Personalized Oxycodone Dosing: Using Pharmacogenetic Testing and Clinical Pharmacokinetics to Reduce Toxicity Risk and Increase Effectiveness

Linares, Oscar A.; Daly, David D.; Linares, Annemarie Daly; Stefanovski, Darko; Boston, Raymond C.

doi:10.1111/pme.12380

Cited by 37 publications

(27 citation statements)

References 76 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(14) Further, pharmacogenetics data suggest that opioids including hydrocodone, oxycodone, and codeine may be ineffective in up to 10% of the Caucasian population. (30,31,32) As a result, best practice recommendations note that opioid analgesics should be reserved for the minority of situations in which optimal doses of NSAIDs and/or acetaminophen/aspirin provide insufficient pain management. (14,29)…”

Section: Discussionmentioning

confidence: 99%

Dental opioid prescribing and multiple opioid prescriptions among dental patients

McCauley¹,

Hyer²,

Ramakrishnan³

et al. 2016

The Journal of the American Dental Association

View full text Add to dashboard Cite

Background Despite increased attention to dentists’ role in curbing opioid misuse, abuse, and diversion, information regarding prescribing practices and the frequency of multiple concurrent opioid prescriptions among dental patients is limited. Methods Prescription drug monitoring program (PDMP) data for South Carolina representing dispensed medication for patients prescribed at least one opioid by a dentist over the most recently available two-year frame (2012–2013) was reviewed. Descriptive analyses examined: (1) types, frequency of dental opioid prescriptions; and, (2) frequency of existing multiple concurrent opioid prescriptions among dental patients. Results Nearly all dispensed dental opioid prescriptions (99.9%; n = 653,650) were for immediate release opioids and were initial fills (96.2%). Hydrocodone (76.1%) and oxycodone (12.2%) combination products were the most frequently dispensed opioids prescribed by dentists. Individuals under 21 years of age received 11.2% of dentist prescribed opioids dispensed. Patients with multiple concurrent opioid prescriptions were identified within 30-day (n=113,818), 90-day (n=166,124), and 180-day (n=205,576) timeframes. Conclusions Dentists prescribed a high volume of immediate release opioids dispensed in South Carolina. A notable minority of dental patients had incident(s) of multiple pre-existing opioid prescriptions, a factor implicated in patient misuse, abuse, overdose, and diversion Practical Implications Use of a PDMP prior to prescribing provides a record of controlled substances dispensed to a patient, and may inform prescribing, coordination of care, and addiction screening or referral. Patients should be provided information regarding misuse behaviors and their risks, as well as the importance of secure storage and disposal of leftover opioid medications.

show abstract

Section: Discussionmentioning

confidence: 99%

Dental opioid prescribing and multiple opioid prescriptions among dental patients

McCauley¹,

Hyer²,

Ramakrishnan³

et al. 2016

The Journal of the American Dental Association

View full text Add to dashboard Cite

show abstract

“…Indeed, we commonly observe in clinical practice that the first several pain assessment-treatment-evaluation cycles often require a co-adaptation between the patient and the healthcare delivery system to identify which analgesic strategies optimally provide sustained, successful pain management. 20,21 Rather than rewarding healthcare delivery systems for offering a non-selective “kitchen sink” approach to postoperative pain management principally predicated on high-dose opioid analgesia, which can lead to substantial increases in patient safety events with insignificant decreases in pain intensity across the hospital population, it may be advantageous to encourage expedited assessment-treatment-evaluation cycles to hasten the co-adaptation and personalization of analgesic strategies to individual patients. The time to SuPPR thus partially considers the adaptability of the healthcare system to an individual patient’s needs in requiring a sustained improvement, rather than a linear trend that may feature a decreasing overall trend in pain intensity yet still permit repeated episodes of severe pain.…”

Section: Discussionmentioning

confidence: 99%

Time to Onset of Sustained Postoperative Pain Relief (SuPPR)

Tighe

King

Zou

et al. 2016

The Clinical Journal of Pain

View full text Add to dashboard Cite

Objectives Prior work on postoperative pain trajectories have examined pain score changes over time using daily averages of pain scores. However, little is known about the time required until patients consistently report minimal postoperative pain. Materials and Methods We conducted a retrospective cohort study of surgical case data from 7,293 adult patients to examine the impact of age, gender, and the type of surgery on the time to sustained postoperative pain relief (SuPPR). We defined SuPPR as the time required until a patient reports the first of multiple (2, 3, 4, or 5 sequential measurements; e.g., SuPPR-2, SuPPR-3, etc.), uninterrupted, mild pain scores (≤4/10). Results Overall, SuPPR times ranged from 3 min for SuPPR-2 and 9 min for SuPPR-5 to 160.1 h for SuPPR-2 and 183.1 h for SuPPR-5. For the SuPPR-2 outcome, the median time to event was 10.9 h (interquartile range [IQR], 3–26.1 h) after surgery. For the SuPPR-5 outcomes, the median time to event was 31.5 h (IQR, 17.8–54.2 h) after surgery. The peak median difference between two sequential SuPPR definitions was between SuPPR-3 and SuPPR-2 at 9 h, with subsequent decreases to 6.5 h between SuPPR-4 and SuPPR-3, and 5.2 h between SuPPR-5 and SuPPR-4. There were statistically different differences across SuPPR 2 through 5 definitions by age, gender, and type of surgery. Discussion Although additional analyses are necessary, SuPPR may represent a novel method for evaluating acute pain service performance.

show abstract

“…In our patient dose selection of anesthetic and ancillary medication based on clinical experience, convenience, cost, pharmacokinetic and pharmacodynamic properties of the drugs [8]. In addition to these approach, combine clinical pharmacokinetics with pharmacogenetics based approaches are also emerging for dose selection of medications [9]. These patients should be given adequate premedication to reduce stress.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management of a Patient with Hypertrophic Obstructive Cardiomyopathy in a Place with Limited Resources

Sigdel¹,

Basnet²

2014

J Anesth Clin Res

View full text Add to dashboard Cite

Hypertrophic Obstructive Cardiomyopathy (HOCM) is a rare genetic disorder of heart characterized by Left Ventricular Outflow Tract (LVOT) obstruction. Clinical presentation ranges from absence of symptoms to sudden death. A 62 year old patient presented with left carcinoma breast was scheduled for modified radical mastectomy. The patient was being treated for hypertension but was diagnosed as HOCM just two weeks prior. Anesthetic management of these patients presents considerable challenges and requires maintenance of desired hemodynamic parameters and management of specific complications. Factors like tachycardia, hypovolemia, vasodilation and increased cardiac contractility leads to exacerbation of the obstruction. We managed to successfully maintain the desired hemodynamics throughout the surgery and the patient was discharged home on the postoperative day.

show abstract

Personalized Oxycodone Dosing: Using Pharmacogenetic Testing and Clinical Pharmacokinetics to Reduce Toxicity Risk and Increase Effectiveness

Cited by 37 publications

References 76 publications

Dental opioid prescribing and multiple opioid prescriptions among dental patients

Dental opioid prescribing and multiple opioid prescriptions among dental patients

Time to Onset of Sustained Postoperative Pain Relief (SuPPR)

Anesthetic Management of a Patient with Hypertrophic Obstructive Cardiomyopathy in a Place with Limited Resources

Contact Info

Product

Resources

About