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Text
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URL Address
<a href="http://doi.org/10.1002/phar.2269" target="_blank" rel="noreferrer noopener">http://doi.org/10.1002/phar.2269</a>
Rights
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Pages
724-729
Issue
6
Volume
39
Dublin Core
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Title
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Efficacy of Tramadol for Pain Management in Patients Receiving Strong Cytochrome P450 2D6 Inhibitors
Publisher
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Pharmacotherapy
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
2019-06
Subject
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CYP2D6; cytochrome P450; drug interaction; pain control; tramadol
Creator
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Frost Derek A; Soric Mate M; Kaiser Ricky; Neugebauer Rachel E
Description
An account of the resource
STUDY OBJECTIVE: Tramadol is metabolized by cytochrome P450 (CYP) 2D6 to form an active metabolite that exhibits its analgesic effect. Medications that inhibit this enzyme are used often in practice, yet the clinical impact of this interaction on the analgesic effects of tramadol has yet to be fully described. The objective was to determine whether a clinically relevant decrease in pain control is observed in patients taking scheduled tramadol concomitantly with a strong CYP2D6 inhibitor. DESIGN: Retrospective cohort study. SETTING: Large health care system. PATIENTS: One hundred fifty-two adult inpatients who received scheduled tramadol for at least 24 hours with (76 patients) or without (76 patients) a strong CYP2D6 inhibitor between January 1, 2012, and February 28, 2017, were included in the analysis. Patients hospitalized for opioid use disorder or those receiving substandard dosing of tramadol were excluded. MEASUREMENTS AND MAIN RESULTS: The primary outcome was mean breakthrough opiate consumption in the presence and absence of CYP2D6 inhibitors. Secondary outcomes included mean pain scores, length of hospital stay, tramadol discontinuation rates, and prespecified subgroup analyses based on patient sex, race, and specific CYP2D6 inhibitor administered. Patients receiving concurrent CYP2D6 inhibitors required significantly more breakthrough morphine milligram equivalents per day compared with patients receiving scheduled tramadol without CYP2D6 inhibitors (geometric mean ± SD 18.2 ± 6.3 vs 5.7 ± 6.7 mg morphine milligram equivalents, p<0.001). No significant differences existed between cohorts for mean pain score, length of hospital stay, or tramadol discontinuation rate. CONCLUSION: This study demonstrated a clinically relevant decrease in the efficacy of tramadol when used for pain control in patients receiving a strong CYP2D6 inhibitor. These results should encourage clinicians to review medication lists for this interaction and adjust regimens accordingly to ensure adequate pain control.
Identifier
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<a href="http://doi.org/10.1002/phar.2269" target="_blank" rel="noreferrer noopener">10.1002/phar.2269</a>
2019
CYP2D6
cytochrome P450
Department of Pharmacy Practice
drug interaction
Frost Derek A
June 2019 Update
Kaiser Ricky
NEOMED College of Pharmacy
Neugebauer Rachel E
pain control
Pharmacotherapy
Soric Mate M
tramadol
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Hyperlink
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URL
10.3233/PRM-220048
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Efficacy of intrathecal morphine administration in pediatric patients undergoing selective dorsal rhizotomy
Creator
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Jared Pennington
Shawnelle Contini
Miraides Brown
Nupur Goel
Tsulee Chen
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Purpose: The purpose of this study was to evaluate the effectiveness of intrathecal morphine following selective dorsal rhizotomy in pediatric patients previously diagnosed with cerebral palsy.
Methods: This was a retrospective, cohort analysis over the course of four years. The analysis consisted of a treatment group which received intrathecal morphine (5 mcg/kg) injection and a control group that did not receive the injection prior to dural closure. All patients underwent multilevel laminectomies for selective dorsal rhizotomy at Akron Children's Hospital. The effectiveness of the treatment was measured by total dose of hydromorphone administered on patient-controlled analgesia (PCA), number of days on oral narcotics, and cumulative dose of oral narcotic.
Results: Of the analyzed 15 pediatric patients, seven patients received intrathecal morphine injection while the other eight did not receive the treatment prior to dural closure. There was a difference of 1135 mcg in total PCA dose between the study group (3243 mcg) and the control group (4378 mcg). The total PCA dose based on weight was lower in the study group (163 mcg/kg) than in the control group (171 mcg/kg).
Conclusion: Based on these findings, the administration of intrathecal morphine clinically reduces the opiate need in the first 96 hours post-operatively.
Source
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J Pediatr Rehabil Med
. 2023 Feb 16. doi: 10.3233/PRM-220048. Online ahead of print.
Language
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English
2023
Cerebral palsy
intrathecal morphine
pain control
Selective dorsal rhizotomy