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Comparative Risks of Opioid Overdose in Patients on Oxycodone Initiating Selective Serotonin Reuptake Inhibitors.

Katsiaryna Bykov1, C Andrew Basham1, Nazleen F Khan1

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Summary
This summary is machine-generated.

Selective serotonin reuptake inhibitors (SSRIs) co-prescribed with oxycodone showed a low incidence of opioid overdose. Sertraline was associated with a slightly lower overdose rate compared to other SSRIs when added to oxycodone.

Keywords:
Cohort studiesDrug interactionDrug safetyOpiate overdoseOpioidOxycodonePharmacoepidemiologySelective serotonin reuptake inhibitors

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Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Epidemiology

Background:

  • Selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed with oxycodone.
  • SSRIs may potentiate opioid-induced respiratory depression.
  • The comparative risk of opioid overdose with different SSRIs added to oxycodone is not well-established.

Purpose of the Study:

  • To compare the risk of opioid overdose among patients initiating different SSRIs while on oxycodone.
  • To assess the comparative effects of specific SSRIs (sertraline, citalopram, escitalopram, fluoxetine, paroxetine) on opioid overdose risk.

Main Methods:

  • A cohort study using US commercial and public health insurance claims data (2004-2020).
  • Inclusion of adults initiating an SSRI while on oxycodone, followed for 365 days for opioid overdose events.
  • Propensity score matching and weighted Cox proportional hazard models were used to estimate hazard ratios.

Main Results:

  • The study included 753,263 individuals initiating SSRIs with oxycodone.
  • Opioid overdose incidence rates ranged from 10.8 to 15.2 per 1,000 person-years across SSRIs.
  • Compared to sertraline, other SSRIs showed slightly higher hazard ratios for overdose (e.g., citalopram HR 1.24, fluoxetine HR 1.26).

Conclusions:

  • The incidence of opioid overdose was low in patients adding an SSRI to oxycodone.
  • Sertraline was associated with a statistically similar, but numerically lower, rate of opioid overdose compared to other SSRIs studied.
  • Findings suggest potential differences in overdose risk among SSRIs when co-prescribed with oxycodone.