National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
Sydney Medical School, The University of Sydney, Sydney, Australia.
Drug Alcohol Rev. 2022 Jul;41(5):1071-1077. doi: 10.1111/dar.13462. Epub 2022 Mar 17.
Tapentadol is a centrally acting opioid analgesic prescribed for the treatment of moderate to severe pain. The study aimed to determine the characteristics of Australian toxicity deaths related to tapentadol.
All cases in which tapentadol use was coded contributory to death (n = 159) were retrieved from the National Coronial Information System (1 July 2000-31 December 2020).
The mean age was 48.5 (18-81) and 56% were female. Documented histories of problems with chronic pain (66%), mental health (60.4%), substance use (44%) and injecting drug use (23.3%) were common. The majority of deaths were deemed unintentional (76.1%) and in 18.9% pre-existing disease was co-contributory. The median peripheral blood tapentadol concentration was 1.00 mg L (0.02-47.00), and the median aortic concentration was 2.05 mg L (0.10-30.00). In all cases, psychoactive drugs other than tapentadol were also detected, most commonly antidepressants (72.3%), opioids (66.7%), hypnosedatives (64.2%) and gabapentinoids (43.4%). Of cases where autopsies were conducted, 27.7% were diagnosed with cardiomegaly and 18.5% with severe coronary artery stenosis. Pulmonary oedema (68.1%), aspiration of vomitus (39.5%) and acute pneumonia (26.9%) were common.
The typical tapentadol-related toxicity death involved unintentional death in the presence of multiple drugs, although a notable minority were intentional self-harm. Multiple morbidities were common. The identification and characteristics of these cases indicate that the adverse event profile of tapentadol needs to be considered in the setting of polypharmacy.
曲马多是一种作用于中枢的阿片类镇痛药，用于治疗中重度疼痛。本研究旨在确定与曲马多相关的澳大利亚毒性死亡的特征。
从国家验尸信息系统（2000 年 7 月 1 日至 2020 年 12 月 31 日）中检索编码为与死亡相关的曲马多使用（n=159）的所有病例。
平均年龄为 48.5（18-81）岁，56%为女性。常见的有慢性疼痛（66%）、精神健康问题（60.4%）、物质使用（44%）和注射药物使用（23.3%）的病史。大多数死亡被认为是意外的（76.1%），18.9%的死亡是由先前存在的疾病共同引起的。外周血曲马多的中位数浓度为 1.00mg/L（0.02-47.00），主动脉浓度中位数为 2.05mg/L（0.10-30.00）。在所有情况下，除曲马多以外的其他精神活性药物也被检测到，最常见的是抗抑郁药（72.3%）、阿片类药物（66.7%）、催眠镇静药（64.2%）和加巴喷丁类药物（43.4%）。在进行尸检的病例中，27.7%被诊断为心肌肥大，18.5%被诊断为严重冠状动脉狭窄。肺水肿（68.1%）、呕吐物吸入（39.5%）和急性肺炎（26.9%）很常见。
典型的与曲马多相关的毒性死亡涉及存在多种药物的意外死亡，尽管少数是故意的自我伤害。多种合并症很常见。这些病例的识别和特征表明，在多药治疗的情况下，需要考虑曲马多的不良事件谱。
