Journal of pain & palliative care pharmacotherapy
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By 2050, it is predicted that 26% of the population will be aged 80 and over. Although older people have much to contribute, one challenging aspect of an aging population is the increasing rate of dementia. ⋯ This report is adapted from paineurope 2013; Issue 2, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International LTD. and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.
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J Pain Palliat Care Pharmacother · Aug 2013
Randomized Controlled TrialA new model for using quantitative urine testing as a diagnostic tool for oxycodone treatment and compliance.
We conducted a prospective, randomized, cross-sectional study to develop and validate a new model to predict oxycodone in urine that can be used to help evaluate whether patients are complying with their oxycodone dosing regimens. We studied 20 patients: eight black women, two white women, six black men, and four white men; ages 48 ± 10 years (mean ± SD); weight 97 ± 32 kg. Pain levels before treatment averaged 9.5 ± 0.9 out of 10. ⋯ One patient was 35% below the prediction; the other was 51% above. Our model accurately predicts oxycodone in urine (±10% for 90% of the patients). The model appears clinically useful for evaluating the results of a quantitative urine test, since it objectively discriminates between (1) a "normal" patient complying with their oxycodone dosing regimen, and (2) a patient who may require genetic testing to distinguish between unusual metabolism or abuse.
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J Pain Palliat Care Pharmacother · Aug 2013
Potential P-glycoprotein pharmacokinetic interaction of telaprevir with morphine or methadone.
Telaprevir (TVR) effects on P-glycloprotein and cytochrome P450 (CYP) may significantly elevate serum levels of morphine and methadone. Recent literature points to major interactions when combining TVR with warfarin or rifampin. Opioid interactions are especially dangerous in hepatitis C patients, as coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) occurs in 50-90% of HIV-infected drug users that are prescribed opioids for chronic pain and/or methadone for maintenance. ⋯ Current recommendations minimize potential drug interactions between telaprevir and opioids, especially methadone, based on a single 7-day trial. We outline the various pharmacokinetic mechanisms involved when combining TVR with methadone or morphine and recommend that current data are not sufficiently robust to minimize the potentially significant interaction with opioids, especially methadone. Clinicians must be mindful of these understated interactions, know that the opioid dose may need to be significantly increased or reduced, and use caution during upward titration of opioids affected by these enzyme systems.