TY - JOUR
T1 - The opioid-P2Y12 inhibitor interaction
T2 - Potential strategies to mitigate the interaction and consideration of alternative analgesic agents in myocardial infarction
AU - Fernando, Himawan
AU - Shaw, James A.
AU - Myles, Paul S.
AU - Peter, Karlheinz
AU - Stub, Dion
PY - 2021/1
Y1 - 2021/1
N2 - Despite advances in medical and interventional management of acute myocardial infarction, treatment of the associated chest pain has remained relatively unchanged since opioids were first utilized in the 1930’s. This dominance can be partially attributed to initial studies suggesting hemodynamic benefits with opioid treatment. However, delayed gastrointestinal absorption of P2Y12 inhibitors due to opioids and the consequent impairment in antiplatelet activity of this established therapy is cause for concern. Coupled with the lack of randomized clinical trial evidence to support widespread opioid use, there is now an opportunity to re-evaluate our approach to analgesia in myocardial infarction. This review characterizes the mechanism of the opioid-P2Y12 inhibitor interaction, strategies aimed at mitigating the interaction and appraises promising alternative agents to opioid therapy in patients with myocardial infarction.
AB - Despite advances in medical and interventional management of acute myocardial infarction, treatment of the associated chest pain has remained relatively unchanged since opioids were first utilized in the 1930’s. This dominance can be partially attributed to initial studies suggesting hemodynamic benefits with opioid treatment. However, delayed gastrointestinal absorption of P2Y12 inhibitors due to opioids and the consequent impairment in antiplatelet activity of this established therapy is cause for concern. Coupled with the lack of randomized clinical trial evidence to support widespread opioid use, there is now an opportunity to re-evaluate our approach to analgesia in myocardial infarction. This review characterizes the mechanism of the opioid-P2Y12 inhibitor interaction, strategies aimed at mitigating the interaction and appraises promising alternative agents to opioid therapy in patients with myocardial infarction.
KW - Acute myocardial infarction
KW - Analgesia in chest pain
KW - High on treatment platelet reactivity
KW - Opioid-antiplatelet drug interaction
KW - Opioid-P2Y inhibitor interaction
KW - Pain relief in myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=85090480684&partnerID=8YFLogxK
U2 - 10.1016/j.pharmthera.2020.107665
DO - 10.1016/j.pharmthera.2020.107665
M3 - Review Article
C2 - 32835826
AN - SCOPUS:85090480684
VL - 217
JO - Pharmacology and Therapeutics
JF - Pharmacology and Therapeutics
SN - 0163-7258
M1 - 107665
ER -