What are the therapeutic alternatives to dextropropoxyphene in France? A prescribers’ survey

Aubrun, Frédéric; Chrétien, E.; Letrilliart, Laurent; Ginoux, M.; Belhassen, Manon; Lantéri-Minet, Michel; Ganse, Éric Van; Beloeil, Hélène; Martinez, Valéria; Aveline, Christophe; Bloc, Sébastien; Cabaton, J.; Carlès, Michel; Cuvillon, Philippe; Dadure, Christophe; Marret, Emmanuel; Nouette‐Gaulain, Karine; Marion, Olivier; Pj, Zetlaoui

doi:10.1016/j.accpm.2016.01.007

Cited by 6 publications

(4 citation statements)

References 13 publications

(6 reference statements)

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“…Of interest, the results of this study differ from the results of a survey performed among Pain specialists asked to describe alternatives to DXP in France [23]. HCPs declared tramadol combined with PC to be the substitutive analgesic of choice, while only 24% of considered PC alone as a substitute.…”

Section: Discussioncontrasting

confidence: 67%

Use of analgesics in France, following dextropropoxyphene withdrawal

Ganse

Belhassen

Ginoux

et al. 2018

BMC Health Serv Res

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BackgroundIn 2009, the European Medicines Agency recommended withdrawal of dextropropoxyphene (DXP); in March 2011 it was withdrawn from the market in France. Up until that time the combination dextropropoxyphene-paracetamol (DXP/PC) was widely used for analgesia. At withdrawal, French regulators recommended that DXP/PC be replaced by other step 2 analgesics, i.e. tramadol, codeine, or opium-containing drugs, or by PC for a weak level of pain. To investigate prescribing behaviours after DXP/PC withdrawal, dispensations of analgesics before and after withdrawal were analysed.MethodsAggregated dispensation data of analgesics prescribed between January 2009 and December 2012 in the Rhône-Alpes region were obtained from the general health insurance claims data; changes in analgesic dispensation over time were analysed with the ATC/DDD methodology. Pre (Jan-June 2009) and post-withdrawal (Jan-June 2012) changes of DDDs where computed for each analgesic step.ResultsThe dispensations of DXP/PC experienced a two-step decrease until 2011. Over the withdrawal period 2009-2012, there was a 14% decrease in the overall use of analgesic (from 109 to 94 DDDs), while the use of step 2 analgesics declined by 46% (− 22 DDDs, from 47 to 25 DDDs). This latter decline included a cessation of use of DXP/PC (29 DDDs in 2009) that were only in part (+ 7 DDDs, from 18 to 25 DDDs) compensated by increased use of codeine, tramadol and opium, in monotherapy or combined with PC. For step 1 analgesics, use increased with 9%, mostly PC (+ 8 DDDs, from 31 to 39 DDDs). Step 3 analgesics dispensations remained largely unchanged over this period (around 3 DDDs).ConclusionsIn the Rhône-Alpes region, DXP/PC withdrawal was accompanied in part by an increased use of same level analgesics, and in part by an increased use of PC in monotherapy. The extent of DXP/PC use before withdrawal, and the increased use of PC after DXP withdrawal, underline the complexity of pain management.

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Section: Discussioncontrasting

confidence: 67%

Use of analgesics in France, following dextropropoxyphene withdrawal

Ganse

Belhassen

Ginoux

et al. 2018

BMC Health Serv Res

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“…Prior to the publication of these guidelines, an impact study conducted in a French regional hospital had suggested that there may have been a switch towards the use of paracetamol and tramadol as a consequence of the withdrawal of dextropropoxyphene combinations [28]. A further survey conducted among prescribers involved in pain management confirmed this switch [29]. In our study, the increased consumption of paracetamol, ibuprofen and other mild opioids, was likely to result from the implementation of these guidelines by prescribing physicians.…”

Section: Figurementioning

confidence: 48%

“…Thus, the nonrational prescription of opioids grows, increasing the risk of public health consequences . The ease of administration of transdermal and transmucosal formulations may also partly explain the rise in prescriptions of fentanyl .…”

Section: Discussionmentioning

confidence: 99%

Trends in analgesic consumption in France over the last 10 years and comparison of patterns across Europe

Hider‐Mlynarz

Cavalié

Maison

2018

Brit J Clinical Pharma

129

106

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“…Following its suppression, all step 2 analgesics use rose during the immediate following years, before the switch clearly favoured tramadol. However, the withdrawal of dextropropoxyphene/paracetamol association can also partly explain the rise of step 1 analgesics use and the decrease of step 2 consumption, as not all dextropropoxyphene prescriptions were replaced by a step 2 drug, as this was previously described by other studies 7 8…”

Section: Discussion/conclusionmentioning

confidence: 83%

Analgesic consumption evolution at the emergency department of a university hospital (2006–2017): a defined daily doses based analysis

et al. 2018

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ObjectivePain management in the emergency department (ED) is a key issue that must be regularly evaluated. Practice evaluation gold standard remains patient file analysis, but is highly time consuming. The aim of this study is to evaluate the interest of a defined daily dose (DDD) based analysis in the evaluation of pain management in the ED.MethodsA local indicator was elaborated based on the DDD concept: the defined dose per admission (DDA). Unlike the DDD that corresponds to a standardised total dose administered over a day, the DDA represents the average total dose administrated to a patient throughout the stay in the ED. A DDA was assigned to every analgesic, from step 1 to step 3. Oral and injectable forms were studied, but transdermal forms were not considered. DDA values were assimilated to the existing DDDs when these were officially established by the WHO. When values were not defined by the WHO, mean values observed in local practice were selected. Annual numbers of patients admitted to the ED and quantities of each analgesic supplied by the pharmacy ward were annually extracted from respective data files. Paediatric patients being treated at a specific separate ED, only adults were considered throughout the study. Raw quantities of analgesics used each year were converted to their equivalent amounts in DDA, and then expressed in numbers of DDA per 100 admissions (DDA/100A). This indicator allowed us to describe relative evolutions of analgesics prescriptions from 2006 to 2017.ResultsAnalgesic overall use rose from 18.4 to 30.2 DDA/100A between 2006 and 2017, representing a prescription increase of 64%. Throughout the study, step 1 analgesics rose from 10.8 to 19.3 DDA/100A (+79%), step 3 from 1.8 to 5.4 (+200%) and step 2 remained stable around 5.6 DDA/100A. The integration of orodispersible paracetamol tablets in 2013 allowed us to halve the consumption of injectable paracetamol in the long term and had no effect on classic paracetamol oral forms such as tablets or capsules. Tramadol increased from 41% to 78% among step 2 analgesics after the withdrawal of dextropropoxyphene in 2011. Codeine use shows a steady decline from 1.9 DDA/100A in 2011 to 0.72 in 2017.Discussion/conclusionThe DDA concept appears to be an effective tool for assessing long-term analgesic-use trends at hospital EDs. This tool can also mitigate one major bias at EDs, that is the lack of traceability of analgesic administration in emergency contexts. This tool could be adjusted by integrating the average length of stay in the ED.

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What are the therapeutic alternatives to dextropropoxyphene in France? A prescribers’ survey

Cited by 6 publications

References 13 publications

Use of analgesics in France, following dextropropoxyphene withdrawal

Use of analgesics in France, following dextropropoxyphene withdrawal

Trends in analgesic consumption in France over the last 10 years and comparison of patterns across Europe

Analgesic consumption evolution at the emergency department of a university hospital (2006–2017): a defined daily doses based analysis

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