A Double‐Blind Trial of Gabapentin Versus Lorazepam in the Treatment of Alcohol Withdrawal

Myrick, Hugh; Malcolm, Robert; Randall, Patrick K.; Boyle, Elizabeth; Anton, Raymond F.; Becker, Howard C.; Randall, Carrie L.

doi:10.1111/j.1530-0277.2009.00986.x

Cited by 165 publications

(132 citation statements)

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“…Similarly, gabapentin has been indicated for the treatment/ management of drug (e.g. opiates [41]; cannabis [42]), behavioural [43] and alcohol [44] addictions.…”

Section: Gabapentinoids As a Treatment For Addiction?mentioning

confidence: 99%

Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern?

2014

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Gabapentinoids (e.g. pregabalin and gabapentin) are widely used in neurology, psychiatry and primary healthcare but are increasingly being reported as possessing a potential for misuse. In fact, increasing levels of both prescriptions and related fatalities, together with an anecdotally growing black market, have been reported from a range of countries. This article reviews the current evidence base of this potential, in an attempt to answer the question of whether there is cause for concern about these drugs. Potent binding of pregabalin/gabapentin at the calcium channel results in a reduction in the release of excitatory molecules. Furthermore, gabapentinoids are thought to possess GABA-mimetic properties whilst possibly presenting with direct/indirect effects on the dopaminergic 'reward' system. Overall, pregabalin is characterized by higher potency, quicker absorption rates and greater bioavailability levels than gabapentin. Although at therapeutic dosages gabapentinoids may present with low addictive liability levels, misusers' perceptions for these molecules to constitute a valid substitute for most common illicit drugs may be a reason of concern. Gabapentinoid experimenters are profiled here as individuals with a history of recreational polydrug misuse, who self-administer with dosages clearly in excess (e.g. up to 3-20 times) of those that are clinically advisable. Physicians considering prescribing gabapentinoids for neurological/psychiatric disorders should carefully evaluate a possible previous history of drug abuse, whilst being able to promptly identify signs of pregabalin/gabapentin misuse and provide possible assistance in tapering off the medication. Key pointsGabapentinoids are thought to possess GABAmimetic properties, whilst possibly presenting with direct/indirect effects on the dopaminergic 'reward' system.Gabapentinoid experimenters are profiled here as individuals with a history of recreational polydrug misuse, who self-administer with dosages clearly in excess (e.g. up to 3-20 times) of those that are clinically advisable.Physicians considering prescribing gabapentinoids for neurological/psychiatric disorders should carefully evaluate for a possible previous history of drug abuse, whilst being able to promptly identify signs of pregabalin/gabapentin misuse and provide possible assistance in tapering off the medication.

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“…Similarly, gabapentin has been indicated for the treatment/ management of drug (e.g. opiates [41]; cannabis [42]), behavioural [43] and alcohol [44] addictions.…”

Section: Gabapentinoids As a Treatment For Addiction?mentioning

confidence: 99%

Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern?

2014

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“…Га бапентин имел хорошую переносимость и уменьшал выраженность симптомов алкогольного абстинентного синд рома у амбулаторных пациентов. Было показано, что габа пентин снижает частоту употребления алкоголя в течения синдром отмены и в течение недели после синдрома отмены по сравнению с лоразепамом [59]. Недавнее исследование показало, что габапентин в дозе до 3200 мг в первые 24 часа был эффективен в снижении менее острого и тяжелого алко гольного абстинентного синдрома [60].…”

Section: распознание и лечение алкогольного абстинентного синдрома в unclassified

Psychomotor Agitation in Critically Ill Patients and the Role of Sedation

ФедарауМ.¹,

Комполо²,

Papadokos³

2012

rmt

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О Б Щ А Я Р Е А Н И М А Т О Л О Г И Я , 2 0 1 2 , V I I I ; 6 62 www.niiorramn.ru Существующая проблема психомоторных расст ройств, таких как возбуждение, тревога и делирий, многие годы привлекает внимание врачей и сестер отделений реани матологии, а также руководства больниц. Эти состояния мо гут напрямую влиять на оказание медицинской помощи больным, увеличивать их метаболические потребности и в конечном счете увеличивать заболеваемость и летальность. Данные состояния также связаны с увеличением продолжи тельности и стоимости нахождения больных в отделениях реаниматологии. В настоящее время дыхательная недоста точность является наиболее частой причиной поступления больных в отделение реаниматологии и сопровождается вы сокой летальностью. Однако только 16% больных, которым проводится искусственная вентиляция легких, умирают не посредственно от дыхательной недостаточности [1][2][3]. Сре ди внелегочных факторов, влияющих на летальность боль ных в критическом состоянии, возбуждение и делирий оста ются недооцененными и плохо изученными. В связи с этим необходима разработка и применение рекомендаций с сис темным и организационным подходом, направленных на профилактику и лечение данных нарушений.В течение последнего десятилетия были приняты реко мендации и протоколы, посвященные проведению седации в отделении реаниматологии и направленные на поддержание оптимального уровня комфорта и безопасности больных в критическом состоянии [4,5]. Седация и обезболивание рас сматриваются как жизненно важные мероприятия в течение всего периода госпитализации. Это приводит к увеличению усилий медицинского персонала, направленных на седацию и анальгезию у этой категории больных. В последнее время кли ницисты столкнулись со значительной нехваткой седативных препаратов, что повлияло на локальные протоколы отделений реаниматологии по всему миру. Наше растущее понимание важности изменений ментального статуса у больных в крити ческом состоянии и их влиянии на исход в свою очередь по влияло на тактику седации в отделениях реаниматологии. Это привело к изменению оценки и методов лечения больных.Critically ill patients often receive analgesia and sedation to keep them comfortable and to prevent agitation and delirium, which are serious, common and yet frequently underdiagnosed forms of brain dysfunction in intensive care environment with unclear but often unfavorable contribution to patient outcomes. Apart from delirium assessment and screening the most important aspect of ICU management is understanding the drugs given to patients and their specific advantages and disadvantages. It is crucial for clinicians and units to develop guidelines and protocols for the administration of sedatives depending on the type of patient population. Newer drugs, such as dexmedetomidine and remifentanyl, should be intro duced and extensively studied. The immunomodulating effects of sedation also must be explored, as these properties may greatly affect outcome. With an increased understanding of sedative drugs will come an improved ability to use multiple dru...

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“…Rustembegovic and colleagues [86] have also described a case series in which there was a reduction in tonic-clonic seizures in a subset of patients with severe AWS. In a double blind trial of gabapentin versus lorazepam for the treatment of AWS, Myrick and Colleagues [87] found that the administration of gabapentin (1200 mg/day) was as effective as lorazepam for AWS as measured by CIWA-Ar, and that patients receiving gabapentin had reduced alcohol consumption in the immediate post-withdrawal week com-pared to lorazepam. An open trial of gabapentin in acute alcohol withdrawal used an oral loading protocol in 37 patients with a history of severe alcohol withdrawal symptoms [88].…”

Section: Gabapentinmentioning

confidence: 99%

The Use of Antiepileptic Drugs in Acute Neuropsychiatric Conditions: Focus on Traumatic Brain Injury, Pain, and Alcohol Withdrawal

Nejad

Chuang²,

Hirschberg³

et al. 2014

IJCM

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Antiepileptic drugs (AEDs), have demonstrated efficacy treating a number of acute conditions, encompassing a broad range of symptoms and syndromes, in addition to being first-line treatment for epilepsy. Clinically, since their inception, AEDs have been used off-label for acute and chronic medical conditions, both as primary and as adjuvant therapies. In this review, we describe the observed clinical effectiveness of AEDs across a set of commonly encountered acute conditions in the general hospital: traumatic brain injury, pain, alcohol withdrawal. In describing the individual benefits and usages of specific agents, the applicability of these agents to other common neuropsychiatric conditions may be further explored.

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A Double‐Blind Trial of Gabapentin Versus Lorazepam in the Treatment of Alcohol Withdrawal

Cited by 165 publications

References 32 publications

Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern?

Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern?

Psychomotor Agitation in Critically Ill Patients and the Role of Sedation

The Use of Antiepileptic Drugs in Acute Neuropsychiatric Conditions: Focus on Traumatic Brain Injury, Pain, and Alcohol Withdrawal

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