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Potential Cytochrome P450 Drug-Drug Interactions among Pediatric Patients Undergoing Tonsillectomy
John Faria1, Matthew Solverson2, Madlin Faria3
11 University of Rochester, Rochester, New York, USA.
Insights
A small percentage of children undergoing adenotonsillectomy receive medications that may interact with opioid metabolism. Careful consideration of drug-drug interactions is crucial when prescribing opioids to these patients.
Area of Science:
- Pharmacology
- Pediatric Medicine
- Drug Interactions
Background:
- Opioid metabolism is significantly influenced by cytochrome P450 (CYP) enzymes.
- Children undergoing adenotonsillectomy may receive concomitant medications that can affect CYP activity.
- Obstructive sleep apnea, common in this pediatric population, increases sensitivity to opioids.
Purpose of the Study:
- To determine the frequency of potential CYP-mediated drug-drug interactions involving opioid metabolism in children post-adenotonsillectomy.
- To identify specific medications commonly prescribed to this cohort that inhibit or induce CYP enzymes.
Main Methods:
- Retrospective chart review of 1000 pediatric patients undergoing adenotonsillectomy.
- Analysis of discharge medication reconciliation forms for systemic medications.
- Comparison of patient medication lists against FDA-published CYP inducers and inhibitors.
Main Results:
- 157 unique systemic medications were identified postoperatively.
- 3% of patients received a CYP3A4 inhibitor, and 5% received a CYP2D6 inhibitor.
- One patient was prescribed a CYP3A4 inducer (prednisone).
Conclusions:
- A low but significant proportion of children undergoing adenotonsillectomy are exposed to medications with the potential to alter opioid metabolism.
- The potential for drug-drug interactions necessitates careful opioid selection and dosing in this population.
- Further research is warranted to assess the clinical impact of these interactions.
Objective:
To evaluate the frequency of potential cytochrome P450 (CYP) drug-drug interactions affecting opioid metabolism among children undergoing adenotonsillectomy.
Study Design:
Case series with chart review.
Setting:
Tertiary care children's hospital.
Subjects And Methods:
A retrospective review was conducted of 1000 patients undergoing adenotonsillectomy at Children's Hospital of Wisconsin. The discharge medication reconciliation form was reviewed. Each patient's list of medications was compared with various published sources to determine whether medications causing CYP inhibition or induction were present.
Results:
There were 157 unique medications with systemic absorption given postoperatively to this patient cohort. Eight percent of patients were on at least 5 medications after surgery other than their posttonsillectomy medication. The 5 most commonly prescribed medications were albuterol, cetirizine, fluticasone nasal spray, montelukast, and polyethylene glycol. Per a list of known CYP inducers and inhibitors published by the US Food and Drug Administration, 30 (3%) patients were on a medication that inhibited CYP3A4; 1 patient was on a CYP3A4 inducer, prednisone; and 46 (5%) patients were on a medication that inhibited CYP2D6.
Conclusions:
A small fraction of patients undergoing adenotonsillectomy are on medications that potentially alter the metabolism of opioid pain medications. Given the narrow therapeutic index of opioids and increased sensitivity to opioids among patients with obstructive sleep apnea, drug-drug interactions need to be considered as they relate to whether an opioid is appropriate and at what dose.
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