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Florence T Bourgeois – One of the best experts on this subject based on the ideXlab platform.
off label use of prescription Analgesics among hospitalized children in the united statesPharmacoepidemiology and Drug Safety, 2020Co-Authors: Mary M Carmack, Florence T Bourgeois, Charles B Berde, Michael C Monuteaux, Shannon ManziAbstract:
PURPOSE Analgesics are the most frequently administered medications among hospitalized children. However, current analgesic prescribing patterns have not been well defined among hospitalized children. In addition, it is unknown what proportion of prescription Analgesics is approved for use in children and what proportion is used “off-label.” METHODS Nationally representative data from 52 tertiary care children’s hospitals in the Pediatric Health Information System were queried to determine prescribing rates of analgesic medications. We analyzed hospitalizations for children <18 years occurring between 1 April 2010 and 30 June 2018. Food and Drug Administration (FDA) drug labels were reviewed for pediatric information, and prescriptions were classified as on- or off-label based on age, route, and formulation. RESULTS Among 4.9 million hospitalizations, 1.8 million (37.6%, 95% confidence interval [CI] = 37.6-37.7) were associated with use of a prescription analgesic. Overall, 36.7% (95% CI = 36.7-36.7) of hospitalizations included off-label analgesic therapy, with 26.4% (95% CI = 26.4-26.5) associated with two or more off-label Analgesics. Off-label analgesic use was higher among hospitalizations in the intensive care unit (61.5%) or with an operating room procedure (92.8%). Rates of off-label prescribing increased with age, peaking at 50.5% for adolescents. Prescription Analgesics administered most frequently were morphine, fentanyl, and ketorolac, with off-label use occurring in 24.5%, 23.1%, and 11.3% of hospitalizations, respectively. CONCLUSIONS Over a third of pediatric hospitalizations were associated with the administration of prescription Analgesics that have not been labeled for use in children. Our findings highlight the critical need to ensure that safe and effective Analgesics are developed for children and that pediatric labeling is expanded for existing Analgesics to inform treatment decisions.
Monique Elseviers – One of the best experts on this subject based on the ideXlab platform.
Over-the-counter analgesic use.Journal of the American Society of Nephrology : JASN, 2009Co-Authors: M. E. De Broe, Monique ElseviersAbstract:
Chronic analgesic nephropathy, particularly chronic interstitial nephritis and renal papillary necrnecrosis, results from daily use for many years of mixtures containing at least two Analgesics and caffeine or dependence-inducing drugs. Computed tomography scan can accurately diagnose this disease even in the absence of reliable information on previous analgesic use. The occasion to moderate regular use of aspirin and nonsteroidal anti-inflammatory drugs is without renal risk when renal function is normal. Paracetamol use is less clear although the risk is not great. The continued use of non-phenacetin-combined Analgesics with or without nonsteroidal anti-inflammatory drugs is associated with faster progression toward renal impairment. As long as high-risk analgesic mixtures are available over the counter, analgesic nephropathy will continue to be a problem.
Analgesic nephropathy: is it caused by multi-analgesic abuse or single substance use?Drug safety, 1999Co-Authors: Monique Elseviers, M. E. De BroeAbstract:
Analgesic nephropathy is a slowly progressive renal disease, characterised by renal papillary necrnecrosis. Recently, diagnostic criteria for this disease have been defined based on renal computed tomography scanning performed without contrast. The observation of a decreased renal mass of both kidneys, combined with either bumpy contours or papillary calcifications, has been found to have high diagnostic specificity and sensitivity. However, the question remains as to what kind of Analgesics can cause analgesic nephropathy. In the majority of early reports about this condition, phenacetin was singled out as the nephrotoxic culprit. However, during the last decade the nephrotoxic potential of nonphenacetin-containing preparations has become apparent. It is clear that people who abuse Analgesics prefer combination Analgesics containing 2 Analgesics combined with caffeine and/or codeine. In contrast, abuse of products containing only aspirin (acetylsalicylic acid) or paracetamol (acetaminophen) is seldom described and associated renal disease is only occasionally reported. Experimental evidence of the nephrotoxicity of analgesic preparations is not well established. The results of studies involving analgesic administration in animals remain contradictory. Clinical evidence linking high consumption of analgesic preparations with analgesic nephropathy is overwhelming. Most patients who admit to over-consuming Analgesics have taken preparation containing more than one compound. In recent years, it has become more apparent that preparations not containing phenacetin also have the potential to cause nephrotoxicity manifesting as identical renal lesions. Further epidemiological evidence of the nephrotoxic potential of analgesic combinations has come from case-control studies published during the last decade and from 2 prospective cohort studies. Effective prevention of analgesic nephropathy consists of the prohibition of over-the-counter sales of preparation containing at least 2 Analgesics associated with caffeine and/or codeine.
Combination analgesic involvement in the pathogenesis of analgesic nephropathy: the European perspective.American Journal of Kidney Diseases, 1996Co-Authors: Monique Elseviers, M. E. De BroeAbstract:
Analgesic nephropathy (AN) is a chronic renal disease characterized by renal papillary necrnecrosis and interstitial nephritis caused by excessive consumption of analgesic mixtures. In a recent study, diagnostic criteria for AN, based on a computed tomography scan investigation without contrast, were presented. The observation of a decreased renal mass of both kidneys combined with either bumpy contours or papillary calcifications was found to have a high diagnostic performance. Although several case control studies and two prospective studies demonstrated the association between analgesic abuse and nephropathy, the nephrotoxicity of the different analgesic products had not been clearly established. Analgesic abuse can be defined as a daily consumption of analgesic mixtures over a several-year period. Abuse of single Analgesics is rare; it has been clearly demonstrated that abusers prefer analgesic mixtures. In Belgium, the prevalence of AN was positively related to the sales of analgesic mixtures containing two analgesic components plus caffeine and/or codeine. This relationship could not be observed for Analgesics containing only one analgesic component plus caffeine and/or codeine. Moreover, during a European multicenter study, nephrotoxicity of different combinations of analgesic mixtures (all containing caffeine and/or codeine) could be documented in the absence of any previous phenacetin consumption. Epidemiologic observations in Sweden, France, and Belgium regarding incidence of AN, sales figures of Analgesics, and legislative measurements concerning analgesic consumption supported the previous observations.
Wojciech Leppert – One of the best experts on this subject based on the ideXlab platform.
Tramadol as an analgesic for mild to moderate cancer painPharmacological Reports, 2009Co-Authors: Wojciech LeppertAbstract:
In most cancer patients, pain is successfully treated with pharmacological measures such as opioid Analgesics alone or opioid Analgesics combined with adjuvant Analgesics (co-Analgesics). Opioids for mild-to-moderate pain (formerly called weak opioids) are usually recommended in the treatment of cancer pain of moderate intensity. There is a debate whether the second step of the WHO analgesic ladder, which, in Poland, is composed of opioids such as tramadol, codeine, dihydrocodeine (DHC), is still needed for cancer pain treatment. One of the most interesting and useful drugs in this group is tramadol. Its unique mechanism of action, analgesic efficacy and profile of adverse effects are responsible for its successful use in patients with different types of acute and chronic pain, including neuropathic pain. The aim of this article is to summarize the data regarding pharmacodynamics, pharmacokinetics, possible drug interactions, adverse effects, dosing guidelines, equipotency with other opioid Analgesics and clinical studies comparing efficacy, adverse reactions and safety of tramadol to other opioids in cancer pain treatment.
The role of tramadol in cancer pain treatment—a reviewSupportive Care in Cancer, 2005Co-Authors: Wojciech Leppert, Jacek ŁuczakAbstract:
In most cancer patients pain can be successfully treated with pharmacological measures using opioid Analgesics alone or in combination with adjuvant Analgesics (coAnalgesics). Weak opioids are usually recommended in the treatment of moderate cancer pain. There is still a debate as to whether the second step of the WHO analgesic ladder comprising opioid Analgesics such as tramadol, codeine, dihydrocodeine, and dextropropoxyphene is still needed for the treatment of cancer pain. On the basis of our experience and review of the literature we think that there is definitely a place for weak opioids in the treatment of moderate cancer pain. One of the most interesting and useful weak opioids is tramadol (Adolonta, Contramal, Nobligan, Top-Algic, Tramal, Tramal Long, Tramal Retard, Tramundin, Trodon, Ultram, Zydol). Its unique mechanism of action, analgesic efficacy and profile of adverse reactions have been the reason of performing many experimental and clinical studies with tramadol. In this article we summarize data on pharmacology, mechanisms of action, pharmacokinetics, side effects and clinical experience assessing analgesic efficacy, adverse reactions and safety of tramadol in cancer pain.
Chung-wei Christine Lin – One of the best experts on this subject based on the ideXlab platform.
Worsening trends in Analgesics recommended for spinal pain in primary careEuropean Spine Journal, 2018Co-Authors: Stephanie Mathieson, Lisa Valenti, Christopher G. Maher, Helena Britt, Andrew J. Mclachlan, Chung-wei Christine LinAbstract:
Purpose Limited evidence exists on secular trends of Analgesics for spinal pain. We investigated general practitioner’s (GP) recommendations of analgesic medicines for spinal pain and investigated characteristics associated with their recommendation. Methods We accessed data on spinal pain consultations from the Bettering the Evaluation and Care of Health (BEACH) database, a nationally representative database on GP activity in Australia. Data extracted included consultation details and management provided. Medicines recommended were grouped as simple Analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), opioid Analgesics or neuropathic pain medicines. Multivariate logistic regression determined if patient characteristics and GP characteristics were associated with medication recommendations. Results We analysed BEACH data for 9100 GPs who managed 39,303 patients with spinal pain between 2004 and 2014. Over the decade, analgesic recommendations increased. After accounting for patient and GP characteristics, there was a significant increase in the rate single-ingredient opioid Analgesics [annual relative increase of 6% (RR 1.06 (95% CI 1.05–1.07), P
Christopher Okunseri – One of the best experts on this subject based on the ideXlab platform.
Role of Dentists in Prescribing Opioid Analgesics and Antibiotics: An Overview.Dental clinics of North America, 2018Co-Authors: Ralph Dana, Amir Azarpazhooh, Nima Laghapour, Katie J. Suda, Christopher OkunseriAbstract:
Opioid Analgesics and antibiotics prescribed by dentists is a useful and cost-effective measure when prescribed appropriately. Common dental conditions are best managed by extracting the offending tooth, restoring the tooth with an appropriate filling material, performing root canal therapy, and/or fabricating a prosthesis for the edentulous space. Unnecessary prescription of opioid Analgesics and antibiotics to treat dental pain and bacterial infection is a growing public health concern. This article highlights the state of the literature on opioid analgesic and antibiotic prescribing practices in dentistry, the impact of opioid analgesic overdose, and prevention strategies to reduce opioid Analgesics and antibiotic overprescription.
prescription of opioid and nonopioid Analgesics for dental care in emergency departments findings from the national hospital ambulatory medical care surveyJournal of Public Health Dentistry, 2014Co-Authors: Christopher Okunseri, Elaye Okunseri, Qun Xiang, Joshua M Thorpe, Aniko SzaboAbstract:
Objectives The aim of this study was to examine trends and associated factors in the prescription of opioid Analgesics, nonopioid Analgesics, opioid and nonopioid analgesic combinations, and no Analgesics by emergency physicians for nontraumatic dental condition (NTDC)-related visits. Our secondary aim was to investigate whether race/ethnicity is a possible predictor of receiving a prescription for either type of medication for NTDC visits in emergency departments (EDs) after adjustment for potential covariates. Methods We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997-2000 and 2003-2007, and used multinomial multivariate logistic regression to estimate the probability of receiving a prescription for opioid Analgesics, nonopioid Analgesics, or a combination of both, compared with receiving no Analgesics for NTDC-related visits. Results During 1997-2000 and 2003-2007, prescription of opioid Analgesics and combinations of opioid and nonopioid Analgesics increased, and that of no Analgesics decreased over time. The prescription rates for opioid Analgesics, nonopioid Analgesics, opioid and nonopioid analgesic combinations, and no Analgesics for NTDC-related visits in EDs were 43 percent, 20 percent, 12 percent, and 25 percent, respectively. Majority of patients categorized as having severe pain received prescriptions for opioids for NTDC-related visits in EDs. After adjusting for covariates, patients with self-reported dental reasons for visit and severe pain had a significantly higher probability of receiving prescriptions for opioid Analgesics and opioid and nonopioid analgesic combinations. Conclusions Prescription of opioid Analgesics increased over time. ED physicians were more likely to prescribe opioid Analgesics and opioid and nonopioid analgesic combinations for NTDC-related visits with reported severe pain.