group O 4.6, 95% CI, 3.8 to 5.3). No statistically significant differences were found between the groups for NRS at rest or while coughing during the 24-h follow-up period (P = 0.857 and P = 0.973). Mean dose of oral rescue medicine was similar for the groups (P = 0.914). Group T had significantly lower odds for nausea at 2 and 3 h postoperatively (P = 0.040, P = 0.020) and less need for antiemetics than group O. No differences were found for respiratory depression, vomiting, dizziness, pruritus, headache or sedation. CONCLUSION: We found tapentadol to be similar in analgesic efficacy to oxycodone during the first 24 h after hysterectomy, but with significantly less nausea. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03314792.


Assuntos
Analgesia , Dor Crônica , Laparoscopia , Analgésicos Opioides/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Histerectomia/efeitos adversos , Oxicodona/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Fenóis/efeitos adversos , Tapentadol
11.
EBioMedicine ; 63: 103192, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33418508

RESUMO

BACKGROUND: The United States is currently facing an opioid crisis. Novel tools to better comprehend dynamic molecular changes in the brain associated with the opioid abuse are limited. Recent studies have suggested the usefulness of plasma exosomes in better understanding CNS disorders. However, no study has ever characterized exosomes (small extracellular vesicles of endocytic origin) secreted by brain cells to understand the potential neurodegenerative effects of long-term oxycodone self-administration (SA). METHODS: MRI of Cynomolgus monkeys (Macaca fascicularis) was performed to assess alterations in gray matter volumes with oxycodone SA. We isolated total exosomes (TE) from the plasma of these monkeys; from TE, we pulled-out neuron-derived exosomes (NDE), astrocytes-derived exosomes (ADE), and microglia-derived exosomes (MDE) using surface biomarkers L1CAM (L1 cell adhesion molecule), GLAST (Glutamate aspartate transporter) and TMEM119 (transmembrane protein119), respectively. FINDINGS: We observed a significantly lower gray matter volume of specific lobes of the brain (frontal and parietal lobes, and right putamen) in monkeys with ∼3 years of oxycodone SA compared to controls. Higher expression of neurodegenerative biomarkers (NFL and α-synuclein) correlates well with the change in brain lobe volumes in control and oxycodone SA monkeys. We also identified a strong effect of oxycodone SA on the loading of specific miRNAs and proteins associated with neuro-cognitive disorders. Finally, exosomes subpopulation from oxycodone SA group activated NF-κB activity in THP1- cells. INTERPRETATION: These results provide evidence for the utility of brain cells-derived exosomes from plasma in better understanding and predicting the pro-inflammatory and neurodegenerative consequence of oxycodone SA. FUNDING: NIH.


Assuntos
Biomarcadores , Encéfalo/metabolismo , Exossomos/metabolismo , Doenças Neurodegenerativas/etiologia , Doenças Neurodegenerativas/metabolismo , Oxicodona/efeitos adversos , Animais , Astrócitos/metabolismo , Modelos Animais de Doenças , Suscetibilidade a Doenças , Expressão Gênica , Macaca fascicularis , Imageamento por Ressonância Magnética , Masculino , Microglia/metabolismo , Doenças Neurodegenerativas/diagnóstico , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Oxicodona/administração & dosagem , Transporte Proteico , Proteoma , Proteômica/métodos
12.
Eur J Med Res ; 26(1): 4, 2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33422129

RESUMO

BACKGROUND: Intravenous opioids are administered for the management of visceral pain after laparoscopic surgery. Whether oxycodone has advantages over other opioids in the treatment of visceral pain is not yet clear. METHODS: In this study, the analgesic efficiency and adverse events of oxycodone and other opioids, including alfentanil, sufentanil, fentanyl, and morphine, in treating post-laparoscopic surgery visceral pain were evaluated. This review was conducted according to the methodological standards described in the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The PubMed, Embase, and Cochrane databases were searched in December 2019. RESULTS: Ten studies were included in this review. The sample size was 695 participants. The results showed that compared with morphine and fentanyl, oxycodone had a more potent analgesic efficacy on the first day after laparoscopic surgery, especially during the first 0.5 h. There was no significant difference in sedation between the two groups. Compared to morphine and fentanyl, oxycodone was more likely to lead to dizziness and drowsiness. Overall, patient satisfaction did not differ significantly between oxycodone and other opioids. CONCLUSIONS: Oxycodone is superior to other analgesics within 24 h after laparoscopic surgery, but its adverse effects should be carefully considered.


Assuntos
Laparoscopia/métodos , Oxicodona/efeitos adversos , Manejo da Dor , Dor/tratamento farmacológico , Alfentanil/efeitos adversos , Alfentanil/uso terapêutico , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Fentanila/efeitos adversos , Fentanila/uso terapêutico , Humanos , Morfina/efeitos adversos , Morfina/uso terapêutico , Oxicodona/uso terapêutico , Dor/patologia , Sufentanil/efeitos adversos , Sufentanil/uso terapêutico
13.
Psychopharmacology (Berl) ; 238(2): 539-549, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33169203

RESUMO

RATIONALE: Epidemiological data indicate that drivers testing positive for an opioid drug are twice as likely to cause a fatal car crash; however, there are limited controlled data available. OBJECTIVES: The primary aim of this study was to assess the effects of a therapeutic dose range of oxycodone alone and in combination with alcohol on simulated driving performance. METHODS: Healthy participants (n = 10) completed this within-subject, double-blind, placebo-controlled, randomized outpatient study. Six 7-h sessions were completed during which oxycodone (0, 5, 10 mg, p.o.) was administered 30 min before alcohol (0, 0.8 g/kg (15% less for women), p.o.) for a total of 6 test conditions. Driving assessments and participant-, observer-rated, psychomotor and physiological measures were collected in regular intervals before and after drug administration. RESULTS: Oxycodone alone (5, 10 mg) did not produce any changes in driving outcomes or psychomotor task performance, relative to placebo (p > 0.05); however, 10 mg oxycodone produced increases in an array of subjective ratings, including sedation and impairment (p < 0.05). Alcohol alone produced driving impairment (e.g., decreased lateral control) (p < 0.05); however, oxycodone did not potentiate alcohol-related driving or subjective effects. CONCLUSIONS: These preliminary data suggest that acute doses of oxycodone (5, 10 mg) do not significantly impair acuity on laboratory-based simulated driving models; however, 10 mg oxycodone produced increases in self-reported outcomes that are not compatible with safe driving behavior (e.g., sedation, impairment). Additional controlled research is needed to determine how opioid misuse (higher doses; parenteral routes of administration) impacts driving risk.


Assuntos
Dirigir sob a Influência/psicologia , Etanol/efeitos adversos , Modelos Psicológicos , Oxicodona/efeitos adversos , Desempenho Psicomotor/efeitos dos fármacos , Adulto , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Sinergismo Farmacológico , Etanol/administração & dosagem , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/psicologia , Oxicodona/administração & dosagem
14.
Reg Anesth Pain Med ; 46(2): 151-156, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33172902

RESUMO

INTRODUCTION: Opioid exposure during hospitalization for cesarean delivery increases the risk of new persistent opioid use. We studied the effectiveness of stepwise multimodal opioid-sparing analgesia in reducing oxycodone use during cesarean delivery hospitalization and prescriptions at discharge. METHODS: This retrospective cohort study analyzed electronic health records of consecutive cesarean delivery cases in four academic hospitals in a large metropolitan area, before and after implementation of a stepwise multimodal opioid-sparing analgesic computerized order set coupled with provider education. The primary outcome was the proportion of women not using any oxycodone during in-hospital stay ('non-oxycodone user'). In-hospital secondary outcomes were: (1) total in-hospital oxycodone dose among users, and (2) time to first oxycodone pill. Discharge secondary outcomes were: (1) proportion of oxycodone-free discharge prescription, and (2) number of oxycodone pills prescribed. RESULTS: The intervention was associated with a significant increase in the proportion of non-oxycodone users from 15% to 32% (17% difference; 95% CI 10 to 25), a decrease in total in-hospital oxycodone dose among users, and no change in the time to first oxycodone dose. The adjusted OR for being a non-oxycodone user associated with the intervention was 2.67 (95% CI 2.12 to 3.50). With the intervention, the proportion of oxycodone-free discharge prescription increased from 4.4% to 8.5% (4.1% difference; 95% CI 2.5 to 5.6) and the number of prescribed oxycodone pills decreased from 30 to 18 (-12 pills difference; 95% CI -11 to -13). CONCLUSIONS: Multimodal stepwise analgesia after cesarean delivery increases the proportion of oxycodone-free women during in-hospital stay and at discharge.


Assuntos
Analgésicos Opioides , Oxicodona , Analgésicos , Analgésicos Opioides/efeitos adversos , Feminino , Hospitais , Humanos , Oxicodona/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Alta do Paciente , Padrões de Prática Médica , Gravidez , Prescrições , Estudos Retrospectivos
15.
Acta Anaesthesiol Scand ; 65(1): 40-46, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32790073

RESUMO

BACKGROUND: The value of intravenous oxycodone compared to morphine remains controversial. The purpose of this trial was to compare opioid-related adverse events (ORAES) of intravenous oxycodone and morphine after total hip arthroplasty. METHODS: Patients scheduled for total hip arthroplasty were enrolled in this study of post-operative pain treatment with intravenous oxycodone or intravenous morphine (ratio 1:1). After surgery, patients received similar drug regimens for titration in the post-operative care unit followed by intravenous patient-controlled analgesia (PCA). The primary outcome was the number of patients with ≥1 ORAEs within the first 24 hours defined as either nausea, vomiting, respiratory depression, pruritus, urinary retention requiring evacuation, allergy, hallucinations. Secondary outcomes included pain scores and opioid consumption. RESULTS: The analysis included 238 patients with similar characteristics. There were 55 patients with at least one ORAEs in the oxycodone group vs 46 in the morphine group: 48% vs 40%, P = .19; relative risk = 1.22 (0.91:1.63). Intravenous oxycodone vs intravenous morphine requirements were respectively (median, IQR): 6 (0-11) vs 8 (0-12) mg (P = .06) for titration, 15 (8-26) vs 8 (5-16) mg (P = .001) for PCA, and 22 (12-37) mg vs 19 (11-28) mg for cumulated intravenous consumption (P = .048). During the first 24 hours, there was no difference in secondary outcomes (oxycodone vs morphine, respectively, in %): nausea (15 vs 13), vomiting (5 vs 5), urinary retention (20 vs 12) or pain scores. CONCLUSION: This study demonstrates that IV oxycodone did not significantly reduce ORAEs within the first 24 hours compared to similar ratio of IV morphine.


Assuntos
Analgésicos Opioides , Oxicodona , Analgesia Controlada pelo Paciente , Analgésicos Opioides/efeitos adversos , Método Duplo-Cego , Humanos , Morfina/efeitos adversos , Oxicodona/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico
16.
Gerontology ; 67(1): 9-16, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33260183

RESUMO

BACKGROUND: With a rapidly aging population, the need for endoscopic retrograde cholangiopancreatography (ERCP) is increasing. The commonly used sedation anesthesia in ERCP is a combination of propofol and fentanyl, even though fentanyl may cause some adverse reactions such as respiratory depression. OBJECTIVES: This study aimed to evaluate the efficacy of oxycodone combined with propofol versus fentanyl combined with propofol for sedation anesthesia during ERCP. METHODS: A total of 193 patients aged from 65 to 80 years undergoing ERCP were enrolled and randomized into two groups: an "oxycodone combined with propofol" group (group OP, n = 97) and a "fentanyl combined with propofol" group (group FP, n = 96). The rate of perioperative adverse events as well as the recovery time, patients' satisfaction, and endoscopists' satisfaction were noted. RESULTS: There was no difference in the frequency of hypotension or bradycardia between the two groups, but there were more episodes of desaturation (SpO2 <90% for >10 s in 8.3%), postoperative nausea (7.3%), and vomiting (5.2%) in group FP than in group OP. Patients' satisfaction in group FP was lower than that in group OP. The recovery time was longer in group FP than in group OP. CONCLUSIONS: Oxycodone combined with propofol was effective in ERCP, with a low incidence of perioperative adverse events.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Sedação Consciente/métodos , Fentanila , Oxicodona , Propofol , Idoso , Período de Recuperação da Anestesia , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Bradicardia/etiologia , Bradicardia/prevenção & controle , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Quimioterapia Combinada/métodos , Feminino , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Humanos , Hipotensão/etiologia , Hipotensão/prevenção & controle , Hipóxia/etiologia , Hipóxia/prevenção & controle , Masculino , Oxicodona/administração & dosagem , Oxicodona/efeitos adversos , Satisfação do Paciente , Propofol/administração & dosagem , Propofol/efeitos adversos , Resultado do Tratamento
17.
Pain Manag ; 11(2): 201-215, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33300384

RESUMO

Opioid overdoses and deaths continue to be a problem in the USA with a significant portion related to prescribed opioid analgesic agents. The role of pharmacogentic factors in opioid addiction is an active area of research. While all opioid analgesic agents have some addictive potential, it is clear that there are some with greater addictive potential. Oxycodone is the most widely abused opioid analgesic and it appears to predispose to chronic use with high likability by users. Fentanyl and hydromorphone are both very lipophilic allowing rapid penetration into the CNS, but are not rated as highly as other agents. Providers should consider the risk of addiction with the opioids they prescribe and give those with a lower addictive potential.


Assuntos
Analgésicos Opioides/efeitos adversos , Prescrições de Medicamentos/normas , Fentanila/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/genética , Oxicodona/efeitos adversos , Farmacogenética , Humanos
18.
Pain Manag ; 11(1): 39-47, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32996831

RESUMO

Aim: To explore fracture outcomes with tapentadol or oxycodone, two opioids with differing mechanisms of action. Materials & methods: Retrospective cohort pilot study, using MarketScan® Commercial and Medicare Supplemental claims databases, on patients with postoperative pain, back pain, or osteoarthritis and ≥1 claim for tapentadol (n = 16,457), oxycodone (n = 1,356,920), or both (n = 15,893) between June 2009 and December 2015. Results: During 266,826 and 9,007,889 days of tapentadol and oxycodone treatment, patients evidenced 1080 and 72,275 fractures, respectively. Fracture rates per treatment-year were 1.512 for tapentadol and 3.013 for oxycodone. Conclusion: Examination of administrative claims has inherent limitations, but this exploratory analysis indicates a lower fracture rate with tapentadol than oxycodone in the analyzed dataset, which needs confirmation by further clinical trials.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor nas Costas/tratamento farmacológico , Fraturas Ósseas/induzido quimicamente , Osteoartrite/tratamento farmacológico , Oxicodona/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Tapentadol/efeitos adversos , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Dor nas Costas/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Osteoartrite/epidemiologia , Dor Pós-Operatória/epidemiologia , Projetos Piloto , Estudos Retrospectivos , Estados Unidos/epidemiologia
19.
Gan To Kagaku Ryoho ; 47(12): 1687-1690, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33342984

RESUMO

We retrospectively investigated the use of oral hydromorphone for cancer pain. Nineteen patients treated for cancer pain with oral hydromorphone were reviewed in this study. Cancers had occurred in the gastrointestinal (n=4), lung(n=3), breast(n=2), bone and soft tissue(n=2), hematological(n=2), and others(n=6). The administered opioids before switching to hydromorphone were morphine, oxycodone, and tapentadol. The mean oral morphine equivalent daily dose (OMEDD)was 89.3 mg. The average dose of hydromorphone administered was 16.4 mg/day, and average NRS 10(numerical rating scale: 0-10)scores of cancer pain before and after switching were 4.1 and 3.8, respectively, showing no significant differences. In this study, switching from other opioids to oral hydromorphone was feasible with an approved conversion ratio, ie, an oral hydromorphone-to-oral morphine ratio of 1:5. No severe adverse effects were observed. The oral hydromorphone extended-release formulation was administered every 24 h, as a tiny tablet formulation that is preferable owing to easy administration and adherence.


Assuntos
Hidromorfona , Neoplasias , Analgésicos Opioides/efeitos adversos , Humanos , Hidromorfona/efeitos adversos , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Oxicodona/efeitos adversos , Estudos Retrospectivos
20.
Int J Mol Sci ; 21(21)2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33153023

RESUMO

Human immunodeficiency virus (HIV) is associated with co-morbid affective and stress-sensitive neuropsychiatric disorders that may be related to dysfunction of the hypothalamic-pituitary-adrenal (HPA) stress axis. The HPA axis is perturbed in up to 46% of HIV patients, but the mechanisms are not known. The neurotoxic HIV-1 regulatory protein, trans-activator of transcription (Tat), may contribute. We hypothesized that HPA dysregulation may contribute to Tat-mediated interactions with oxycodone, a clinically-used opioid often prescribed to HIV patients. In transgenic male mice, Tat expression produced significantly higher basal corticosterone levels with adrenal insufficiency in response to a natural stressor or pharmacological blockade of HPA feedback, recapitulating the clinical phenotype. On acute exposure, HIV-1 Tat interacted with oxycodone to potentiate psychomotor and anxiety like-behavior in an open field and light-dark transition tasks, whereas repeated exposure sensitized stress-related psychomotor behavior and the HPA stress response. Pharmacological blockade of glucocorticoid receptors (GR) partially-restored the stress response and decreased oxycodone-mediated psychomotor behavior in Tat-expressing mice, implicating GR in these effects. Blocking corticotrophin-releasing factor (CRF) receptors reduced anxiety-like behavior in mice that were exposed to oxycodone. Together, these effects support the notion that Tat exposure can dysregulate the HPA axis, potentially raising vulnerability to stress-related substance use and affective disorders.


Assuntos
Transtornos de Ansiedade/etiologia , Sistema Hipotálamo-Hipofisário/metabolismo , Oxicodona/efeitos adversos , Sistema Hipófise-Suprarrenal/metabolismo , Transtornos Psicomotores/etiologia , Produtos do Gene tat do Vírus da Imunodeficiência Humana/fisiologia , Animais , Transtornos de Ansiedade/induzido quimicamente , Transtornos de Ansiedade/metabolismo , Transtornos de Ansiedade/patologia , Depressão/etiologia , Depressão/metabolismo , Depressão/patologia , Progressão da Doença , Interações Medicamentosas , Infecções por HIV/complicações , Infecções por HIV/metabolismo , Infecções por HIV/patologia , Infecções por HIV/psicologia , HIV-1/fisiologia , Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Sistema Hipotálamo-Hipofisário/patologia , Masculino , Camundongos , Camundongos Transgênicos , Transtornos do Humor/etiologia , Transtornos do Humor/metabolismo , Transtornos do Humor/patologia , Sistema Hipófise-Suprarrenal/efeitos dos fármacos , Sistema Hipófise-Suprarrenal/patologia , Transtornos Psicomotores/induzido quimicamente , Transtornos Psicomotores/patologia , Transtornos Psicomotores/virologia , Estresse Psicológico/induzido quimicamente , Estresse Psicológico/genética , Estresse Psicológico/metabolismo , Estresse Psicológico/patologia , Produtos do Gene tat do Vírus da Imunodeficiência Humana/genética , Produtos do Gene tat do Vírus da Imunodeficiência Humana/farmacologia
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