CYP2D6-Metabolized Opioids and Antidepressant Concomitant Use Increases Adverse Events in Nursing Home Residents

Recent findings have shed light on the potential risks associated with the simultaneous use of CYP2D6-metabolized opioids alongside CYP2D6-inhibiting (as opposed to CYP2D6-neutral) antidepressants among older nursing home residents. The retrospective cohort target trial emulation study revealed worsening pain and an increased likelihood of experiencing various adverse events in this population. Results were published in Annals of Internal Medicine.

Researchers analyzed data from 2010 to 2021 that included 29,435 long-term residents aged 65 and older and enlisted in Medicare. These individuals were receiving CYP2D6-metabolized opioids with a disease indication for antidepressant use. The study aimed to examine the connections between the “concomitant use of CYP2D6-metabolized opioids and antidepressants with clinical outcomes and opioid-related adverse events (ORAEs),” they wrote in the study.

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Clinical outcomes included worsening pain, physical function, and depression from baseline to quarterly minimum data set (MDS) assessments and were analyzed using modified Poisson regression models. ORAE outcomes included the number of pain-related hospitalizations and emergency department (ED) visits, opioid use disorder (OUD), and opioid overdose. These factors were analyzed with negative binomial or Poisson regression models.

Results showed that the use of CYP2D6-inhibiting antidepressants was associated with a higher risk of adverse effects. Specifically, there was an increased risk of worsening pain [95% CI, 1.09 to 1.17]) as well as higher adjusted incidence rate ratios of pain-related hospitalization (1.37 [CI, 1.19 to 1.59]), pain-related ED visit (1.49 [CI, 1.24 to 1.80]), and OUD (1.93 [CI, 1.37 to 2.73]). No significant differences were found in physical function, depression, or opioid overdose rates between the studied groups.

The study, funded by the National Institute on Aging, is only generalizable to NH residents, authors said.

Reference

Wei YJ, Winterstein AG, Schmidt S, et al. Clinical and adverse outcomes associated with concomitant use of cyp2d6-metabolized opioids with antidepressants in older nursing home residents: a target trial emulation study. Ann Intern Med. Published online July 23, 2024. doi:10.7326/M23-3109