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Potential Cytochrome P450 Drug-Drug Interaction Among Adult and Adolescent Patients Undergoing Tonsillectomy.
OTO Open. 2020 Apr-Jun; 4(2):2473974X20932503.OO

Abstract

Objective

To assess the frequency of potential drug-drug interactions affecting cytochrome P450 (CYP)-mediated metabolism of opioids among adult and adolescent patients who underwent adenotonsillectomy.

Study Design

Retrospective chart review.

Setting

Tertiary care university hospital.

Patients and Methods

A retrospective review was conducted of 279 patients who underwent adenotonsillectomy at the University of Rochester. The discharge medication list was reviewed for all patients, and their postoperative medications were compared with a reference list published by the Food and Drug Administration and the University of Indiana's Department of Clinical Pharmacology (Flockhart Table) to determine whether CYP-inducing or CYP-inhibiting medication was present.

Results

Out of 279 patients, 197 different medications were taken postoperatively. Approximately 70% of patients were taking 2 medications in addition to the standard postoperative analgesics (acetaminophen, hydrocodone, oxycodone, morphine, and/or ibuprofen). The 5 most commonly prescribed medications excluding the posttonsillectomy medications were oral contraceptives, ondansetron, amoxicillin, albuterol, and methylprednisolone. Four percent of patients were taking a medication that inhibits CYP3A4; <1% were taking a medication that induces CYP3A4; and 15% were taking a medication that inhibits CYP2D6.

Conclusions

Nearly 20% of the patients in this cohort were taking a medication that may alter opioid metabolism through induction or inhibition of CYP3A4 or CYP2D6. Some of these interactions have the potential to be more clinically relevant than others, particularly interactions that can lead to enhanced toxicity of opioids due to accumulation of active metabolites.

Authors+Show Affiliations

University of Rochester, Rochester, New York, USA.University of Rochester, Rochester, New York, USA.Independent, Rochester, New York, USA.University of Rochester, Rochester, New York, USA.University of Rochester, Rochester, New York, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32596625

Citation

Nimmagadda, Sai, et al. "Potential Cytochrome P450 Drug-Drug Interaction Among Adult and Adolescent Patients Undergoing Tonsillectomy." OTO Open, vol. 4, no. 2, 2020, p. 2473974X20932503.
Nimmagadda S, Wong SJ, Faria M, et al. Potential Cytochrome P450 Drug-Drug Interaction Among Adult and Adolescent Patients Undergoing Tonsillectomy. OTO Open. 2020;4(2):2473974X20932503.
Nimmagadda, S., Wong, S. J., Faria, M., Allen, P., & Faria, J. (2020). Potential Cytochrome P450 Drug-Drug Interaction Among Adult and Adolescent Patients Undergoing Tonsillectomy. OTO Open, 4(2), 2473974X20932503. https://doi.org/10.1177/2473974X20932503
Nimmagadda S, et al. Potential Cytochrome P450 Drug-Drug Interaction Among Adult and Adolescent Patients Undergoing Tonsillectomy. OTO Open. 2020 Apr-Jun;4(2):2473974X20932503. PubMed PMID: 32596625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Potential Cytochrome P450 Drug-Drug Interaction Among Adult and Adolescent Patients Undergoing Tonsillectomy. AU - Nimmagadda,Sai, AU - Wong,Stephanie Jung-Ying, AU - Faria,Madlin, AU - Allen,Paul, AU - Faria,John, Y1 - 2020/06/18/ PY - 2020/01/27/received PY - 2020/05/09/accepted PY - 2020/6/30/entrez KW - adenotonsillectomy KW - adult KW - cytochrome P450 KW - medication interaction KW - obstructive sleep apnea KW - opioid KW - patient safety KW - tonsillectomy SP - 2473974X20932503 EP - 2473974X20932503 JF - OTO open JO - OTO Open VL - 4 IS - 2 N2 - Objective: To assess the frequency of potential drug-drug interactions affecting cytochrome P450 (CYP)-mediated metabolism of opioids among adult and adolescent patients who underwent adenotonsillectomy. Study Design: Retrospective chart review. Setting: Tertiary care university hospital. Patients and Methods: A retrospective review was conducted of 279 patients who underwent adenotonsillectomy at the University of Rochester. The discharge medication list was reviewed for all patients, and their postoperative medications were compared with a reference list published by the Food and Drug Administration and the University of Indiana's Department of Clinical Pharmacology (Flockhart Table) to determine whether CYP-inducing or CYP-inhibiting medication was present. Results: Out of 279 patients, 197 different medications were taken postoperatively. Approximately 70% of patients were taking 2 medications in addition to the standard postoperative analgesics (acetaminophen, hydrocodone, oxycodone, morphine, and/or ibuprofen). The 5 most commonly prescribed medications excluding the posttonsillectomy medications were oral contraceptives, ondansetron, amoxicillin, albuterol, and methylprednisolone. Four percent of patients were taking a medication that inhibits CYP3A4; <1% were taking a medication that induces CYP3A4; and 15% were taking a medication that inhibits CYP2D6. Conclusions: Nearly 20% of the patients in this cohort were taking a medication that may alter opioid metabolism through induction or inhibition of CYP3A4 or CYP2D6. Some of these interactions have the potential to be more clinically relevant than others, particularly interactions that can lead to enhanced toxicity of opioids due to accumulation of active metabolites. SN - 2473-974X UR - https://www.unboundmedicine.com/medline/citation/32596625/Potential_Cytochrome_P450_Drug-Drug_Interaction_Among_Adult_and_Adolescent_Patients_Undergoing_Tonsillectomy L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32596625/ DB - PRIME DP - Unbound Medicine ER -
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