Open AccessRisk of Hepatotoxicity‐Related Hospitalizations among Patients Treated with Opioid/Acetaminophen Combination Prescription Pain Medications
Author(s) -
Duh Mei Sheng,
Vekeman Francis,
Korves Caroline,
Lefebvre Patrick,
Dial Ellison,
LatremouilleViau Dominick,
Wei Robert S.,
Stangle Bruce E.,
Lafeuille MarieHelene,
Michna Edward,
Greenberg Paul E.
Publication year - 2010
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2010.00979.x
Subject(s) - medicine , acetaminophen , opioid , hydrocodone , confidence interval , anesthesia , poisson regression , oxycodone , hazard ratio , incidence (geometry) , retrospective cohort study , population , physics , receptor , environmental health , optics
Objective. This study determined the risk of serious hepatotoxicity resulting in hospitalizations among patients prescribed opioid/acetaminophen combinations. Methods. A retrospective cohort study using an insurance claims database was conducted. Adult patients with ≥1 claim for oxycodone/acetaminophen or hydrocodone/acetaminophen combinations were included (N = 1,228,356). A pre–post design was employed to compare serious hepatotoxicity risk before versus after initiation of opioid/acetaminophen combination. Serious hepatotoxicity risk between the opioid/acetaminophen group and a control group of opioid‐alone users (N = 11,809) was also examined. Within the opioid/acetaminophen group, risk of hepatotoxicity‐related hospitalizations pre‐ versus post‐opioid/acetaminophen treatment was compared using the normal approximation with the binomial distribution. The incidence rate of hepatotoxicity‐related hospitalizations for the opioid/acetaminophen group was compared with the opioid‐alone group using multivariate Poisson regression adjusting for baseline differences between groups. Results. Of the opioid/acetaminophen cohort, hepatotoxicity‐related hospitalization risk in the 6‐month post‐opioid/acetaminophen period was lower than that in the pre‐period with a risk reduction of 1.2 per 10,000 (pre‐period = 0.12%; 95% confidence interval [CI], 0.12 to 0.13; post‐period = 0.11%; 95% CI, 0.11 to 0.12). In the 12‐month period, risk increased in the post‐period by 2.4 per 10,000 (pre‐period = 0.14%; 95% CI, 0.14 to 0.15; post‐period = 0.17%; 95% CI, 0.16 to 0.18). After adjusting for confounders, the opioid‐alone group did not demonstrate a lower rate of hepatotoxicity‐related hospitalizations than the opioid/acetaminophen group (incidence rate ratio of opioid‐alone over opioid/acetaminophen = 2.9; 95% CI, 1.8 to 4.7). Conclusions. There is no population data‐based evidence supporting elevated risk of hepatotoxicity‐related hospitalization associated with opioid/acetaminophen combinations.