Pregabalin ve Gabapentin Kullanım Bozuklukları

Gabapentinoidler (pregabalin ve gabapentin), presinaptik ekstitatör nörotransmitterlerin salınımını azaltarak etkilerini gösteren antiepileptik ilaçlardır. Gabapentinoidler oral, intranazal ve intravenöz olarak terapötik ila süpraterapötik arasında değişen dozlarda kötüye kullanılabilir. Ama tipik olarak supraterapötik dozları içerir. Son yıllarda gabapentin ve pregabalin yaygın bir şekilde reçete edilmekte, karaborsada ve internette dahi satışı yapılmakta, böylece olası birçok yan etkilere neden olmaktadır. Gabapentinoidlerin kötüye kullanımı, mahkûmları ve bağımlılık tedavisine katılan kişileri içeren nüfus temelli çalışmalardan elde edilen verilerle 2010 yılına dayanmaktadır. Bu zamandan beri gabapentinoidlerle ilgili kötüye kullanım, zehirlenme ve kesilme sendromu vaka raporları artmıştır. Gabapentinoidlerle ilişkili tehlike ve bağımlılık riski diğer sedatif ve psikoaktif ilaçlardan daha düşüktür. Mevcut veya geçmiş madde kullanım bozukluğu (MKB) ve psikiyatrik komorbiditesi olan bireylerde kötüye kullanım riski daha yüksektir. Klinisyenler, gabapentinoidleri başlamadan önce MKB (özellikle opioid), psikiyatrik ve kullandığı ilaç öykülerini değerlendirmelidir. Yüksek riskli hastalarda, gabapentinoidlerle tedaviden kaçınılmalı veya vazgeçilmez ise dikkatli bir şekilde sıkı bir tedavi takibi ve reçeteli izlem yaparak sınırlı bir süre boyunca uygulanmalıdır. Tedaviyi sonlandırırken, kesilme sendromu gelişimesini önlemek için kademeli doz azaltımı yapılmalıdır.

Pregabalin and Gabapentin Use Disorders

Gabapentinoids (pregabalin and gabapentin) are antiepileptic drugs that exert their effects by decreasing the release of presynaptic excitatory neurotransmitters. Gabapentinoids can be misused orally, intranasally and intravenously, with doses ranging from therapeutic to supratherapeutic, but typically include supratherapeutic doses. In recent years, gabapentin and pregabalin have been becoming prescribed widely and sold on black markets and internet, thereby, causing many potential side-effects. Misuse of gabapentinoids dates back to 2010 through data obtained in population-based studies involving prisoners and persons attending addiction treatment. Since this time case reports of abuse, intoxication and discontinuation syndrome related to gabapentinoids have been increased. The risk of hazards and dependence associated with gabapentinoids is lower than that of other sedative and psychoactive drugs. Individuals with current or past substance use disorder (SUD) and psychiatric comorbidity are are at higher risk for abuse. Clinicians should evaluate the history of SUD (particularly opioid) history, psychiatric history, and concomitant medications of the patient before initiating gabapentinoids. These drugs should be avoided in patients at high risks or, if indispensable, administered over a limited time span with caution by using a strict therapy and prescription monitoring. While terminating treatment, gradual dose reduction should be done to prevent from developing discontinuation syndrome.

Kaynakça

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