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[PMID]:29486013
[Au] Autor:Wallach JD; Ross JS
[Ad] Endereço:Collaboration for Research Integrity and Transparency, Yale Law School, New Haven, Connecticut.
[Ti] Título:Gabapentin Approvals, Off-Label Use, and Lessons for Postmarketing Evaluation Efforts.
[So] Source:JAMA;319(8):776-778, 2018 02 27.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Ácidos Cicloexanocarboxílicos
Uso Off-Label
[Mh] Termos MeSH secundário: Aminas
Seres Humanos
Vigilância de Produtos Comercializados
Ácido gama-Aminobutírico
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Nm] Nome de substância:
0 (Amines); 0 (Cyclohexanecarboxylic Acids); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180228
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.21897


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[PMID]:29279555
[Au] Autor:Masuda R; Ajimi J; Murata T
[Ad] Endereço:Department of Anesthesiology, Tokai University Hachioji Hospital.
[Ti] Título:Pharmacotherapy for Neuropathic Pain in Japan.
[So] Source:J Nippon Med Sch;84(6):258-267, 2017.
[Is] ISSN:1347-3409
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Neuropathic pain (NeP) results from injury to, or disease of, the peripheral or central components of the neural systems involved in pain. In contrast to inflammatory pain, NeP can persist after healing from the initial injury has resolved. Antipyretic agents, such as non-steroidal anti-inflammatory drugs, steroids, and acetaminophen are ineffective, while specific agents such as gabapentinoids, antidepressants, antiepileptics, and opioids are effective in treating NeP. In this review, we address the definition of NeP, pharmacotherapy for NeP in Japan, pain classification, setting goals for successful NeP medication, and the Japanese algorithm for the pharmacotherapy of NeP with specific prescription guidance.
[Mh] Termos MeSH primário: Aminas/administração & dosagem
Analgésicos Opioides/administração & dosagem
Anticonvulsivantes/administração & dosagem
Antidepressivos/administração & dosagem
Ácidos Cicloexanocarboxílicos/administração & dosagem
Cloridrato de Duloxetina/administração & dosagem
Neuralgia/tratamento farmacológico
Pregabalina/administração & dosagem
Ácido gama-Aminobutírico/administração & dosagem
[Mh] Termos MeSH secundário: Idoso
Algoritmos
Aminas/efeitos adversos
Analgésicos Opioides/efeitos adversos
Anticonvulsivantes/efeitos adversos
Antidepressivos/efeitos adversos
Ácidos Cicloexanocarboxílicos/efeitos adversos
Esquema de Medicação
Cloridrato de Duloxetina/efeitos adversos
Feminino
Seres Humanos
Japão
Neuralgia/classificação
Manejo da Dor
Pregabalina/efeitos adversos
Ácido gama-Aminobutírico/efeitos adversos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics, Opioid); 0 (Anticonvulsants); 0 (Antidepressive Agents); 0 (Cyclohexanecarboxylic Acids); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin); 9044SC542W (Duloxetine Hydrochloride)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1272/jnms.84.258


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[PMID]:29241365
[Au] Autor:Mason BJ; Quello S; Shadan F
[Ad] Endereço:a Pearson Center for Alcoholism and Addiction Research , The Scripps Research Institute , La Jolla , CA , USA.
[Ti] Título:Gabapentin for the treatment of alcohol use disorder.
[So] Source:Expert Opin Investig Drugs;27(1):113-124, 2018 Jan.
[Is] ISSN:1744-7658
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Alcohol misuse is the fifth leading risk factor for premature death and disability worldwide. Fewer than 10% of afflicted Americans receive pharmacological treatment for alcohol use disorder. Gabapentin is a calcium channel GABAergic modulator that is widely used for pain. Studies showing reduced drinking and decreased craving and alcohol-related disturbances in sleep and affect in the months following alcohol cessation suggest therapeutic potential for alcohol use disorder. Areas covered: Human laboratory and clinical studies assessing gabapentin for alcohol use disorder are reviewed. Data were obtained by searching for English peer-reviewed articles on PubMed, reference lists of identified articles, and trials registered on clinicaltrials.gov. Additionally, the mechanism of action of gabapentin specific to alcohol use disorder, and studies of gabapentin for alcohol withdrawal and non-alcohol substance use disorders are summarized. Expert opinion: Alcohol use disorder represents a challenge and large, unmet medical need. Evidence from single-site studies lend support to the safety and efficacy of gabapentin as a novel treatment for alcohol use disorder, with unique benefits for alcohol-related insomnia and negative affect, relative to available treatments. Proprietary gabapentin delivery systems may open a path to pivotal trials and registration of gabapentin as a novel treatment for alcohol use disorder.
[Mh] Termos MeSH primário: Consumo de Bebidas Alcoólicas/prevenção & controle
Alcoolismo/tratamento farmacológico
Aminas/uso terapêutico
Ácidos Cicloexanocarboxílicos/uso terapêutico
Ácido gama-Aminobutírico/uso terapêutico
[Mh] Termos MeSH secundário: Alcoolismo/fisiopatologia
Aminas/efeitos adversos
Aminas/farmacologia
Animais
Bloqueadores dos Canais de Cálcio/efeitos adversos
Bloqueadores dos Canais de Cálcio/farmacologia
Bloqueadores dos Canais de Cálcio/uso terapêutico
Ácidos Cicloexanocarboxílicos/efeitos adversos
Ácidos Cicloexanocarboxílicos/farmacologia
Seres Humanos
Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico
Distúrbios do Início e da Manutenção do Sono/etiologia
Síndrome de Abstinência a Substâncias/tratamento farmacológico
Ácido gama-Aminobutírico/efeitos adversos
Ácido gama-Aminobutírico/farmacologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Amines); 0 (Calcium Channel Blockers); 0 (Cyclohexanecarboxylic Acids); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE
[do] DOI:10.1080/13543784.2018.1417383


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[PMID]:28451875
[Au] Autor:Peckham AM; Fairman KA; Sclar DA
[Ad] Endereço:Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern University, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA. apeckh@midwestern.edu.
[Ti] Título:Prevalence of Gabapentin Abuse: Comparison with Agents with Known Abuse Potential in a Commercially Insured US Population.
[So] Source:Clin Drug Investig;37(8):763-773, 2017 Aug.
[Is] ISSN:1179-1918
[Cp] País de publicação:New Zealand
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Despite international calls to make gabapentin a controlled substance, studies of gabapentin use/abuse patterns are limited to small/high-risk samples and adverse event reports. OBJECTIVE: The aim of this study was to conduct a systematic assessment of the abuse potential/prevalence of gabapentin in a large sample. DATA SOURCE: Truven Health MarketScan Commercial Claims and Encounters database, years 2013-2015. ELIGIBILITY CRITERIA: Patients with two or more claims for one or more abusable drugs and ≥12 months' continuous enrollment were sampled for Lorenz curve analysis. Prevalence analysis was limited to those with ≥120 days of therapy. METHODS: Abuse potential was measured as Lorenz-1 (consumption of drug supply by top 1% of users) of ≥15%. Dose thresholds were morphine milligram equivalent (MME) standards for opioids, and maximum labeled doses in milligrams (mg) for other drugs. RESULTS: Lorenz-1 values were 37% opioids, 19% gabapentin, 15% pregabalin, 14% alprazolam, and 13% zolpidem. The top 1% gabapentin users filled prescriptions for a mean (median) 11,274 (9534) mg/day, more than three times the recommended maximum (3600 mg). Of these, one-quarter used or diverted ≥12,822 mg/day. The top 1% opioid and pregabalin users filled prescriptions for a mean (median) 180 (127) MMEs and 2474 (2219) mg/day, respectively. Of patients using opioids + gabapentin simultaneously, 24% had three or more claims exceeding the dose threshold within 12 months. LIMITATIONS: Established threshold criteria for gabapentinoid abuse are uncertain. Indications for gabapentinoid use (e.g. hot flashes, restless legs syndrome) were not measured. CONCLUSION: Gabapentin use patterns are similar to those of other abusable medications. High daily doses pose safety and/or diversion concerns, and investigation of the medical consequences of gabapentin abuse is needed.
[Mh] Termos MeSH primário: Aminas
Ácidos Cicloexanocarboxílicos
Transtornos Relacionados ao Uso de Substâncias/epidemiologia
Ácido gama-Aminobutírico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Prevalência
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Amines); 0 (Cyclohexanecarboxylic Acids); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1007/s40261-017-0530-3


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[PMID]:29191838
[Au] Autor:Peckham AM; Fairman KA; Sclar DA
[Ad] Endereço:Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern University, 19555 N 59th Avenue, Glendale, AZ 85308, USA.
[Ti] Título:Call for increased pharmacovigilance of gabapentin.
[So] Source:BMJ;359:j5456, 2017 11 30.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Ácidos Cicloexanocarboxílicos
Farmacovigilância
[Mh] Termos MeSH secundário: Sistemas de Notificação de Reações Adversas a Medicamentos
Aminas
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos
Seres Humanos
Ácido gama-Aminobutírico
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Amines); 0 (Cyclohexanecarboxylic Acids); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5456


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[PMID]:29321467
[Au] Autor:Miao J; Aboagye DE; Chulpayev B; Liu L; Ishkanian G; Kolanuvada B; Alaie D; Petrillo RL
[Ad] Endereço:Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.
[Ti] Título:Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case.
[So] Source:Am J Case Rep;19:41-46, 2018 Jan 11.
[Is] ISSN:1941-5923
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND Neuromyelitis optica (NMO) is a rare demyelinating disease of the central nervous system; NMO predominantly affects the spinal cord and optic nerves. The diagnosis is based on history, clinical presentation, seropositive NMO-IgG antibody, and notably, exclusion of other diseases. Despite the absence of definitive therapeutic strategies for NMO, methylprednisolone pulse therapy and plasma exchange are used for acute phase treatment, while immunosuppressive agent(s) are recommended to prevent relapses and improve prognosis. Here, we report a repeating relapse NMO case due to lack of regular and maintenance therapy. CASE REPORT A 58-year-old female with chronic NMO presented with a three-day history of new-onset right leg weakness and pain. The patient was diagnosed with NMO three years ago and presented with her fourth attacks. During her initial diagnosis, she was initiated on steroids. One year later, she developed the first relapse and was treated with steroids and rituximab, leading to 1.5-year remission. After the second relapse, steroids and rituximab was still given as maintenance therapy, but was not followed. Thus, the third relapse occurred in five months. During this hospitalization, she received initially high-dose solumedrol (1 g daily for five days) in addition to gabapentin 100 mg (gradually increased to 300 mg) three times a day for muscle spasms. Due to worsening of paresthesia and hemiparesis, it was decided to place her on plasma exchange treatment. After two plasma exchanges, the patient's condition was improved and she regained strength in her lower extremity. She completed five more cycles of plasma exchange, and was then discharged on steroid therapy (prednisone 20 mg daily for 10 days then taper) as maintenance therapy and with follow-up in neurology clinic. CONCLUSIONS Over the span of three years, the patient has had three relapses since her NMO diagnosis where her symptoms have worsened. Steroid therapy alone seemed not insufficient in managing her more recent relapses. Nonadherence to NMO treatment likely increased her risk for recurrence, thus regular and long-term maintenance therapy is imperative to delay the progression and prevent relapse in NMO.
[Mh] Termos MeSH primário: Glucocorticoides/uso terapêutico
Imunossupressores/uso terapêutico
Neuromielite Óptica/diagnóstico
Neuromielite Óptica/terapia
Troca Plasmática
Rituximab/uso terapêutico
Cooperação e Adesão ao Tratamento
[Mh] Termos MeSH secundário: Aminas/uso terapêutico
Analgésicos/uso terapêutico
Autoanticorpos/sangue
Biomarcadores/sangue
Doença Crônica
Ácidos Cicloexanocarboxílicos/uso terapêutico
Feminino
Seres Humanos
Fatores Imunológicos/sangue
Meia-Idade
Neuromielite Óptica/sangue
Troca Plasmática/métodos
Prognóstico
Recidiva
Resultado do Tratamento
Ácido gama-Aminobutírico/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics); 0 (Autoantibodies); 0 (Biomarkers); 0 (Cyclohexanecarboxylic Acids); 0 (Glucocorticoids); 0 (Immunologic Factors); 0 (Immunosuppressive Agents); 4F4X42SYQ6 (Rituximab); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE


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[PMID]:29210970
[Au] Autor:Tinsbloom B; Muckler VC; Stoeckel WT; Whitehurst RL; Morgan B
[Ad] Endereço:Brandi Tinsbloom, DNP, CRNA, is a graduate of the Duke University Nurse Anesthesia Program. She is a practicing CRNA at a regional medical center in Pinehurst, NC. She has interests in community hospitals and outpatient and office-based practices. Virginia C. Muckler, DNP, CRNA, CHSE, is Assistant Professor in the Duke University Nurse Anesthesia Program in Durham, NC. She serves as a reviewer for multiple journals, is a National League for Nursing Simulation Leader, has served as a simulation consultant nationally and internationally, and serves on national and state associations. William T. Stoeckel, MD, is the owner of Wake Plastic Surgery in Cary, NC. He completed his plastic surgery training at Wake Forest University in 2002 and has been in his solo private practice since. He specializes in body and breast outpatient plastic surgery procedures using MAC anesthesia. Robert L. Whitehurst, MSN, CRNA, is founder and President of Advanced Anesthesia Solutions. He received his BSN from East Carolina University and his MSN (Anesthesia) from Duke University. Robert has practiced as a CRNA in academic institutions, community hospitals, and outpatient and office-based practices since 2004. Robert is an advocate for patients and CRNA practice as Chair of NCANA PAC and his work to expand the availability of anesthesia services to underserved settings. Brett Morgan, DNP, CRNA, is Assistant Professor at the Duke University School of Nursing and the Director of the Nurse Anesthesia Specialty Program. In addition to his faculty role, Dr. Morgan practices clinical anesthesia in office-based settings throughout the research triangle.
[Ti] Título:Evaluating the Implementation of a Preemptive, Multimodal Analgesia Protocol in a Plastic Surgery Office.
[So] Source:Plast Surg Nurs;37(4):137-143, 2017 Oct/Dec.
[Is] ISSN:1550-1841
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Many patients undergoing plastic surgery experience significant pain postoperatively. The use of preemptive, multimodal analgesia techniques to reduce postoperative pain has been widely described in the literature. This quality improvement project evaluated the implementation of a preemptive, multimodal analgesia protocol in an office-based plastic surgery facility to decrease postoperative pain, decrease postoperative opioid consumption, decrease postanesthesia care time, and increase patient satisfaction. The project included adult patients undergoing surgical procedures at an outpatient plastic and cosmetic surgery office, and the protocol consisted of oral acetaminophen 1,000 mg and gabapentin 1,200 mg. Using a pre-/postintervention design, data were collected from patient medical records and telephone interviews of patients receiving the standard preoperative analgesia regimen (preintervention group: n = 24) and the evidence-based preemptive, multimodal analgesia protocol (postintervention group: n = 23). Results indicated no significant differences between the pre- and postintervention groups for any of the outcomes measured. However, results showed that patients in both groups experienced moderate to severe pain postoperatively. In addition, adverse side effects such as dizziness and drowsiness were higher in the postintervention group than in the preintervention group. Although this quality improvement project did not meet the goals it set out to achieve for patients undergoing plastic surgery, it did illustrate the substantial presence of pain after surgical procedures. Thus, clinicians need to continue to focus on identifying targeted treatment plans that use multimodal, non-opioid-based strategies to manage and prevent postoperative pain.
[Mh] Termos MeSH primário: Manejo da Dor/métodos
Dor Pós-Operatória/prevenção & controle
Cuidados Pré-Operatórios/métodos
Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos
[Mh] Termos MeSH secundário: Acetaminofen/administração & dosagem
Adulto
Idoso
Procedimentos Cirúrgicos Ambulatórios
Aminas/administração & dosagem
Analgésicos não Entorpecentes/administração & dosagem
Analgésicos Opioides/efeitos adversos
Análise de Variância
Ácidos Cicloexanocarboxílicos/administração & dosagem
Feminino
Seres Humanos
Masculino
Meia-Idade
Avaliação de Resultados (Cuidados de Saúde)
Medição da Dor
Dor Pós-Operatória/tratamento farmacológico
Cuidados Pós-Operatórios
Ácido gama-Aminobutírico/administração & dosagem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics, Non-Narcotic); 0 (Analgesics, Opioid); 0 (Cyclohexanecarboxylic Acids); 362O9ITL9D (Acetaminophen); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171218
[Lr] Data última revisão:
171218
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE
[do] DOI:10.1097/PSN.0000000000000201


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[PMID]:28972983
[Au] Autor:Gomes T; Juurlink DN; Antoniou T; Mamdani MM; Paterson JM; van den Brink W
[Ad] Endereço:Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
[Ti] Título:Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study.
[So] Source:PLoS Med;14(10):e1002396, 2017 Oct.
[Is] ISSN:1549-1676
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Prescription opioid use is highly associated with risk of opioid-related death, with 1 of every 550 chronic opioid users dying within approximately 2.5 years of their first opioid prescription. Although gabapentin is widely perceived as safe, drug-induced respiratory depression has been described when gabapentin is used alone or in combination with other medications. Because gabapentin and opioids are both commonly prescribed for pain, the likelihood of co-prescription is high. However, no published studies have examined whether concomitant gabapentin therapy is associated with an increased risk of accidental opioid-related death in patients receiving opioids. The objective of this study was to investigate whether co-prescription of opioids and gabapentin is associated with an increased risk of accidental opioid-related mortality. METHODS AND FINDINGS: We conducted a population-based nested case-control study among opioid users who were residents of Ontario, Canada, between August 1, 1997, and December 31, 2013, using administrative databases. Cases, defined as opioid users who died of an opioid-related cause, were matched with up to 4 controls who also used opioids on age, sex, year of index date, history of chronic kidney disease, and a disease risk index. After matching, we included 1,256 cases and 4,619 controls. The primary exposure was concomitant gabapentin use in the 120 days preceding the index date. A secondary analysis characterized gabapentin dose as low (<900 mg daily), moderate (900 to 1,799 mg daily), or high (≥1,800 mg daily). A sensitivity analysis examined the effect of concomitant nonsteroidal anti-inflammatory drug (NSAID) use in the preceding 120 days. Overall, 12.3% of cases (155 of 1,256) and 6.8% of controls (313 of 4,619) were prescribed gabapentin in the prior 120 days. After multivariable adjustment, co-prescription of opioids and gabapentin was associated with a significantly increased odds of opioid-related death (odds ratio [OR] 1.99, 95% CI 1.61 to 2.47, p < 0.001; adjusted OR [aOR] 1.49, 95% CI 1.18 to 1.88, p < 0.001) compared to opioid prescription alone. In the dose-response analysis, moderate-dose (OR 2.05, 95% CI 1.46 to 2.87, p < 0.001; aOR 1.56, 95% CI 1.06 to 2.28, p = 0.024) and high-dose (OR 2.20, 95% CI 1.58 to 3.08, p < 0.001; aOR 1.58, 95% CI 1.09 to 2.27, p = 0.015) gabapentin use was associated with a nearly 60% increase in the odds of opioid-related death relative to no concomitant gabapentin use. As expected, we found no significant association between co-prescription of opioids and NSAIDs and opioid-related death (OR 1.11, 95% CI 0.98 to 1.27, p = 0.113; aOR 1.14, 95% CI 0.98 to 1.32, p = 0.083). In an exploratory analysis of patients at risk of combined opioid and gabapentin use, we found that 46.0% (45,173 of 98,288) of gabapentin users in calendar year 2013 received at least 1 concomitant prescription for an opioid. This study was limited to individuals eligible for public drug coverage in Ontario, we were only able to identify prescriptions reimbursed by the government and dispensed from retail pharmacies, and information on indication for gabapentin use was not available. Furthermore, as with all observational studies, confounding due to unmeasured variables is a potential source of bias. CONCLUSIONS: In this study we found that among patients receiving prescription opioids, concomitant treatment with gabapentin was associated with a substantial increase in the risk of opioid-related death. Clinicians should consider carefully whether to continue prescribing this combination of products and, when the combination is deemed necessary, should closely monitor their patients and adjust opioid dose accordingly. Future research should investigate whether a similar interaction exists between pregabalin and opioids.
[Mh] Termos MeSH primário: Aminas/uso terapêutico
Analgésicos Opioides/uso terapêutico
Ácidos Cicloexanocarboxílicos/uso terapêutico
Overdose de Drogas/mortalidade
Dor/tratamento farmacológico
Insuficiência Respiratória/mortalidade
Ácido gama-Aminobutírico/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Idoso
Anti-Inflamatórios não Esteroides/uso terapêutico
Estudos de Casos e Controles
Causas de Morte
Overdose de Drogas/etiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Ontário/epidemiologia
Insuficiência Respiratória/induzido quimicamente
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics, Opioid); 0 (Anti-Inflammatory Agents, Non-Steroidal); 0 (Cyclohexanecarboxylic Acids); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171004
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pmed.1002396


  9 / 5395 MEDLINE  
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[PMID]:28906391
[Au] Autor:Liu B; Liu R; Wang L
[Ad] Endereço:aDepartment of Anesthesiology, Linyi People's Hospital bDepartment of Anesthesiology, Women and Children's Health Care Hospital of Linyi, Shandong, China.
[Ti] Título:A meta-analysis of the preoperative use of gabapentinoids for the treatment of acute postoperative pain following spinal surgery.
[So] Source:Medicine (Baltimore);96(37):e8031, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Gabapentinoid drugs, which include gabapentin and pregabalin, play an established role in the management of neuropathic pain. However, whether preoperative administration of gabapentinoids has a beneficial role in controlling acute pain after spinal surgery is unknown. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the efficacy and safety of the preoperative use of gabapentinoids (gabapentin and pregabalin) for the treatment of acute postoperative pain following spinal surgery. METHODS: In March 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Library, and Google databases. RCTs comparing gabapentinoids (gabapentin and pregabalin) with placebo in patients undergoing spine surgery were retrieved. The primary endpoint was the visual analogue scale (VAS) score with rest or mobilization at 6, 12, 24, and 48 hours and cumulative morphine consumption at 24 and 48 hours. The secondary outcomes were complications of nausea, vomiting, sedation, dizziness, headache, urine retention, pruritus, and visual disturbances. After tests for publication bias and heterogeneity among studies were performed, data were aggregated for random-effects models when necessary. RESULTS: Sixteen clinical studies (gabapentin group n = 8 and pregabalin group n = 8) were ultimately included in the meta-analysis. Gabapentinoids were associated with reduced pain scores at 6, 12, 24, and 48 hours. Similarly, gabapentinoids were associated with a reduction in cumulative morphine consumption at 24 and 48 hours. Furthermore, gabapentinoids can significantly reduce the occurrence of nausea, vomiting, and pruritus. There were no significant differences in the occurrence of sedation, dizziness, headache, visual disturbances, somnolence, or urine retention. CONCLUSIONS: Preoperative use of gabapentinoids was able to reduce postoperative pain, total morphine consumption, and morphine-related complications following spine surgery. Further studies should determine the optimal dose and whether pregabalin is superior to gabapentin in controlling acute pain after spine surgery.
[Mh] Termos MeSH primário: Dor Aguda/tratamento farmacológico
Aminas/uso terapêutico
Analgésicos/uso terapêutico
Ácidos Cicloexanocarboxílicos/uso terapêutico
Dor Pós-Operatória/tratamento farmacológico
Pregabalina/uso terapêutico
Coluna Vertebral/cirurgia
Ácido gama-Aminobutírico/uso terapêutico
[Mh] Termos MeSH secundário: Dor Aguda/etiologia
Aminas/efeitos adversos
Analgésicos/efeitos adversos
Ácidos Cicloexanocarboxílicos/efeitos adversos
Seres Humanos
Pregabalina/efeitos adversos
Ensaios Clínicos Controlados Aleatórios como Assunto
Ácido gama-Aminobutírico/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics); 0 (Cyclohexanecarboxylic Acids); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008031


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[PMID]:28906382
[Au] Autor:Wang L; Dong Y; Zhang J; Tan H
[Ad] Endereço:aDepartment of Anesthesiology bDepartment of Rehabilitation cDepartment of Gastroenterology, Linyi People's Hospital, Shandong Province, China.
[Ti] Título:The efficacy of gabapentin in reducing pain intensity and postoperative nausea and vomiting following laparoscopic cholecystectomy: A meta-analysis.
[So] Source:Medicine (Baltimore);96(37):e8007, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: It is unknown whether gabapentin is effective in reducing acute pain following laparoscopic cholecystectomy. The purpose of the current meta-analysis was to evaluate the efficacy of gabapentin in reducing pain intensity and postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. METHODS: All randomized controlled trials (RCTs) evaluating the efficacy of gabapentin in reducing pain intensity and PONV after laparoscopic cholecystectomy were searched on the following databases: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Google database, the Chinese Wanfang database, and the China National Knowledge Infrastructure (CNKI). The most recent literature search was conducted on March 21, 2017. Outcomes including visual analog scale (VAS) at 12 and 24 hours, total morphine consumption, and the occurrence of PONV. Continuous outcomes were expressed as the weighted mean difference (WMD) and 95% confidence interval (CI), and the one discontinuous outcome was expressed as risk ratio (RR) and 95% CI. Stata 12.0 software was used for meta-analysis. RESULTS: A total of 9 studies involving 966 patients were identified. In total, there were 484 gabapentin subjects and 482 controls. Compared with the control group, gabapentin was associated with lower VAS at 12 hours (WMD = -10.18, 95% CI: -17.36 to -2.80, P = .007) and 24 hours (WMD = -6.33, 95% CI: -8.41 to -4.25, P = .000), which was equivalent on a 110-point VAS scale to 10.18 points at 12 hours and 6.33 points at 24 hours. Compared with the control group, gabapentin was associated with less total morphine consumption by approximately 110.83 mg (WMD = -110.83, 95% CI: -183.25 to -38.42, P = .003). In addition, the occurrence of nausea and vomiting in gabapentin was decreased (25.2% vs 47.6, RR = 0.53, 95% CI: 0.44-0.63, P = .000). CONCLUSION: Gabapentin was efficacious in reducing postoperative pain, total morphine consumption, and morphine-related complications following laparoscopic cholecystectomy. In addition, there was a negative correlation between the gabapentin dosage and the occurrence of nausea and vomiting. The number of included studies is limited, and more studies are needed to verify the effects of gabapentin in laparoscopic cholecystectomy patients.
[Mh] Termos MeSH primário: Aminas/uso terapêutico
Analgésicos/uso terapêutico
Colecistectomia Laparoscópica
Ácidos Cicloexanocarboxílicos/uso terapêutico
Dor Pós-Operatória/prevenção & controle
Náusea e Vômito Pós-Operatório/prevenção & controle
Ácido gama-Aminobutírico/uso terapêutico
[Mh] Termos MeSH secundário: Seres Humanos
Medição da Dor
Ensaios Clínicos Controlados Aleatórios como Assunto
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics); 0 (Cyclohexanecarboxylic Acids); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008007



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