Evaluating the Need for Creation of Quality Metrics Regarding Concomitant Use of Antifungals and Opioids

Abstract

To enhance Medicare & Medicaid’s efforts to combat the opioid epidemic, information was collected to standardize quality of care regarding the prescribing of opioids and antifungal agents. The objective of this study is to evaluate the effect of antifungal agents as pharmacokinetic enhancers to determine if there is a need for the creation of quality metrics concerning their concomitant use with opioids. Utilizing an academic search engine, articles detailing the use of opioids and antifungal agents were collected. Data from each article was categorized into topic/study design, participant characteristics, outcomes, results, and important notes, and used to evaluate the relationship between antifungals and opioids. There is sufficient evidence of clinically significant interactions between the two drug classes, depending upon the metabolic pathway affected. A quality metric of a maximum milligram per day dosage parameter for opioids when used with –azole antifungals is recommended. A quality metric of avoidance of terbinafine with the use of opioids that rely upon the CYP2D6 pathway is recommended due to decreased efficacy of the analgesic effects of opioids coupled with an increased risk of adverse drug reactions of both agents. The creation of quality metrics would aid in identification of associated risks and varying effects of antifungal agents when concomitant use with opioids is deemed necessary.