Selecting an appropriate medication for treating neuropathic pain in patients with diabetes: a study using the U.K. and Germany Mediplus databases.
OBJECTIVE
To evaluate the appropriateness of prescribing select neuropathic pain medications to diabetes patients based on the potential for drug-drug interactions with medications diabetes patients were prescribed continuously for > or =3 months (chronic use).


METHODS
Medical records of patients with a diagnosis of diabetes or use of antidiabetic medications between January 1, 2002 and September 30, 2005 in the U.K. and Germany Mediplus databases were obtained.


METHODS
Medication use profiles were evaluated between April 2004 and September 2005. The metabolic pathways associated with medications that were prescribed chronically to at least 10% of study patients were compared with the metabolic pathways of neuropathic pain medications to identify potential drug-drug interactions.


RESULTS
A total of 40,448 patients in the U.K. (63.6 +/- 16.6 years, 51% male) and 31,930 patients in Germany (68.9 +/- 12.7 years, 46% male) were identified. Frequently prescribed medications in the U.K. included aspirin (33.7%), metformin (32.7%), simvastatin (25.5%), atorvastatin (19.4%), atenolol (18.1%), and in Germany hydrochlorothiazide (35.8%), aspirin (25.2%), metformin (21.6%), metoprolol (20.3%), and simvastatin (18.3%). Several neuropathic pain medications have potential for drug-drug interactions with medications prescribed to diabetes patients. Examples include (neuropathic pain medications vs. diabetes medications): duloxetine, paroxetine, and methadone (CYP2D6 inhibitors) and oxycodone HCL, hydrocodone (CYP2D6 substrates) vs. metoprolol and bisoprolol (CYP2D6 substrates); and carbamazepine (CYP3A4 inducer) vs. simvastatin, and atorvastatin (CYP3A4 substrates).


CONCLUSIONS
Our findings underscore the need for medical vigilance when selecting medications for treating neuropathic pain in diabetes patients.
Avalon Health Solutions, Inc., Philadelphia, Pennsylvania 19103, USA. mgore@avalonhealthsolutions.com
Mugdha
M
Gore
Alesia
A
Sadosky
Douglas
D
Leslie
Amy Heck
AH
Sheehan
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000493:pharmacokinetics / Q000627:therapeutic use; D016208:Databases, Factual; D048909:Diabetes Complications / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D008297:Male; D053858:Metabolic Networks and Pathways / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
D000700:Analgesics; D007004:Hypoglycemic Agents