Adverse Drug Reactions to Opioids: A Study in a National Pharmacovigilance Database

• Published in: Drug safety Vol. 46; no. 11; pp. 1133 - 1148
• Main Authors: Gustafsson, Moa, Matos, Cristiano, Joaquim, João, Scholl, Joep, van Hunsel, Florence
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-11-2023; Springer Nature B.V
• Subjects: Abuse; Adverse Drug Reaction Reporting Systems; Analgesics; Analgesics, Opioid - adverse effects; Anesthesia; Buprenorphine; Constipation; Coronaviruses; COVID-19; Dizziness; Dizziness - chemically induced; Drug abuse; Drug dosages; Drug overdose; Drug Safety and Pharmacovigilance; Drug-Related Side Effects and Adverse Reactions - epidemiology; Errors; Expenditures; Female; Fentanyl; Gender differences; Hormones; Humans; Hypersensitivity; Male; Medical errors; Medicine; Medicine & Public Health; Narcotics; Nausea; Nausea - chemically induced; Nausea - epidemiology; Opioids; Original Research Article; Oxycodone; Pain; Pharmaceutical industry; Pharmacists; Pharmacology/Toxicology; Pharmacovigilance; Prescription drugs; Safety; Sex; Sexes; Sexual disorders; Side effects; Tramadol; Tramadol - adverse effects; Vaccines; Vomiting; Vomiting - chemically induced; Women; United States > US; Netherlands; Europe
• ISSN: 0114-5916; 1179-1942
• DOI: 10.1007/s40264-023-01351-y

Introduction
Opioids are commonly used as analgesics; however, like any medicine, they can produce adverse drug reactions (ADRs), including nausea, constipation, dependence, and respiratory depression, that result in harmful and fatal events. Therefore, it is essential to monitor the safety of these drugs in clinical practice.
Objective
This study aimed to characterize the safety profile of opioids by conducting a descriptive study based on a spontaneous reporting system (SRS) for ADRs in The Netherlands, focusing on abuse, misuse, medication errors, and differences between sexes.
Methods
Reports submitted to the Netherlands Pharmacovigilance Centre Lareb from January 2003 to December 2021 with an opioid drug as the suspected/interacting medicine were analyzed. Reporting odds ratios (RORs) for drug-ADR combinations were calculated, analyzed, and corrected for sex and drug utilization (expenditure) for the Dutch population.
Results
A total of 8769 reports were analyzed. Tramadol was the opioid with the most reports during the period (
n
 = 2746), while oxycodone or tramadol had the highest number of reports per year in the study period. The most reported ADRs from opioid use were nausea, followed by dizziness and vomiting, independent of sex, and all of them were more often reported in women. Vomiting associated with tramadol (ROR females/males = 2.17) was significantly higher in women. Buprenorphine was responsible for most ADRs when corrected for expenditure, with high RORs observed with application site hypersensitivity, application site reaction, and application site rash. Fentanyl gave rise to most of the reports of ADRs concerning abuse, misuse, and medication errors.
Conclusion
Patients treated with opioids experienced ADRs, primarily nausea, dizziness, and vomiting. For those groups of drugs, no significant differences were found between the sexes, except for the vomiting associated with tramadol. In general, ADRs related to opioids presented higher RORs when uncorrected and corrected for sexes and expenditure than other drugs. There was more disproportionate reporting for ADRs concerning abuse, misuse, and medication errors for opioids than other drugs in the Dutch SRS.