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. 2017 Jun;26(6):685-693.
doi: 10.1002/pds.4201. Epub 2017 Mar 29.

Low-dose Naltrexone and Opioid Consumption: A Drug Utilization Cohort Study Based on Data From the Norwegian Prescription Database

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Free PMC article

Low-dose Naltrexone and Opioid Consumption: A Drug Utilization Cohort Study Based on Data From the Norwegian Prescription Database

Guttorm Raknes et al. Pharmacoepidemiol Drug Saf. .
Free PMC article

Abstract

Purpose: Low-dose naltrexone (LDN) is used in a wide range of conditions, including chronic pain and fibromyalgia. Because of the opioid antagonism of naltrexone, LDN users are probably often warned against concomitant use with opioids. In this study, based on data from the Norwegian prescription database, we examine changes in opioid consumption after starting LDN therapy.

Methods: We included all Norwegian patients (N = 3775) with at least one recorded LDN prescription in 2013 and at least one dispensed opioid prescription during the 365 days preceding the first LDN prescription. We allocated the patients into three subgroups depending on the number of collected LDN prescriptions and recorded the number of defined daily doses (DDDs) on collected prescriptions on opioids, nonsteroidal anti-inflammatory drugs and other analgesics and antipyretics from the same patients.

Results: Among the patients collecting ≥4 LDN prescriptions, annual average opioid consumption was reduced by 41 DDDs per person (46%) compared with that of the previous year. The reduction was 12 DDDs per person (15%) among users collecting two to three prescriptions and no change among those collecting only one LDN prescription. We observed no increase in the number of DDDs in nonsteroidal anti-inflammatory drugs or other analgesics and antipyretics corresponding to the decrease in opioid use.

Conclusions: Possibly, LDN users avoided opioids because of warnings on concomitant use or the patients continuing on LDN were less opioid dependent than those terminating LDN. Therapeutic effects of LDN contributing to lower opioid consumption cannot be ruled out. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.

Keywords: drug utilization; naltrexone; off label prescribing; opioids; painkillers; pharmacoepidemiology; prescription database.

Figures

Figure 1
Figure 1
Flowchart showing the inclusion of patients and painkiller prescriptions from NorPD
Figure 2
Figure 2
Time to first opioid prescription after starting LDN. The proportion of patients that had not collected an opioid prescription by time since the first LDN prescription. Data presented in three patient cohorts defined by number of LDN prescriptions collected in the study period. [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
The effect of LDN on opioid consumption. Cumulative average opioid dose according to NorPD 1 year before and after the first LDN prescription in subgroups defined by number of LDN prescriptions collected. As a visual aid, an extrapolated linear regression line of opioid consumption 1 year before the first LDN prescription in the LDN ≥4 subgroup is added. [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 4
Figure 4
The effect of LDN on total analgesic consumption. Cumulative average dose of opioids, NSAIDs, other analgesics and antipyretics according to NorPD 1 year before and after the first LDN prescription in subgroups defined by number of LDN prescriptions collected. As a visual aid, an extrapolated linear regression line of opioid consumption 1 year before the first LDN prescription in the LDN ≥4 group is added. [Colour figure can be viewed at wileyonlinelibrary.com]

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