naloxone and Infections

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Clinical Trials as Topic; Critical Care; Cross Infection; Disseminated Intravascular Coagulation; Hemodynamics; Heparin; Humans; Immunization, Passive; Infections; Naloxone; Sepsis; Shock, Septic

The objective was to estimate the annual interaction management cost of agonist opioid treatment (AOT) for opioid-dependent (OD) patients with buprenorphine-naloxone (Suboxone®) (B/N) or methadone associated with concomitant treatments for infectious (HIV) or psychiatric comorbidities. A costs analysis model was developed to calculate the associated cost of AOT and interaction management. The AOT cost included pharmaceutical costs, drug preparation, distribution and dispensing, based on intake regimen (healthcare center or take-home) and type and frequency of dispensing (healthcare center or pharmacy), and medical visits. The cost of methadone also included single-dose bottles, monthly costs of custody at pharmacy, urine toxicology drug screenings and nursing visits. Potential interactions between AOT and concomitant treatments (antivirals, antibacterials/antifungals, antipsychotics, anxiolytics, antidepressant and anticonvulsants), were identified to determine the additional use of healthcare resources for each interaction management. The annual cost per patient of AOT was €1,525.97 for B/N and €1,467.29 for methadone. The average annual cost per patient of interaction management was €257.07 (infectious comorbidities), €114.03 (psychiatric comorbidities) and €185.55 (double comorbidity) with methadone and €7.90 with B/N in psychiatric comorbidities. Total annual costs of B/N were €1,525.97, €1,533.87 and €1,533.87 compared to €1,724.35, €1,581.32 and €1,652.84 for methadone per patient with infectious, psychiatric or double comorbidity respectively.Compared to methadone, the total cost per patient with OD was lower with B/N (€47.45-€198.38 per year). This is due to the differences in interaction management costs associated with the concomitant treatment of infectious and/or psychiatric comorbidities.. El objetivo fue estimar en pacientes con dependencia a opiáceos (DO), el coste anual del manejo de interacciones del tratamiento sustitutivo con buprenorfina/naloxona (Suboxone®) (B/N) o metadona, asociado con tratamientos concomitantes por comorbilidades infecciosas (VIH) o psiquiátricas. Se realizó un análisis de costes (€, 2013), del tratamiento sustitutivo y del manejo de interacciones. El coste del tratamiento de B/N incluyó costes farmacológicos, elaboración, distribución y dispensación, en función del régimen de administración (centro asistencial o domiciliaria) y del tipo y frecuencia de dispensación (centro asistencial o farmacia), y visitas al especialista para prescripción. El coste de tratamiento con metadona incluyó, además, frascos monodosis, coste de custodia en farmacia, determinación en orina y visitas a enfermería. Se identificaron las interacciones para determinar los recursos sanitarios adicionales consumidos por la administración conjunta del tratamiento sustitutivo y concomitante (antirretrovirales, bactericidas/antifúngicos, antipsicóticos, ansiolíticos, antidepresivos y anticonvulsivos). El coste anual/paciente estimado del tratamiento sustitutivo fue de 1.525,97€ (B/N) y 1.467,29€ (metadona). El coste promedio anual/paciente estimado del manejo de interacciones fue de 257,07€ (infecciosas), 114,03€ (psiquiátricas) y 185,55€ (ambas) con metadona, y de 7,90€ con B/N por comorbilidades psiquiátricas. El coste total anual/paciente estimado de B/N fue 1.525,97€, 1.533,87€ y 1.533,87€ comparado con 1.724,35€, 1.581,32€ y 1.652,84€ de metadona, en pacientes que presentan comorbilidad infecciosa, psiquiátrica o ambas, respectivamente. Comparado con metadona, el coste total por paciente con DO de B/N fue menor (47,45€-198,38€ anuales) derivado de la diferencia del coste por manejo de interacciones del tratamiento concomitante de las comorbilidades infecciosas y/o psiquiátricas.

Topics: Analgesics, Opioid; Buprenorphine; Drug Interactions; Health Care Costs; Humans; Infections; Mental Disorders; Methadone; Naloxone; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders

Topics: Critical Care; Cross Infection; Hemodynamics; Humans; Infections; Internal Medicine; Multiple Organ Failure; Naloxone; Prognosis; Sepsis; Shock, Septic

Immediate attention must be given to the respiratory system of the heroin abuser; then he should be given naloxone HCl. Search for evidence of use of additional drugs, which may compound problems. Pulmonary edema, aspiration pneumonia and pulmonary embolization are the most common complications. Infections, particularly endocarditis, and cardiac arrhythmia also occur with heroin overdose. Hepatitis is common. Treatment must include not only attention to the presenting symptoms but also referral to a rehabilitation center when possible.

Topics: Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Dose-Response Relationship, Drug; Emergency Service, Hospital; Endocarditis; Female; Genital Diseases, Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infections; Male; Methadone; Naloxone; Pulmonary Edema; Respiratory Insufficiency