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Abstract

Analgesics are mostly used in cancer patients receiving palliative care to improve the quality of life of patients. Besides analgesics, cancer patients receiving palliative care were also given other drugs in combination to overcome other symptoms of cancer, and this combination could potentially cause drug interactions. This study was aimed to analyze the potential of drug interactions with analgesics in cancer patients. The study design was cross-sectional with a retrospective method and descriptive study. The sample of this study was cancer palliative care patient’s prescription at Dharmais Cancer Hospital in the period of January – December 2017. The sample analyzed in this study consisted of 273 prescriptions. This study found that there were 191 prescriptions (69.9%) of analgesics which potential- ly interacted with 316 interaction cases. Fentanyl and morphine with 61 cases (19.3%), morphine and gabapentin with 60 cases (18.9%) and morphine and amitriptyline with 33 cases (10.4%) were observed as the three most analgesics-other drugs interaction. Based on severity levels, there were 73.5% of major interaction, 26.3% of moderate interaction, and 0.2% of minor interaction. This study concluded that high occurrence of drug interactions was observed in analgesic drugs, therefore close monitoring is needed in cancer patient receiving palliative care.

References

Chen, C., Upward, J., Arumugham, T., Stier, B., & Davy, M. (2015). Gabapentin Enacarbil and Morphine Administered in Combination Versus Alone: A Double-blind, Randomized, Pharmacokinetic, and Tolerability Comparison. Clinical Therapeutics, 37(2), 349-357. doi:10.1016/j.clinthera.2014.10.015.

Davies, E., & Higginson, I. J. (2004). Better palliative care for older people. Copenhagen, Denmark: World Health Organization, Regional Office for Europe.

Dawson, J., L., L., Osman, G., L., Djamgoz, M., & G. (2014). Management of cancer pain: 1. Wider implications of orthodox analgesiks. International Journal of General Medicine, 49. doi:10.2147/ijgm.s42187.

Delafuente, J. (2008). Pharmacokinetic and pharmacodynamic alterations in the geriatric patient. The Consultant Pharmacist®, 23(4), 324-334.

Departemen Kesehatan Republik Indonesia. (2006). Pedoman Pelayanan Farmasi (Tata Laksana Terapi Obat) untuk Pasien Geriatri. Jakarta: Direktorat Jendral Bina Kefarmasian dan Alat Kesehatan Departemen Kesehatan Republik Indonesia. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States. (2016). JAMA, 315(15), 1624–1645. doi:10.1001/jama.2016.1464

Drug Interactions. (n.d.). website: http://www.micromedexsolutions.com/micromedex2/4.34.0/WebHelp/Tools/Interactions/D rug_Interactions_severity_definitions.htm. Elumelu, TN. (2013). Palliative Care Experience in Breast and Uterine Cervical Cancer Patients in Ibadan, Nigeria. Journal of Palliative Care & Medicine, 03(01). doi:10.4172/2165-7386.1000139.

Feng, X., Zhu, L., & Zhou, Q. (2017). Opioid analgesiks-related pharmacokinetic drug interactions: From the perspectives of evidence based on randomized controlled trials and clinical risk management. Journal of Pain Research, Volume 10, 1225-1239. doi:10.2147/jprs138698.

Franconi, F., & Campesi, I. (2014). Pharmacogenomics, pharmacokinetics and pharmacodynamics: interaction with biological differences between men and women. British Journal of Pharmacology, 171(3), 580-594.

Jain, P., Pai, K., & Chatterjee, A. (2015). The prevalence of severe pain, its etiopathological characteristics and treatment profile of patients referred to a tertiary cancer care pain clinic. Indian Journal of Palliative Care, 21(2), 148. doi:10.4103/0973-1075.156467.

Kementerian Kesehatan Republik Indonesia. (2017). Petunjuk Teknis Paliatif Kanker pada Dewasa. Jakarta: Kementerian Kesehatan Republik Indonesia.

Komite Farmasi dan Terapi RSKD. (2017). Formularium Rumah Sakit Kanker Dharmais. Jakarta: Komite Farmasi dan Terapi RSKD RS Kanker Dharmais.

Kotlinska-Lemieszek, A., Klepstad, P., & Haugen, D. F. (2015). Clinically significant drug– drug interactions involving opioid analgesiks used for pain treatment in patients with cancer: A systematic review. Drug Design, Development and Therapy, 5255. doi:10.2147/dddts86983.

Kuczynska, J. (2017). How should conversion from oral morphine to fentanyl patches be carried out?.19 Desember 2017. https://www.sps.nhs.uk/articles/how-should-conversionfrom-oral-morphine-to-fentanyl-patches-be-carried-out/.

Leeuwen, R. V. (2012). Potential drug interactions among cancer patients using oral cytostatic drugs: a prevalence study. Http://isrctn.org/>. doi:10.1186/isrctn01739090.

Masman, A. D., van Dijk, M., Tibboel, D., Baar, F. P. M., & Mathôt, R. A. A. (2015). Medication use during end-of-life care in a palliative care centre. International Journal of Clinical Pharmacy, 37(5), 767–775. http://doi.org/10.1007/s11096-015-0094-3.

McClay, H. (2010). Pain management in palliative care - choice of analgesia. Journal of the Malta College of Pharmacy Practice, (16), 28-31.

Moore, R. A., Derry, S., Aldington, D., Cole, P., & Wiffen, P. J. (2015). Amitriptyline for neuropathic pain in adults. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd008242.pub3.

Namazi, S., Kheshti, R., & Aalipour, M. (2016). A comparison of five common drug–drug interaction software programs regarding accuracy and comprehensiveness. Journal of Research in Pharmacy Practice, 5(4), 257. doi:10.4103/2279-042x.192461.

Paice, J. A. and Ferrell, B. (2011), The management of cancer pain. CA: A Cancer Journal for Clinicians, 61: 157–182. doi:10.3322/caac.20112. Panigoro, Sonar Soni. (2014). Rencana Strategis Pengembangan Pusat Kanker Nasional Indonesia, Sebuah Studi Kasus. http://journal.ui.ac.id/index.php/arsi/article/viewFile/5207/3492.

Pieretti, S., Giannuario, A. D., Giovannandrea R. D., Marzoli, F., Piccaro, G., Minosi, P., Aloisi, A. M. (2016) Gender differences in pain and its relief. Ann 1st Super Sanita 52 (2), 184-189. doi: 10.4415/ANN_16_02_09.

Rana, S. P., Ahmed, A., Kumar, V., Chaudhary, P. K., Khurana, D., & Mishra, S. (2011). Successful Management of a Difficult Cancer Pain Patient by Appropriate Adjuvant and Morphine Titration. Indian Journal of Palliative Care, 17(2), 162–165.

Rastogi, R., Swarm, R. A., & Patel, T. A. (2011). Case Scenario: Opioid Association with Serotonin Syndrome. Anesthesiology, 1. doi:10.1097/aln.0b013e31823940c0.

Soldin, O. P., & Mattison, D. R. (2009). Sex Differences in Pharmacokinetics and Pharmacodynamics. Clinical Pharmacokinetics, 48(3), 143-157. doi:10.2165/00003088200948030-00001. Stockley, I. H. (2008). Stockleys drug interactions: a source book of interactions, their mechanisms, clinical importance, and management. London: Pharmaceutical Press.

Su, M. (2015). Amitriptyline Therapy in Chronic Pain. International Archives of Clinical Pharmacology, 1(1). doi:10.23937/2572-3987.1510001.

Truven Health Analytics. (2017). Micromedex Solutions: Drug Interactions. http://remotelib.ui.ac.id:2232/micromedex2/librarian/PFDefaultActionId/evidencexpert. Show Drug Inter actions Results.

Turnheim, K. (2003). When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Experimental gerontology, 38(8), 843-853.

Upadhyay, S., Jain, R., Chauhan, H., Gupta, D., Mishra, S., & Bhatnagar, S. (2008). Oral Morphine Overdose in a Cancer Patient Antagonized by Prolonged Naloxone Infusion. American Journal of Hospice and Palliative Medicine®, 25(5), 401-405. doi:10.1177/1049909108319260.

Vincent, K., & Tracey, I. (2008). Hormones and Their Interaction with the Pain Experience. Reviews in Pain, 2(2), 20-24. doi:10.1177/204946370800200206

Vizcaychipi, M. P. (2007). Serotonin Syndrome triggered by Tramadol. BJA: British Journal of Anaesthesia, 99 (ELetters Supplement). doi:10.1093/bja/el_2126

World Health Organization. (2014). Global Atlas of Palliative Care at the End of Life. Diambil dari http://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf

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