-
Physical Chemistry Chemical Physics :... Jan 2021Interactions of the analgesic medications dextropropoxyphene (DPP, opioid), paracetamol (PCL, nonnarcotic), tramadol (TDL, nonnarcotic), ibuprofen (IBN, nonsteroidal...
Interactions of the analgesic medications dextropropoxyphene (DPP, opioid), paracetamol (PCL, nonnarcotic), tramadol (TDL, nonnarcotic), ibuprofen (IBN, nonsteroidal anti-inflammatory drug (NSAID)), and naproxen (NPX, NSAID) with pristine graphene (GN) and nitrogen-doped GN (NGN; containing only graphitic N atoms) nanosheets were explored using density functional theory (DFT) in the gas and aqueous phases. Calculations in the aqueous phase were performed using the integral equation formalism polarized continuum model (IEFPCM). Calculated geometry-optimized structures, partial atomic charges (determined using Natural Bond Orbital analysis), highest occupied molecular orbital (HOMO)-lowest unoccupied molecular orbital (LUMO) energy gaps, work functions (determined using time-dependent DFT), and molecular electrostatic potential plots showed that the adsorption process is physical in nature (viz. physisorption), primarily due to noncovalent π-π and van der Waals interactions. In addition, calculated adsorption energies (ΔEad) were exergonic, indicating that formation of the analgesic/GN and analgesic/NGN complexes is thermodynamically favorable in the gas (ΔEad values for analgesic/GN and analgesic/NGN were in the range of -66.56 kJ mol-1 to -106.78 kJ mol-1) and aqueous phases (ΔEad values for analgesic/GN and analgesic/NGN complexes were in the range of -58.75 kJ mol-1 to -100.46 kJ mol-1). Generally, for GN and NGN, adsorption was more endergonic in the aqueous phase by as much as +10.41 kJ mol-1. Calculated solvation energies (ΔEsolvation) were exergonic for all analgesic/GN complexes (ΔEsolvation values were in the range of -56.50 kJ mol-1 to -66.17 kJ mol-1) and analgesic/NGN complexes (ΔEsolvation values were in the range of -77.26 kJ mol-1 to -87.96 kJ mol-1), with analgesic/NGN complexes exhibiting greater stability in aqueous solutions (∼20 kJ mol-1 more stable). In summary, the results of this theoretical study demonstrate that the adsorption and solvation of analgesics on GN and NGN nanosheets is thermodynamically favorable. In addition, generally, analgesic/NGN complexes exhibit higher adsorption affinities and solvation energies in the gas and aqueous phases. Therefore, GN and NGN nanosheets are potential adsorbents for extracting analgesic contaminants from aqueous environments such as aquatic ecosystems.
PubMed: 33355576
DOI: 10.1039/d0cp05543c -
Frontiers in Pharmacology 2019Wnt/β-catenin signaling is involved in various biological processes, including the development of the central nervous system. The dysfunction of mitochondria has been...
Wnt/β-catenin signaling is involved in various biological processes, including the development of the central nervous system. The dysfunction of mitochondria has been shown to participate in the progress of subarachnoid hemorrhage (SAH). Traumatic subarachnoid hemorrhage (tSAH) is a serious complication in acute craniocerebral trauma. Opioids can activate the canonical Wnt/β-catenin signaling pathway. c-Myc, a downstream protein of Wnt/β-catenin signaling, contributes to the fusion of mitochondria. Here, we investigated the protective roles of Propoxyphene (Pro) against Oxyhemoglobin (OxyHb)-induced primary cultured neuron apoptosis. The data indicated that Pro rescued active-β-catenin from OxyHb-induced decline. Furthermore, Pro attenuated OxyHb-induced apoptosis and fission of mitochondria in primary cortical neurons. However, the protective effects were abrogated under active-β-catenin-deficient conditions. Together, the data presented here showed that Pro, a weak opioid analgesic drug, attenuates OxyHb-induced mitochondria-dependent apoptosis in an active-β-catenin-c-Myc-dependent manner.
PubMed: 32082150
DOI: 10.3389/fphar.2019.01616 -
Asian Journal of Psychiatry Aug 2019Prescription drug suicide merits study to guide the development of strategies to reduce suicide risk. We examined prescription drug suicide specifically in non-abusers...
BACKGROUND
Prescription drug suicide merits study to guide the development of strategies to reduce suicide risk. We examined prescription drug suicide specifically in non-abusers of prescription drugs; this is a relatively unexplored subject.
METHODS
Six-year data on prescription drug suicide in non-abusers were extracted from the records of the Department of Forensic Medicine at the All India Institute of Medical Sciences, New Delhi. These records contained information obtained from the scene of the suicide, from interviews with relatives of the deceased, and from forensic toxicological analyses at two laboratories.
RESULTS
There were 27 (8%) cases of prescription drug suicide in non-abusers out of 338 cases of suicidal poisoning. The mean age of this sample was 26 years. The sample was 74% male. Nearly half of the cases (44%) were students. A combination of dextropropoxyphene with dicyclomine, with or without paracetamol, was used by 41% of cases. Overdose was achieved through the ingestion of 10-40 (median, 30) tablets or by the injection of 2-3 (median, 2) vials of medication. In 52% of cases, it appeared that the drugs had been procured over the counter.
CONCLUSIONS
It is reassuring that the absolute number of prescription drug suicides in non-abusers was small; the findings, however, are important because they could serve as a baseline for assessing time trends in future studies. For the present, we suggest that prescription drugs of potential abuse, especially those containing opioids and antispasmodics, should be prescribed and dispensed judiciously, especially to youth.
Topics: Adult; Analgesics, Opioid; Drug Overdose; Female; Forensic Medicine; Humans; India; Male; Parasympatholytics; Physicians; Prescription Drugs; Retrospective Studies; Students; Suicide; Universities; Young Adult
PubMed: 31374376
DOI: 10.1016/j.ajp.2019.07.039 -
The Cochrane Database of Systematic... Aug 2020Acute soft tissue injuries are common and costly. The best drug treatment for such injuries is not certain, although non-steroidal anti-inflammatory drugs (NSAIDs) are... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Acute soft tissue injuries are common and costly. The best drug treatment for such injuries is not certain, although non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended. There is concern about the use of oral opioids for acute pain leading to dependence. This is an update of a Cochrane Review published in 2015.
OBJECTIVES
To assess the benefits or harms of NSAIDs compared with other oral analgesics for treating acute soft tissue injuries.
SEARCH METHODS
We searched the CENTRAL, 2020 Issue 1, MEDLINE (from 1946), and Embase (from 1980) to January 2020; other databases were searched to February 2019.
SELECTION CRITERIA
We included randomised or quasi-randomised controlled trials involving people with acute soft tissue injury (sprain, strain, or contusion of a joint, ligament, tendon, or muscle occurring within 48 hours of inclusion in the study), and comparing oral NSAIDs versus paracetamol (acetaminophen), opioid, paracetamol plus opioid, or complementary and alternative medicine. The outcomes were pain, swelling, function, adverse effects, and early re-injury.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed studies for eligibility, extracted data, and assessed risk of bias. We assessed the quality of the evidence using GRADE methodology.
MAIN RESULTS
We included 20 studies, with 3305 participants. Three studies included children only. The others included predominantly young adults; approximately 60% were male. Seven studies recruited people with ankle sprains only. Most studies were at low or unclear risk of bias; however, two were at high risk of selection bias, three were at high risk of bias from lack of blinding, and five were at high risk of selective outcome reporting bias. Some evidence relating to pain relief was high certainty. Other evidence was either moderate, low or very low certainty, reflecting study limitations, indirectness, imprecision, or combinations of these. Thus, we are certain or moderately certain about some of the estimates, and uncertain or very uncertain of others. Eleven studies, involving 1853 participants compared NSAIDs with paracetamol. There were no differences between the two groups in pain at one to two hours (1178 participants, 6 studies; high-certainty evidence), at days one to three (1232 participants, 6 studies; high-certainty evidence), and at day seven or later (467 participants, 4 studies; low-certainty evidence). There was little difference between the groups in numbers of participants with minimal swelling at day seven or later (77 participants, 1 study; low-certainty evidence). Very low-certainty evidence from three studies (386 participants) means we are uncertain of the finding of little difference between the two groups in return to function at day seven or later. There was low-certainty evidence from 10 studies (1504 participants) that NSAIDs may slightly increase the risk of gastrointestinal adverse events compared with paracetamol. There was low-certainty evidence from nine studies (1679 participants) of little difference in neurological adverse events between the NSAID and paracetamol groups. Six studies, involving 1212 participants compared NSAIDs with opioids. There was moderate-certainty evidence of no difference between the groups in pain at one hour (1058 participants, 4 studies), and low-certainty evidence for no difference in pain at days four or seven (706 participants, 1 study). There was very low-certainty evidence of no important difference between the groups in swelling (84 participants, 1 study). Participants in the NSAIDs group were more likely to return to function in 7 to 10 days (542 participants, 2 studies; low-certainty evidence). There was moderate-certainty evidence (1143 participants, 5 studies) that NSAIDs were less likely to result in gastrointestinal or neurological adverse events compared with opioids. Four studies, involving 240 participants, compared NSAIDs with the combination of paracetamol and an opioid. The applicability of findings from these studies is in question because the dextropropoxyphene combination analgesic agents used are no longer in general use. Very low-certainty evidence means we are uncertain of the findings of no differences between the two interventions in the numbers with little or no pain at day one (51 participants, 1 study), day three (149 participants, 2 studies), or day seven (138 participants, 2 studies); swelling (230 participants, 3 studies); return to function at day seven (89 participants, 1 study); and the risk of gastrointestinal or neurological adverse events (141 participants, 3 studies). No studies reported re-injury rates. No studies compared NSAIDs with oral complementary and alternative medicines, AUTHORS' CONCLUSIONS: Compared with paracetamol, NSAIDs make no difference to pain at one to two hours and at two to three days, and may make no difference at day seven or beyond. NSAIDs may result in a small increase in gastrointestinal adverse events and may make no difference in neurological adverse events compared with paracetamol. Compared with opioids, NSAIDs probably make no difference to pain at one hour, and may make no difference at days four or seven. NSAIDs probably result in fewer gastrointestinal and neurological adverse effects compared with opioids. The very low-certainly evidence for all outcomes for the NSAIDs versus paracetamol with opioid combination analgesics means we are uncertain of the findings of no differences in pain or adverse effects. The current evidence should not be extrapolated to adults older than 65 years, as this group was not well represented in the studies.
Topics: Acetaminophen; Acute Disease; Administration, Oral; Adult; Analgesics; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Bias; Child; Contusions; Female; Humans; Male; Middle Aged; Pain; Randomized Controlled Trials as Topic; Soft Tissue Injuries; Sprains and Strains; Time-to-Treatment; Young Adult
PubMed: 32797734
DOI: 10.1002/14651858.CD007789.pub3 -
Fundamental & Clinical Pharmacology Aug 2020France is experiencing an increase in the number of opioid prescriptions and related fatalities. We carried out a retrospective observational study using data from the... (Observational Study)
Observational Study
France is experiencing an increase in the number of opioid prescriptions and related fatalities. We carried out a retrospective observational study using data from the Paris PCC over a 10-year period. The main objective was to obtain an epidemiological description of the severe reported cases. The secondary objectives were to assess the evolution of the number of these cases and their severity defined by the use of fentanyl and its derivatives, the use of the opioid-poisoning treatment naloxone, and the number of fatalities. During 2008-2017, 268 511 cases were recorded, including 1 122 cases of opioid-related poisoning that required medical management. These poisonings involved tramadol (43%), codeine (25%), dextropropoxyphene (13%), and morphine (8%); most resulted from self-exposure (60%). During the 10-year study period, 130 opioid-related fatalities were recorded in the Paris area, mainly resulting from suicides (39%) in men and were attributed to morphine (27%), tramadol (24%), and methadone (21%). We did not identify an increase in the number of severe opioid-related poisonings or fatalities or in the use of fentanyl or its derivatives. Conversely, we observed an increase in the use of naloxone, suggesting an increase in the severity of opioid poisonings. Our findings show that, until 2017, the opioid overdose epidemiology in the Paris area is different to that in the USA. The systematic analysis of data from the PCCs could be a good tool for health monitoring. To assess trends in France, a national study over a longer period would also be useful.
Topics: Adolescent; Adult; Analgesics, Opioid; Cause of Death; Drug Prescriptions; Female; Humans; Male; Middle Aged; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Paris; Poison Control Centers; Poisoning; Retrospective Studies; Suicide; Time Factors; Young Adult
PubMed: 31945200
DOI: 10.1111/fcp.12534 -
Fundamental & Clinical Pharmacology Apr 2024The combination dextropropoxyphene/paracetamol (DXP/P) was the most prescribed opioid analgesic until its withdrawal in 2011.
BACKGROUND
The combination dextropropoxyphene/paracetamol (DXP/P) was the most prescribed opioid analgesic until its withdrawal in 2011.
OBJECTIVES
This study investigated dispensations of analgesics in chronic users of DXP/P during the 18 months following its withdrawal.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
Topics: Humans; Female; Aged; Analgesics, Opioid; Dextropropoxyphene; Cross-Sectional Studies; Analgesics; Pain
PubMed: 37864449
DOI: 10.1111/fcp.12962 -
European Journal of Hospital Pharmacy :... Sep 2020Pain management in the emergency department (ED) is a key issue that must be regularly evaluated. Practice evaluation gold standard remains patient file analysis, but is...
OBJECTIVE
Pain management in the emergency department (ED) is a key issue that must be regularly evaluated. Practice evaluation gold standard remains patient file analysis, but is highly time consuming. The aim of this study is to evaluate the interest of a defined daily dose (DDD) based analysis in the evaluation of pain management in the ED.
METHODS
A local indicator was elaborated based on the DDD concept: the defined dose per admission (DDA). Unlike the DDD that corresponds to a standardised total dose administered over a day, the DDA represents the average total dose administrated to a patient throughout the stay in the ED. A DDA was assigned to every analgesic, from step 1 to step 3. Oral and injectable forms were studied, but transdermal forms were not considered. DDA values were assimilated to the existing DDDs when these were officially established by the WHO. When values were not defined by the WHO, mean values observed in local practice were selected. Annual numbers of patients admitted to the ED and quantities of each analgesic supplied by the pharmacy ward were annually extracted from respective data files. Paediatric patients being treated at a specific separate ED, only adults were considered throughout the study. Raw quantities of analgesics used each year were converted to their equivalent amounts in DDA, and then expressed in numbers of DDA per 100 admissions (DDA/100A). This indicator allowed us to describe relative evolutions of analgesics prescriptions from 2006 to 2017.
RESULTS
Analgesic overall use rose from 18.4 to 30.2 DDA/100A between 2006 and 2017, representing a prescription increase of 64%. Throughout the study, step 1 analgesics rose from 10.8 to 19.3 DDA/100A (+79%), step 3 from 1.8 to 5.4 (+200%) and step 2 remained stable around 5.6 DDA/100A. The integration of orodispersible paracetamol tablets in 2013 allowed us to halve the consumption of injectable paracetamol in the long term and had no effect on classic paracetamol oral forms such as tablets or capsules. Tramadol increased from 41% to 78% among step 2 analgesics after the withdrawal of dextropropoxyphene in 2011. Codeine use shows a steady decline from 1.9 DDA/100A in 2011 to 0.72 in 2017.
DISCUSSION/CONCLUSION
The DDA concept appears to be an effective tool for assessing long-term analgesic-use trends at hospital EDs. This tool can also mitigate one major bias at EDs, that is the lack of traceability of analgesic administration in emergency contexts. This tool could be adjusted by integrating the average length of stay in the ED.
Topics: Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Dose-Response Relationship, Drug; Drug Administration Schedule; Emergency Service, Hospital; Hospitals, University; Humans; Pain Management; Pain Measurement
PubMed: 32839258
DOI: 10.1136/ejhpharm-2018-001749