• Gilbert J Fanciullo and Tabitha Washington.
• Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. Tabitha.A.Washington@hitchcock.org
• Am J Manag Care. 2011 Sep 1; 17 Suppl 11: S299-304.

AbstractPatients with moderate to severe pain often require opioid therapy, and many of these patients have multiple comorbid conditions requiring several medications. Guidelines for opioid use do not properly address their use in patients taking multiple medications, as they focus primarily on patient selection, monitoring the patient for drug abuse, and treatment adherence. Moreover, guidelines discuss very little regarding potential drug-drug interactions (DDIs) with opioids. The problem of polypharmacy is exacerbated by the fact that multiple conditions are often treated by different specialists, many of whom are not in communication with one another. Because opioids have significant central nervous system and gastrointestinal side effects, and may interact with other medications, it is essential that efforts be made to treat the patient's pain while limiting the risk of side effects and DDIs. In many cases, this involves a thorough assessment of the medications the patient is taking and an attempt to reduce the number of medications. In managed care settings, a medication therapy management program is an excellent way to reduce inappropriate polypharmacy, and should result in cost savings. Clinicians should also consider drug-disease interactions and drug-food interactions that may be unique to individual patients. A proper assessment of these interactions may also provide insight into medications that are inappropriate, ineffective, and/or unnecessary in a particular patient.

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