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BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Use of analgesics in France, following dextropropoxyphene withdrawal

Authors: E. Van Ganse, M. Belhassen, M. Ginoux, E. Chrétien, C. Cornu, C. Ecoffey, F. Aubrun

Published in: BMC Health Services Research | Issue 1/2018

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Abstract

Background

In 2009, the European Medicines Agency recommended withdrawal of dextropropoxyphene (DXP); in March 2011 it was withdrawn from the market in France.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.

Methods

Aggregated 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.

Results

The 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).

Conclusions

In 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.
Literature
1.
Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003 Dec 6;362(9399):1921–8.CrossRefPubMed
2.
Ventafridda V, Tamburini M, Caraceni A, De Conno F, Naldi FA. validation study of the WHO method for cancer pain relief. Cancer. 1987 Feb 15;59(4):850–6.CrossRefPubMed
3.
Committee on the Safety of Medicines of the UK. Overdose risk prompts UK withdrawal of propoxyphene combination. J Pain Palliat Care Pharmacother. 2006;20(4):49–50.CrossRef
4.
5.
6.
Collins SL, Edwards JE, Moore RA, McQuay HJ. Single dose dextropropoxyphene, alone and with paracetamol (acetaminophen), for postoperative pain. Cochrane Database Syst Rev. 2000;2:CD001440.
7.
Gaubert S, Vié M, Damase-Michel C, Pathak A, Montastruc J-L. Dextropropoxyphene withdrawal from a French university hospital: impact on analgesic drug consumption. Fundam Clin Pharmacol. 2009;23(2):247–52.CrossRefPubMed
8.
9.
Hawton K, Bergen H, Simkin S, Brock A, Griffiths C, Romeri E, et al. Effect of withdrawal of co-proxamol on prescribing and deaths from drug poisoning in England and Wales: time series analysis. BMJ. 2009;b2270:338.
10.
Tavassoli N, Lapeyre-Mestre M, Sommet A, Montastruc J-L, French Association of Regional Pharmacovigilance Centres. Reporting rate of adverse drug reactions to the French pharmacovigilance system with three step 2 analgesic drugs: dextropropoxyphene, tramadol and codeine (in combination with paracetamol). Br J Clin Pharmacol. 2009 Sep;68(3):422–6.CrossRefPubMedPubMedCentral
11.
Food And Drug Administration Public Health Service. U S Department Of Health And Human Services null. Food and Drug Administration recommends against the continued use of propoxyphene. J Pain Palliat Care Pharmacother. 2011;25(1):80–2.CrossRef
12.
Li Wan Po A, Zhang WY. Systematic overview of co-proxamol to assess analgesic effects of addition of dextropropoxyphene to paracetamol. BMJ. 1997;315(7122):1565–71.CrossRefPubMedPubMedCentral
13.
Hawton K, Bergen H, Simkin S, Wells C, Kapur N, Gunnell D. Six-year follow-up of impact of co-proxamol withdrawal in England and Wales on prescribing and deaths: time-series study. PLoS Med. 2012;9(5):e1001213.CrossRefPubMedPubMedCentral
14.
Corcoran P, Reulbach U, Keeley HS, Perry IJ, Hawton K, Arensman E. Use of analgesics in intentional drug overdose presentations to hospital before and after the withdrawal of distalgesic from the Irish market. BMC Clin Pharmacol. 2010;10:6.CrossRefPubMedPubMedCentral
15.
Handley SA, Flanagan RJ. Drugs and other chemicals involved in fatal poisoning in England and Wales during 2000 – 2011. Clin Toxicol (Phila). 2014;52(1):1–12.CrossRef
16.
Fender P, Weill A. Epidemiology, public health and medical rates databases. Rev Epidemiol Sante Publique. 2004;52(2):113–7.CrossRefPubMed
17.
18.
Adam F. Comité douleur-anesthésie locorégionale et le comité des référentiels de la Sfar. [Weak opioids. Pain and Locoregional Anesthesia Committee and the Standards Committee of the French Society of Anesthesia and Intensive Care]. Ann Fr Anesth Reanim. 2009;28(2):e61–6.CrossRefPubMed
19.
Bismuth S, Leng EL, Oustric S, Montastruc J-L, Lapeyre-Mestre M. Which analgesic after dextropropoxyphene withdrawal? A survey in a sample of general practitioners in southwest of France. Therapie. 2011;66(1):25–8.CrossRefPubMed
20.
21.
22.
Prows CA, Zhang X, Huth MM, Zhang K, Saldaña SN, Daraiseh NM, et al. Codeine-related adverse drug reactions in children following tonsillectomy: a prospective study. Laryngoscope. 2014;124(5):1242–50.CrossRefPubMed
23.
Aubrun F, Chrétien E, Letrilliart L, Ginoux M, Belhassen M, Lanteri-Minet M, et al. What are the therapeutic alternatives to dextropropoxyphene in France? A prescribers’ survey. Anaesth Crit Care Pain Med. 2017;36(1):15–9.CrossRefPubMed
24.
Becquemont L, Delespierre T, Bauduceau B, Benattar-Zibi L, Berrut G, Corruble E, et al. Consequences of dextropropoxyphene market withdrawal in elderly patients with chronic pain. Eur J Clin Pharmacol. 2014;70(10):1237–42.CrossRefPubMed
25.
Ottewell L, Walker DJ. Co-proxamol: where have all the patients gone? Rheumatology (Oxford). 2008;47(3):375.CrossRef
26.
Duong M, Gulmez SE, Salvo F, Abouelfath A, Lassalle R, Droz C, et al. Usage patterns of single-ingredient and combined paracetamol in France. Br J Clin Pharmacol. 2016;82:498–503.
Metadata
Title
Use of analgesics in France, following dextropropoxyphene withdrawal
Authors
E. Van Ganse
M. Belhassen
M. Ginoux
E. Chrétien
C. Cornu
C. Ecoffey
F. Aubrun
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3058-1

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