Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2025
Opioid Allergy Cross-Reactivity: A Retrospective Study Across Three Opioid Classes.
IgE-mediated opioid hypersensitivities, or true allergies, are rare and most adverse reactions to opioids can be attributed to side effects or to pseudo-allergies. Given that immune-mediated allergies to opioids are uncommon, literature regarding cross-reactivity among opioid classes are limited. This retrospective study aimed to determine the rates of cross-reactivity and tolerance among patients with previously documented opioid allergy or adverse drug reaction (ADR) across three opioid drug classes (natural, semisynthetic, and synthetic opioids). ⋯ A total of 1507 patients were identified with previously documented allergy or ADR to at least one opioid and at least one subsequent opioid drug exposure. No cross-reactivity among any of the opioid drug classes were found resulting in 100% re-exposure tolerance rates with all study arms. These findings could increase confidence in utilizing opioids in patients with historically documented opioid allergies or ADRs.
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J Pain Palliat Care Pharmacother · Jan 2025
Peripheral Edema as an Adverse Drug Reaction to Mirtazapine in an Oral Cavity Cancer Patient Receiving Palliative Care at Tertiary Care Centre: A Case Report.
Mirtazapine is a selective serotonergic antidepressant that functions by blocking adrenergic alpha2-autoreceptors and heteroreceptors and inhibiting 5-HT2 and 5-HT3 receptors. It is a noradrenergic drug. Mirtazapine has anxiolytic or sleep-quality-improving effects, aggravates appetite-stimulation, and has stomach emptying functions. ⋯ The peripheral edema completely resolved after stopping mirtazapine. To the best of our knowledge, this is the first instance of a patient with advanced oral cavity cancer experiencing peripheral edema as a result of receiving mirtazapine medication. Our study will assist medical professionals in identifying the potential use of mirtazapine in situations where peripheral edema develops quickly, facilitating its quick clearance.
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J Pain Palliat Care Pharmacother · Dec 2024
An Older Man with Clonus, Rigidity, Hyperreflexia, and Hand Tremors.
Serotonin toxicity (ST) is a preventable, life-threatening condition caused by serotonergic agents. It typically arises from combined drug use that affects serotonin's release and metabolism. While often presenting with mild symptoms that may be overlooked or misdiagnosed, severe toxicity is associated with significant mortality. ⋯ Accurate diagnosis requires heightened vigilance from healthcare professionals regarding potential drug interactions and familiarity with the specific clinical criteria. Regular revision and adjustment of medications in older patients and preference for the non-pharmacological treatment of chronic pain are essential for preventing ST. This case report is a convenient way for many healthcare professionals to update their knowledge about ST, its diagnosis and management.
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J Pain Palliat Care Pharmacother · Dec 2024
ReviewSafety of Naldemedine for Opioid-Induced Constipation - A Systematic Review and Meta-Analysis.
Naldemedine is a peripheral acting µ-opioid receptor antagonist approved by the Food and Drug Administration to treat opioid-induced constipation. Concerns about side effects like opioid withdrawal prevent its widespread use, especially for cancer patients. We performed this systematic review and meta-analysis to evaluate existing safety data of naldemedine treating opioid-induced constipation following the PRISMA guidelines. ⋯ However, no increased risk for opioid withdrawal was observed. This analysis confirms naldemedine's overall safety in treating opioid-induced constipation, with manageable gastrointestinal side effects. However, the higher adverse events in cancer patients require further investigation to ensure safe use in this population.