Polypharmacy in Patients With Advanced Cancer and Pain: A European Cross-Sectional Study of 2282 Patients

摘要: Abstract Context Patients with advanced cancer need multiple drugs to control symptoms and treat concomitant diseases. At the same time, goal of treatment changes as life expectancy becomes limited. This results in a risk for polypharmacy, maintained use unneeded drugs, drug-drug interactions (DDIs). Objectives The aim study was analyze medications identify drug combinations DDIs cohort pain patients, defined by World Health Organization analgesic ladder Step III opioid. Methods All taken within day patients receiving opioids moderate or severe (Step opioids) were analyzed. Nonopioids adjuvants analyzed their across countries. Unneeded pharmacodynamic pharmacokinetic identified on basis published literature electronic resources. Results In total, 2282 from 17 centers 11 European countries included. They received mean 7.8 (range 1–20). Over one-quarter used 10 more medications. classes most frequently coadministered proton pump inhibitors, laxatives, corticosteroids, paracetamol (acetaminophen), nonsteroidal anti-inflammatory metoclopramide, benzodiazepines, anticoagulants, antibiotics, anticonvulsants, diuretics, antidepressants. nonopioids essential varied Approximately 45% unnecessary potentially about 7% given duplicate antagonizing agents. Exposures frequent increased sedation, gastric ulcerations, bleedings, neuropsychiatric cardiac complications. Many exposed involving cytochrome P450, including 58% who opioid CYP3A4 (izoenzyme P450) substrate, than 10% major inhibitors inducers. Conclusion treated high number drugs. Nonopioid analgesics corticosteroids are used, but different patterns between found. receive at serious DDIs. These findings demonstrate that therapy these needs be evaluated continuously.