Co-use of CYP2D6-metabolized opioids and antidepressants associated with adverse events in older nursing home patients

Co-use of CYP2D6-metabolized opioids and antidepressants associated with adverse events in older nursing home patients

Abstract: https://www.acpjournals.org/doi/10.7326/M23-3109     

URL goes live when the embargo lifts     

A target trial emulation study found that concomitant use of CYP2D6-metabolized opioids (hydrocodone, codeine, tramadol, and oxycodone) with antidepressants was associated with adverse outcomes among older nursing home residents. This is important because opioids metabolized by the cytochrome P450 (CYP) 2D6 (CYP2D6) enzyme are commonly prescribed among older adults, including those living in nursing homes. In fact, more than one-third of Medicare nursing home (NH) residents (the population studied in this trial) with chronic pain received prescription opioids concurrently with antidepressants between 2011 and 2015. The findings are published in Annals of Internal Medicine.

Researchers from The Ohio State University used a target trial emulation design to investigate the associations of concomitant use of CYP2D6-metabolized opioids and antidepressants with clinical outcomes and opioid-related adverse events (ORAEs) in older Medicare recipients. The authors used a 100% NH sample linked to Medicare claims for long-term residents aged 65 years and older receiving CYP2D6-metabolized opioids with a disease indication for antidepressant use and looked for worsening pain, physical function, and depression from baseline and incident rates of pain-related hospitalizations and emergency department (ED) visits, opioid use disorder (OUD), and opioid overdose. They found that the use of CYP2D6-metabolized opioids concomitantly with CYP2D6-inhibiting (vs. CYP2D6-neutral) antidepressants was associated with a higher risk for worsening pain and higher incidence rates for pain-related hospitalization, pain-related ED visit, and OUD, with no difference in physical function, depression, and OD. According to the authors, these findings suggest that when co-use of opioids and antidepressants is clinically needed, selecting CYP2D6-neutral antidepressants (such as citalopram and sertraline) may provide better or equal clinical and adverse outcomes.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with the corresponding author Yu-Jung Jenny Wei, PhD, please contact Brittany McClasky at [email protected].