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Prolonged post-operative hydrocodone usage due to psychotropic drug interaction

  • Aaron G. Whitt , Viana F. Karimi , Jeremy T. Gaskins , Ruby E. Renfrow , Abbey R. Roach , Arthur L. Malkani , Brandi Hartley , Madhusudhan R. Yakkanti and Saeed A. Jortani EMAIL logo
Published/Copyright: December 16, 2024
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Drug Metabolism and Personalized Therapy
From the journal Drug Metabolism and Personalized Therapy Volume 40 Issue 1

Abstract

Objectives

To explore pain outcomes in patients prescribed hydrocodone and psychotropic medications with or without CYP2D6 inhibition activity.

Methods

Patients hospitalized for lower/limited upper extremity injuries who were prescribed hydrocodone alongside a psychotropic medication were considered for this study (n=224). A subset of these patients (n=178) was prescribed a psychotropic medication known to inhibit CYP2D6, while the remainder (n=46) were prescribed psychotropic medications without CYP2D6 inhibition activity. Patient demographics and pain outcomes were collected by electronic health record review and interviews.

Results

Patients taking a psychotropic inhibitor of CYP2D6 exhibited longer duration of opioid use post-discharge (median 33 days [IQR 10–99]) compared with patients taking a psychotropic non-inhibitor (4 days [2–20], p<0.001). No significant differences were observed with in-hospital pain outcomes, including total dose of hydrocodone administered, duration of hydrocodone use, pain index scores, and the occurrence of common mild/moderate/severe hydrocodone side effects.

Conclusions

Patients prescribed at least one psychotropic inhibitor of CYP2D6 were more likely to continue using hydrocodone for up to 3 months following surgery. Knowledge of these critical drug-drug interactions could enhance clinical practice and improve patient outcomes. This study highlights negative post-operative pain outcomes in patients prescribed hydrocodone alongside a psychotropic inhibitor of CYP2D6. The results of this study indicate that patients taking psychotropic medications that inhibit CYP2D6 are at increased risk for prolonged hydrocodone use following orthopedic surgery.

Keywords: pain management; drug-drug interactions; mental health disorders; hydrocodone; opioids; post-operative analgesia
Corresponding author: Saeed A. Jortani, Department of Pathology and Laboratory Medicine, School of Medicine, University of Louisville, 511 S. Floyd St. (Suite 227), Louisville, KY 40202, USA, E-mail:
Aaron G. Whitt and Viana F. Karimi contributed equally to this work.

Acknowledgments

The contributions of Drs. Keivan Hossainijad, Staneslava Prather, Cynthia Maluf are greatly appreciated.

  1. Research ethics: The study was approved by the University of Louisville Institutional Review Board (IRB # 16.0707) and was carried out in accordance with the principles of the Declaration of Helsinki.

  2. Informed consent: Informed consent was obtained from all individuals included in this study.

  3. Author contributions: Aaron G. Whitt: Writing- original draft, Visualization, Data curation, Supervision. Viana F. Karimi: Conceptualization, Data curation, Investigation, Methodology, Writing- original draft, Visualization. Jeremy T. Gaskins: Conceptualization, Data curation, Investigation, Methodology, Formal analysis, Software, Writing-review and editing, Visualization. Ruby E. Renfrow: Data curation, Investigation, Methodology, Writing- original draft, visualization. Abbey R. Roach: Conceptualization, Writing-review and editing. Arthur L. Malkani: Supervision, Writing-review and editing. Brandi Hartley: Supervision, Writing-review and editing. Madhusudhan R. Yakkanti: Supervision, Writing-review and editing. Saeed A. Jortani: Conceptualization, Supervision, Methodology, Investigation, Resources, Writing- original draft, Project administration, Funding acquisition. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no competing interests.

  6. Research funding: This work was funded by the Office of the Assistant Secretary of Defense for Health Affairs, through the Department of Defense Broad Agency Announcement W81XWH-BAA-14-1 under Award No. W81XWH-17-1-0040. The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014 is the awarding and administering acquisition office. The opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.

  7. Data availability: Data will be made available upon request.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/dmpt-2024-0031).

Received: 2024-06-24
Accepted: 2024-10-21
Published Online: 2024-12-16

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/dmpt-2024-0031
Keywords for this article
pain management; drug-drug interactions; mental health disorders; hydrocodone; opioids; post-operative analgesia

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Unlocking the therapeutic potential and personalized therapy of testosterone: a comprehensive review
  4. Original Articles
  5. Prolonged post-operative hydrocodone usage due to psychotropic drug interaction
  6. An open-label, single dose, safety and pharmacokinetic study of Withania somnifera root extract in healthy volunteers
  7. Effect of metformin on exercise capacity in treatment naïve type 2 diabetes patients
  8. Molecular docking and in vitro evaluation of glucosamine sulfate targeting MMP-3, MMP-9, and IL-4 for potential osteoarthritis treatment
  9. CYP2D6 genetic polymorphisms impact on tamsulosin efficacy and safety in patients with benign prostatic hyperplasia
  10. Predicting of factors associated with valsartan response among hypertensive patients attending the Jordan University Hospital
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