Economic Implications of Potential Drug–Drug Interactions in Chronic Pain Patients

Robert Taylor Jr; Joseph V Pergolizzi Jr; R Amy Puenpatom; Kent H Summers


Expert Rev Pharmacoeconomics Outcomes Res. 2013;13(6):725-734. 

In This Article

Expert Commentary

Five recent studies on the prevalence and economic outcomes associated with DDEs in the general noncancer pain population and two large chronic pain populations (OA and cLBP) were independently published and reported that DDEs occur frequently and are associated with significantly higher and substantial cost differentials. This financial burden has not yet been fully recognized by health care providers or society. For that reason, polypharmacy should be carefully monitored even in younger patients who take concurrent medications to manage complex conditions such as chronic pain. Prescribing physicians should avoid prescribing multiple concurrent medications that metabolize via the CYP450 enzyme system to avoid the risk of a potential pharmacokinetic DDI. Since these studies relied on similar methodologies and the same investigators, results were combined here to emphasize that among patients taking CYP450-metabolized opioid analgesics to help control moderate to severe pain associated with chronic noncancer pain, DDEs were not uncommon and when they did occur, they were associated with higher health care payments. The chronic pain patient population is growing and such patients' treatments frequently require polypharmacy. The dangers of polypharmacy may not be fully appreciated by clinicians. Clinicians prescribing agents for chronic pain patients should be cognizant of which drugs are metabolized via the CYP450 enzyme system and, when possible, find suitable alternate agents that do not expose patients to the risk of pharmacokinetic drug interactions.