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Analgesics during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Limited data are available on the pharmacokinetics of analgesics during pregnancy, and the findings are not entirely consistent. For example, acetaminophen has a decreased half-life and increased clearance in one study, but it is unchanged in another at about the same gestational age (Table 8.1). The pharmacokinetics of meperidine in pregnancy are unchanged compared to non-pregnant controls, and the same is true of the kinetics of meptazinol. In contrast, morphine has a decreased half-life and increased clearance, implying the need for increased frequency or dose regimen to maintain adequate analgesia. Indomethacin has a decreased half-life, and Cmax, which also implies dose or frequency regimen adjustment. In contrast, sodium salicylate has an increased half-life during late pregnancy. Low-dose aspirin apparently does not significantly affect umbilical artery circulation (Owen et al., 1993; Veille et al., 1993). Notably, the half-life for aspirin increases during pregnancy, implying that a dose decrease in amount and/or frequency may be needed (Table 8.1).
Analgesia And Anesthesia
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Michele Mele, Valentina Bellussi, Laura Felder
There is weak evidence of more frequent adverse effects such as maternal nausea, vomiting, and drowsiness with meptazinol compared to meperidine. However, both tramadol and pentazocine have fewer maternal side effects when compared with meperidine [16], making these two agents the ones with the best evidence of both moderate efficacy and lowest incidence of side effects among the opioid analgesic agents. Respiratory and neurobehavioral depression can be reversed with the use of the pure opioid antagonist naloxone.
Benzylpenicillin (Penicillin G)
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Alasdair M. Geddes, Ian M. Gould, Jason A. Roberts, Jason A. Trubiano, M. Lindsay Grayson
Jarisch–Herxheimer reactions can also occur when certain other infections are treated by Pen G. They are frequent in leptospirosis and result in fever, hypotension, and precipitation or aggravation of the features of the disease. The reaction may even precipitate the need for hemodialysis and adult respiratory distress syndrome (Friedland and Warrell, 1991; Emmanouilides et al., 1994). It may follow the use of Pen G for the treatment of yaws, rat bite fever, anthrax, and, rarely, meningococcal meningitis (Berkowitz et al., 1983; see section 7). A Jarisch–Herxheimer reaction can complicate the treatment of some infections by other antibiotics. A severe form may be provoked by tetracyclines in louse-borne relapsing fever, which may be fatal (Bryceson, 1976). High-dose corticosteroids, given before or at the time of tetracycline treatment, does not alter the reaction, but it is diminished by meptazinol (a partial opioid antagonist), given i.v. in a dose of 300–500 mg to adults (Teklu et al., 1983). The reaction occasionally follows tetracycline treatment of brucellosis and tularemia (see Chapter 67, Tetracycline) and chloramphenicol use in typhoid fever (see Chapter 86, Chloramphenicol and Thiamphenicol).
Non-opioid antinociceptive drugs : risk of respiratory depression and death related to concomitant use of gabapentinoids in addition to opioids
Published in Expert Opinion on Drug Safety, 2023
Marine Tambon, Berenice Montarnal, Marianne Lepetit, Maryse Lapeyre-Mestre
The nested case–control study by Chen et al was performed on the Clinical Practice Research Database (CPRD) in the UK, from a cohort of all opioid analgesic users (oral or transdermal formulations of codeine, dihydrocodeine, dextropropoxyphene, meptazinol, fentanyl, morphine, oxycodone, buprenorphine, hydromorphone, pethidine, tramadol and tapentadol), aged more than 18 years at opioid initiation for drugs prescribed between 2000 and 2015, and eligible to link with the UK national death registry (ONS) [45]. Cases were identified from information provided by the Office for National Statistics (ONS) death certificates, defined as opioid-related deaths by the authors with ICD-10 codes related to mental and behavioral drug disorders (except alcohol and tobacco), drug poisoning, and intentional self-poisoning. Deaths related to methadone were excluded. In the nested case–control study, each of the 230 identified cases (2 cases did not match to any potential controls) was matched to 4 controls based on a disease risk score (920 controls). Concurrent prescriptions of any opioid and more than one daily dose of gabapentinoids were associated with opioid-related death (aOR 6.2 [2.9–13.5]). The case-crossover study was performed on the 232 cases of opioid-related death and found a significant association for exposure to gabapentinoids (aOR 2.33 [1.01–5.34]), while no significant association was observed with high dose (more than 120 mg morphine (MME)) of opioids (aOR 1.58 [0.59–4.26]) [44].
Regional variation in longitudinal trajectories of primary care opioids prescribing across Health Boards in Scotland: a population-based study
Published in Expert Review of Clinical Pharmacology, 2022
Teng-Chou Chen, Amanj Kurdi, Ting-Li Su, Li-Chia Chen
The monthly and annual opioid utilization for each practice between January 2016 and December 2018 was measured as the number of Defined Daily Doses (DDDs) per 1000 registrants. For each practice, opioid preparations which can be assigned a DDD and indicated for pain relief were extracted from the monthly practice-level dispensing data, including codeine, tramadol, dihydrocodeine, tapentadol, meptazinol, hydromorphone, pethidine, dextropropoxyphene, morphine, fentanyl, oxycodone, and buprenorphine. Buprenorphine products categorized as analgesics according to the British National Formulary (BNF; code 0407020B0) were included [26]. On the contrary, opioids generally prescribed for opioid dependence, such as buprenorphine sublingual (BNF code 0410030A0 and 0410030B0) and methadone, were excluded.
The impact of the COVID-19 pandemic lockdown measures on the prescribing trends and utilization of opioids in the English primary care setting: segmented-liner regression analysis
Published in Expert Review of Clinical Pharmacology, 2022
Oula Nawaf Sindi, Faisal Salman Alshaikh, Brian Godman, Amanj Kurdi
This analysis was based on a retrospective, cross-sectional study of the opioids dispensed in the primary care setting in England using Prescription Cost Analysis (PCA) data, an aggregated, publicly available dataset. PCA datasets contain information about all prescribed medicines issued by GPs in the community in the UK, which includes medication’s name, quantity, strength, and formulation [12]. Opioid utilization was measured 12 months pre (March 2019–February 2020) and 12 months post the first national COVID-19 lockdown (April 2020–March 2021) including March 2020 when lockdown measures were enforced, equating to a total study duration of 25 months. This study included all of the opioid prescriptions that are indicated for pain management stratified into strong opioids (morphine, hydrophone, fentanyl, oxycodone, diamorphine, tramadol, tapentadol, methadone, buprenorphine, dipipanone, pentazocine, and pethidine) and weak opioids (codeine, dihydrocodeine, and meptazinol) based on the British National Formulary (BNF) classification [13]. Some methadone and buprenorphine preparations that are included in section 4.10 of the BNF are mostly used for opioids substitution therapy/opioid dependence [13]. Consequently, they were excluded as these preparations are unlikely to be prescribed for pain relief in the UK [14]. The study did not require ethical approval as we used publicly available datasets.