Whitt Aaron G, Karimi Viana F, Gaskins Jeremy T, Renfrow Ruby E, Roach Abbey R, Malkani Arthur L, Hartley Brandi, Yakkanti Madhusudhan R, Jortani Saeed A
Department of Pathology and Laboratory Medicine, 5170 University of Louisville , Louisville, KY, USA.
Department of Bioinformatics and Biostatistics, School of Medicine, 5170 University of Louisville , Louisville, KY, USA.
Drug Metab Pers Ther. 2024 Dec 16;40(1):13-21. doi: 10.1515/dmpt-2024-0031. eCollection 2025 Mar 1.
To explore pain outcomes in patients prescribed hydrocodone and psychotropic medications with or without CYP2D6 inhibition activity.
Patients hospitalized for lower/limited upper extremity injuries who were prescribed hydrocodone alongside a psychotropic medication were considered for this study (n=224). A subset of these patients (n=178) was prescribed a psychotropic medication known to inhibit CYP2D6, while the remainder (n=46) were prescribed psychotropic medications without CYP2D6 inhibition activity. Patient demographics and pain outcomes were collected by electronic health record review and interviews.
Patients taking a psychotropic inhibitor of CYP2D6 exhibited longer duration of opioid use post-discharge (median 33 days [IQR 10-99]) compared with patients taking a psychotropic non-inhibitor (4 days [2-20], p<0.001). No significant differences were observed with in-hospital pain outcomes, including total dose of hydrocodone administered, duration of hydrocodone use, pain index scores, and the occurrence of common mild/moderate/severe hydrocodone side effects.
Patients prescribed at least one psychotropic inhibitor of CYP2D6 were more likely to continue using hydrocodone for up to 3 months following surgery. Knowledge of these critical drug-drug interactions could enhance clinical practice and improve patient outcomes. This study highlights negative post-operative pain outcomes in patients prescribed hydrocodone alongside a psychotropic inhibitor of CYP2D6. The results of this study indicate that patients taking psychotropic medications that inhibit CYP2D6 are at increased risk for prolonged hydrocodone use following orthopedic surgery.
探讨开具了氢可酮以及有或没有CYP2D6抑制活性的精神药物的患者的疼痛结局。
本研究纳入因下肢/上肢有限损伤住院且开具了氢可酮及一种精神药物的患者（n = 224）。这些患者中的一部分（n = 178）开具了已知可抑制CYP2D6的精神药物，其余患者（n = 46）开具的精神药物无CYP2D6抑制活性。通过电子健康记录审查和访谈收集患者人口统计学数据和疼痛结局。
与服用非CYP2D6抑制剂精神药物的患者相比，服用CYP2D6抑制剂精神药物的患者出院后使用阿片类药物的持续时间更长（中位数33天[四分位间距10 - 99]），而服用非抑制剂精神药物的患者为4天[2 - 20]，p<0.001）。在院内疼痛结局方面未观察到显著差异，包括氢可酮的给药总量、氢可酮使用持续时间、疼痛指数评分以及常见轻/中/重度氢可酮副作用的发生情况。
开具至少一种CYP2D6抑制剂精神药物的患者在术后长达3个月内更有可能继续使用氢可酮。了解这些关键的药物相互作用可改善临床实践并提高患者结局。本研究强调了开具氢可酮及CYP2D6抑制剂精神药物的患者术后疼痛结局不佳。本研究结果表明，服用抑制CYP2D6的精神药物的患者在骨科手术后长期使用氢可酮的风险增加。
