Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study

Objectives Sex as a biological variable affects response to opioids. However, few reports describe the prevalence of specific adverse reactions to commonly prescribed opioids in men and women separately. A large cohort was used to investigate sex differences in type and occurrence of adverse reactio...

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Main Authors: Liwei Wang, Debra J Jacobson, Virginia M Miller, Nicholas B Larson, Ye Zhu, Guilherme S Lopes, Suzette Bielinski, Ann M Moyer, Ruoxiang Jiang, Dana C Cavanaugh, Jennifer St Sauver
Format: Article
Language:English
Published: BMJ Publishing Group 2021-06-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/11/6/e044157.full
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author Liwei Wang
Debra J Jacobson
Virginia M Miller
Nicholas B Larson
Ye Zhu
Guilherme S Lopes
Suzette Bielinski
Ann M Moyer
Ruoxiang Jiang
Dana C Cavanaugh
Jennifer St Sauver
author_facet Liwei Wang
Debra J Jacobson
Virginia M Miller
Nicholas B Larson
Ye Zhu
Guilherme S Lopes
Suzette Bielinski
Ann M Moyer
Ruoxiang Jiang
Dana C Cavanaugh
Jennifer St Sauver
author_sort Liwei Wang
collection DOAJ
description Objectives Sex as a biological variable affects response to opioids. However, few reports describe the prevalence of specific adverse reactions to commonly prescribed opioids in men and women separately. A large cohort was used to investigate sex differences in type and occurrence of adverse reactions associated with use of codeine, tramadol, oxycodone and hydrocodone.Design Retrospective cohort study.Setting Participants in the Right Drug, Right Dose, Right Time (RIGHT) Study.Participants The medical records of 8457 participants in the RIGHT Study who received an opioid prescription between 1 January 2004 and 31 December 2017 were reviewed 61% women, 94% white, median age (Q1–Q3)=58 (47–66).Primary and secondary outcome measures Adverse reactions including gastrointestinal, skin, psychiatric and nervous system issues were collected from the allergy section of each patient’s medical record. Sex differences in the risk of adverse reactions due to prescribed opioids were modelled using logistic regression adjusted for age, body mass index, race and ethnicity.Results From 8457 participants (of which 449 (5.3%) reported adverse reactions), more women (6.5%) than men (3.4%) reported adverse reactions to at least one opioid (OR (95% CI)=2.3 (1.8 to 2.8), p<0.001). Women were more likely to report adverse reactions to tramadol (OR (95% CI)=2.8 (1.8 to 4.4), p<0.001) and oxycodone (OR (95% CI)=2.2 (1.7 to 2.9), p<0.001). Women were more likely to report gastrointestinal (OR (95% CI)=3.1 (2.3 to 4.3), p<0.001), skin (OR (95% CI)=2.1 (1.4 to 3.3), p=0.001) and nervous system issues (OR (95% CI)=2.3 (1.3 to 4.2), p=0.004).Conclusions These findings support the importance of sex as a biological variable to be factored into pain management studies.
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spelling doaj-art-d6b751371b2b42f9955b3d78a6ed33772024-11-20T09:35:10ZengBMJ Publishing GroupBMJ Open2044-60552021-06-0111610.1136/bmjopen-2020-044157Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort studyLiwei Wang0Debra J Jacobson1Virginia M Miller2Nicholas B Larson3Ye Zhu4Guilherme S Lopes5Suzette Bielinski6Ann M Moyer7Ruoxiang Jiang8Dana C Cavanaugh9Jennifer St Sauver10Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USADepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USAMayo Clinic Women’s Health Research Center, Mayo Clinic, Rochester, Minnesota, USADivision of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USAcardiologistDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USADivision of Epidemiology, Mayo Clinic, Rochester, Minnesota, USADepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USADepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USADepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USADepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USAObjectives Sex as a biological variable affects response to opioids. However, few reports describe the prevalence of specific adverse reactions to commonly prescribed opioids in men and women separately. A large cohort was used to investigate sex differences in type and occurrence of adverse reactions associated with use of codeine, tramadol, oxycodone and hydrocodone.Design Retrospective cohort study.Setting Participants in the Right Drug, Right Dose, Right Time (RIGHT) Study.Participants The medical records of 8457 participants in the RIGHT Study who received an opioid prescription between 1 January 2004 and 31 December 2017 were reviewed 61% women, 94% white, median age (Q1–Q3)=58 (47–66).Primary and secondary outcome measures Adverse reactions including gastrointestinal, skin, psychiatric and nervous system issues were collected from the allergy section of each patient’s medical record. Sex differences in the risk of adverse reactions due to prescribed opioids were modelled using logistic regression adjusted for age, body mass index, race and ethnicity.Results From 8457 participants (of which 449 (5.3%) reported adverse reactions), more women (6.5%) than men (3.4%) reported adverse reactions to at least one opioid (OR (95% CI)=2.3 (1.8 to 2.8), p<0.001). Women were more likely to report adverse reactions to tramadol (OR (95% CI)=2.8 (1.8 to 4.4), p<0.001) and oxycodone (OR (95% CI)=2.2 (1.7 to 2.9), p<0.001). Women were more likely to report gastrointestinal (OR (95% CI)=3.1 (2.3 to 4.3), p<0.001), skin (OR (95% CI)=2.1 (1.4 to 3.3), p=0.001) and nervous system issues (OR (95% CI)=2.3 (1.3 to 4.2), p=0.004).Conclusions These findings support the importance of sex as a biological variable to be factored into pain management studies.https://bmjopen.bmj.com/content/11/6/e044157.full
spellingShingle Liwei Wang
Debra J Jacobson
Virginia M Miller
Nicholas B Larson
Ye Zhu
Guilherme S Lopes
Suzette Bielinski
Ann M Moyer
Ruoxiang Jiang
Dana C Cavanaugh
Jennifer St Sauver
Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study
BMJ Open
title Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study
title_full Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study
title_fullStr Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study
title_full_unstemmed Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study
title_short Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study
title_sort sex differences in type and occurrence of adverse reactions to opioid analgesics a retrospective cohort study
url https://bmjopen.bmj.com/content/11/6/e044157.full
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