Current Evidence on Abuse and Misuse of Gabapentinoids
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REVIEW ARTICLE
Current Evidence on Abuse and Misuse of Gabapentinoids Staffan Hägg1 · Anna K. Jönsson2,3 · Johan Ahlner2,3
© The Author(s) 2020
Abstract This review summarizes current evidence on the abuse and misuse of the gabapentinoids pregabalin and gabapentin. Pharmacovigilance studies, register-based studies, surveys, clinical toxicology studies, and forensic toxicology studies were identified and scrutinized with the goal to define the problem, identify risk factors, and discuss possible methods to reduce the potential for abuse and misuse. Studies found that gabapentinoids are abused and misused and that individuals with a history of psychiatric disorders or substance use disorder seem to be at high risk. Moreover, some evidence supports the notion that patients with opioid use disorders may be at an increased risk of abusing gabapentinoids. Available evidence also suggests that abuse and misuse are more frequent in users of pregabalin compared with users of gabapentin. Health professionals and prescribers should be aware of the risk for misuse of pregabalin and gabapentin, which eventually could lead to abuse, substance dependence, and intoxications. Prescribing to patients belonging to risk populations such as those with psychiatric disorders or substance use disorder should be avoided if possible and, if prescribed, signs of misuse and abuse should be monitored. Key Points The gabapentinoids pregabalin and gabapentin have a potential for being abused and misused, which could result in substance dependence and intoxications. Individuals with a history of psychiatric disorders or substance use disorder seem to be at high risk for misuse and abuse. Some evidence suggests that patients with opioid use disorders may be at an increased risk of abusing gabapentinoids. Available evidence suggests that abuse and misuse are more frequent in users of pregabalin compared with gabapentin. * Staffan Hägg [email protected] 1
Futurum, Jönköping, Region Jönköping County and Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Futurum, Hus B4, Ryhov Hospital, S‑551 85 Jönköping, Sweden
2
Division of Drug Research, Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
3
Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden
1 Introduction The gabapentinoids, pregabalin and gabapentin, are widely used for the treatment of epileptic and pain disorders. Pregabalin is also used for generalized anxiety disorder, diabetic peripheral neuropathy, post-herpetic neuralgia, and fibromyalgia [1]. Another gabapentinoid, mirogabalin, is in clinical development and has recently been introduced in Japan for the treatment of peripheral neuropathic pain [2]. Gabapentinoids are structurally similar to gamma-aminobutyric acid (GABA); however, they do not act on GABA receptors or have effects on GABA synthesis or metabolism. They are
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