Daveluy Amélie, Bryan Michael Charles, Miremont-Salamé Ghada, Lassalle Régis, Lacueille Clémentine, Grelaud Angela, Floccia Marie, Haramburu Françoise, Lapeyre-Mestre Maryse, Micallef Joëlle, Salvo Francesco
Centre d'addictovigilance de Bordeaux, Department of Medical Pharmacology, University Hospital of Bordeaux, Bordeaux, France.
INSERM, BPH, University of Bordeaux, Bordeaux, France.
Fundam Clin Pharmacol. 2024 Apr;38(2):389-397. doi: 10.1111/fcp.12962. Epub 2023 Oct 21.
The combination dextropropoxyphene/paracetamol (DXP/P) was the most prescribed opioid analgesic until its withdrawal in 2011.
This study investigated dispensations of analgesics in chronic users of DXP/P during the 18 months following its withdrawal.
A cross-sectional study repeated yearly was conducted by using the French reimbursement database from 2006 to 2015. Chronic DXP/P users were defined as patients who received at least 40 boxes of DXP/P in the year prior to withdrawal. Data on analgesic dispensing were analyzed at DXP/P withdrawal (T0) and then every 6 months for 18 months.
A total of 63 671 subjects had a DXP/P reimbursement in the year prior to its discontinuation, of whom 7.1% were identified as chronic users (mean age: 71.5 years, women: 68.7%). Among the patients taking DXP/P alone at T0 (74.6%), one fourth switched to a peripheral analgesic, one fourth to a combination of peripheral analgesic/opioid, one fourth to another opioid, and the others mainly discontinued their treatment (14.1%) or died. During the following 12 months, most of the subjects taking only peripheral analgesics continued this treatment, while half of the subjects with a combination of opioid/peripheral analgesic or taking only an analgesic remained on this type of treatment.
Eighteen months after DXP/P withdrawal, more than 10% of patients stopped taking an analgesic. Vigilance is required regarding any change in analgesics by regularly reassessing patients' pain and, in the case of opioid treatments, by monitoring the risk of use disorders.
右丙氧芬/对乙酰氨基酚组合制剂（DXP/P）在2011年退市前是处方量最大的阿片类镇痛药。
本研究调查了DXP/P退市后18个月内慢性使用者的镇痛药配药情况。
利用2006年至2015年法国报销数据库进行每年重复一次的横断面研究。慢性DXP/P使用者定义为在退市前一年至少接受40盒DXP/P的患者。在DXP/P退市时（T0）分析镇痛药配药数据，然后在18个月内每6个月分析一次。
共有63671名受试者在DXP/P停用前一年有该药报销记录，其中7.1%被确定为慢性使用者（平均年龄：71.5岁，女性：68.7%）。在T0时单独服用DXP/P的患者中（74.6%），四分之一转而使用外周镇痛药，四分之一转而使用外周镇痛药/阿片类药物组合，四分之一转而使用另一种阿片类药物，其他患者主要停止治疗（14.1%）或死亡。在接下来的12个月中，大多数仅服用外周镇痛药的受试者继续这种治疗，而一半使用阿片类药物/外周镇痛药组合或仅服用一种镇痛药的受试者仍继续这种治疗。
DXP/P退市18个月后，超过10%的患者停止服用镇痛药。需要保持警惕，通过定期重新评估患者的疼痛情况以及在使用阿片类药物治疗时监测使用障碍风险，关注镇痛药的任何变化。
