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Clin Drug Investig. 2019 Mar 9. doi: 10.1007/s40261-019-00767-8. [Epub ahead of print]

Prescribing Trends of Codeine-containing Medications and Other Opioids in Primary Care After A Regulatory Decision: An Interrupted Time Series Analysis.

Author information

1
Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, 50139, Florence, Italy.
2
Health Search, Italian College of General Practitioners and Primary Care, Via Sestese,61, 50141, Florence, Italy.
3
Italian College of General Practitioners and Primary Care, 50142, Florence, Italy.
4
Health Search, Italian College of General Practitioners and Primary Care, Via Sestese,61, 50141, Florence, Italy. lapi.francesco@simg.it.

Abstract

BACKGROUND AND OBJECTIVES:

In 2014, the Italian Medicines Agency (AIFA) amended the summary of product characteristics of codeine-containing medications limiting their use for maximum three days. This study attempted to clarify the impact of AIFA intervention on prescribing trends and appropriateness of use of codeine-containing medications and other opioids.

METHODS:

Using the Health Search Database, a quasi-experimental interrupted time series analysis was conducted to evaluate changes in prescribing trends and appropriateness of use of codeine-containing medications and opioids between 2013 and 2015.

RESULTS:

Prescribing trends of codeine-containing medications significantly decreased (on average, - 352 days of treatment per month of observation), while long-acting opioids (LAOs) had an overall increase. Trends of inappropriate prescriptions significantly increased for two LAOs (i.e. tapentadol, naloxone-oxycodone), both before and after AIFA intervention.

CONCLUSION:

The use of paracetamol-codeine combination was effectively decreased in Italy because of AIFA intervention. Instead, prescriptions of tapentadol and oxycodone-naloxone stably increased over the study period irrespective of regulatory intervention. Given that the choice of the most appropriate opioid therapy is not straightforward, especially in elderly and/or comorbid patients, general practitioners should consider carefully alternative therapies on the bases of regulatory interventions.

PMID:
30852809
DOI:
10.1007/s40261-019-00767-8

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