Elderly patients with arthritis
who regularly take opioids for pain experience more undesirable and
sometimes dangerous side effects than those on other painkillers, such
as Coxibs and NSAIDs (non-steroidal anti-inflammatory drugs), researchers from Brigham and Women's Hospital, Boston, reveal in Archives of Internal Medicine.
Opioids are a class of drugs commonly prescribed for their painkilling (analgesic) properties. They include substances such as codeine, oxycodone, methadone, or morphine. They may be more easily recognized by the brand names, such as OxyContin, Kadian, Demerol, Percocet, Avinza, Percodan, Darvon, , Vicodin, and Lomotil.
The authors wrote:
They found that patients on opioids had a higher risk of experiencing adverse events compared to those on NSAIDs or Coxibs. Those on NSAIDs had the lowest risk.
The authors reported 101 fractures per 1,000 patients among those on opioids annually, compared to just 19 for those on Coxibs.
Cardiac risk was lower for those on NSAIDs compared to coxib or opioids users.
Opioid usage was linked to a higher risk of death or hospitalization than NSAID usage. Coxib users had the same risk as NSAID users.
21 per 1,000 NSAID users annually experience gastrointestinal tract bleeding, compared to 12 per 1,000 among coxib users.
The authors wrote:
6,275 patients on five types of opioids - tramadol, propoxyphene, codeine, hydrocodone, and oxycodone - were compared for adverse events rates after 30 and 180 days.
Gastrointestinal adverse events risks were similar across all groups throughout the study period, the authors report. Cardiovascular events risk was similar across all groups after 30 days, but at 180 days those on codeine had significantly higher cardiovascular events risk.
When using hydrocodone as a reference point, tramadol users had a 79% lower risk of fracture and those on propoxyphene had a 46% lower risk.
The risk of death was 2.4 times higher among oxycodone users when compared to hydrocodone, and two times higher among codeine users.
The authors wrote:
During a follow-up of a clinical trial, researchers found that approximately 189 days after patients had stopped taking Rofecoxib, their risk of cardiovascular events increased significantly. This was reported in a separate research letter published in the same journal.
"The Comparative Safety of Opioids for Nonmalignant Pain in Older Adults"
Opioids are a class of drugs commonly prescribed for their painkilling (analgesic) properties. They include substances such as codeine, oxycodone, methadone, or morphine. They may be more easily recognized by the brand names, such as OxyContin, Kadian, Demerol, Percocet, Avinza, Percodan, Darvon, , Vicodin, and Lomotil.
The authors wrote:
- "In the United States, one in five adults received a prescription for
an analgesic in 2006, accounting for 230 million prescription
purchases; however, the comparative safety of these drugs is unclear.
Although the cardiovascular safety of nonselective nonsteroidal
anti-inflammatory drugs (nsNSAIDs) and selective cyclooxygenase-2
inhibitors (coxibs) has been called into question, there is little
comparable information about the third major analgesic group, opioids."
They found that patients on opioids had a higher risk of experiencing adverse events compared to those on NSAIDs or Coxibs. Those on NSAIDs had the lowest risk.
The authors reported 101 fractures per 1,000 patients among those on opioids annually, compared to just 19 for those on Coxibs.
Cardiac risk was lower for those on NSAIDs compared to coxib or opioids users.
Opioid usage was linked to a higher risk of death or hospitalization than NSAID usage. Coxib users had the same risk as NSAID users.
21 per 1,000 NSAID users annually experience gastrointestinal tract bleeding, compared to 12 per 1,000 among coxib users.
The authors wrote:
- "Analgesics are used daily by millions of people; however, current
data do not allow patients or physicians to determine which type of
agent is safest. We compared nsNSAIDs, coxibs and opioids across a wide
range of specific safety events and several composite safety events.
Although nsNSAIDs pose certain risks, these analyses support the safety
of these agents compared with other analgesics. The recent concerns
raised about opioid use in non-malignant pain syndromes appear warranted
on the basis of these data."
6,275 patients on five types of opioids - tramadol, propoxyphene, codeine, hydrocodone, and oxycodone - were compared for adverse events rates after 30 and 180 days.
Gastrointestinal adverse events risks were similar across all groups throughout the study period, the authors report. Cardiovascular events risk was similar across all groups after 30 days, but at 180 days those on codeine had significantly higher cardiovascular events risk.
When using hydrocodone as a reference point, tramadol users had a 79% lower risk of fracture and those on propoxyphene had a 46% lower risk.
The risk of death was 2.4 times higher among oxycodone users when compared to hydrocodone, and two times higher among codeine users.
The authors wrote:
- "This study's findings do not agree with a commonly held belief that
all opioids are associated with similar risk. The risks were not
explained by the dosage being prescribed and did not vary across a range
of sensitivity analyses. The risks were substantial and translated into
numbers needed to treat that would be considered clinically
significant. Our findings regarding cardiovascular risk were surprising
and require validation in other data sets."
During a follow-up of a clinical trial, researchers found that approximately 189 days after patients had stopped taking Rofecoxib, their risk of cardiovascular events increased significantly. This was reported in a separate research letter published in the same journal.
"The Comparative Safety of Opioids for Nonmalignant Pain in Older Adults"
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