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Buprenorphine triples harmful adverse events in dementia

The commonly prescribed painkiller, buprenorphine, more than tripled psychiatric and neurological side effects among patients with dementia, according to data presented at the 2018 Alzheimer’s Association International Conference.

“Pain is a symptom that can cause huge distress and it’s important that we can provide relief to people with dementia,” Clive Ballard, MD, co-author of the study and professor of age-related diseases at the University of Exeter Medical School, England, said in a press release.

Ballard and colleagues performed a trial to determine the safety of buprenorphine for pain management among individuals with advanced dementia and significant depression (n = 162). The researchers randomly assigned participants to receive analgesic treatment with paracetamol, buprenorphine or placebo for 13 weeks.

More than half (52.3%; n =23) of patients who received buprenorphine experienced adverse events that led to discontinuation of treatment, compared with 13.3% (n = 6) of those who received placebo. Psychiatric and neurological adverse events, such as personality changes, confusion and sedation, were the most common (69.6%; n = 16). Participants who also used antidepressants had a significantly higher risk for discontinuation (HR = 23.2; 95% CI, 2.95-182).

After adjustment for age, sex, cognitive function and pain at baseline, participants receiving buprenorphine were about 21 times more likely to discontinue treatment (95% CI, 2.12-2.06). During the second day of treatment, daytime activity declined significantly by 21.4%. Daytime activity continued to decline by 12.9% during the first week.

“Sadly, at the moment, we’re harming people when we’re trying to ease their pain,” Ballard said in the release. “We urgently need more research in this area, and we must get this dosing right. We need to establish the best treatment pathway and examine appropriate dosing for people with dementia.” – by Alaina Tedesco

Reference:

Erdal A, et al. A randomized, placebo-controlled trial to investigate safety in people with dementia or buprenorphine transdermal system for pain management. Presented at: Alzheimer’s Association International Conference; July 22-26, 2018; Chicago.

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