I-Neurontin inekhono lokuhlukunyezwa kakhulu kunalokho okucatshangwa ngaphambilini
Kwaphela iminyaka, odokotela babheka i-Neurontin (i-gapapentin) ne-Lyrica (pregabalin) njengezidakamizwa ezincane noma ezingekho zokuhlukunyezwa okungenzeka. Noma kunjalo, ucwaningo oluphuthumayo luveza ukuthi lezi zidakamizwa zivame ukusetshenziswa kabi futhi zihlukumezwe.
Esifundweni sangoMeyi 2017 eshicilelwe ku- Pharmacoepidemiology ne-Drug Safety , i-Buttram nabambhali abambisene nabo baqokomisa umkhuba omusha ophazamisayo. Kuye kwaba nokwanda kwe-Neurontin diversion, futhi lokhu kuphazamiseka kuhlobene nengculazi ye-opioid echitha izingxenye eziningi ze-United States.
Abantu bakhuphuka ekuhlanganiseni kwe-Neurontin kanye ne-opioids kadokotela (isib. I-hydrocodone ne-oxycodone).
Abalobi besifundo babhala okulandelayo:
Idatha efaneleko ibonisa ukuthi i-Neurontin isetshenziselwa kabi ngokuhambisana nama-opioid kadokotela nokuthi i-Neurontin ne-heroin iyahlanganiswa futhi idliwe ndawonye. Abaphathi bezomthetho bathola ukuthi lezi zindlela zokusebenzisa izidakamizwa zibe negalelo ekunciphiseni i-Neurontin.
I-Neurontin neLyrica
Uma ukwelapha ukuboniswa okubuhlungu okungapheli kanye nezimpawu zokungahambi kahle, i-Neurontin neLyrica imishanguzo ethandwayo phakathi kwabahlengikazi bokuqala ukunakekelwa. Lezi zidakamizwa zisebenza kangcono ekwelapheni ubuhlungu obungapheli kunokuba yi-Advil noma i-Tylenol. Ngaphezu kwalokho, ukuxhomeka kwe-opioid kuyinto isifo; ngakho-ke, ama-opioid afana noNorco noma uVicodin asetshenziselwa kuphela ukuphatha ubuhlungu obukhulu nobunzima. Ngamanye amazwi, i-Neurontin inamandla kunezinto ongayithola esitolo sezidakamizwa futhi engasiyingozi kakhulu kunama-opioid.
(U-Heroin uhlobo lwe-opioid.)
Yeka indlela i-Neurontin ne-Lyrica esebenza ngayo
I-Neurontin ekuqaleni yayenziwe ngokwenziwa ngo-1977 njenge-GABA analogue. Cishe eminyakeni eyishumi kamuva, uLyrica, umzala wamakhemikhali waseNeurontin, wakhiwa. I-Neurontin yamukelwa yi-FDA ngo-1993. Ngo-2004, uLyrica wenza ukuhweba.
I-Neurontin neLyrica zibizwa ngokuthi yi- gabapentinoids futhi zenza izenzo ezifanayo.
Nakuba kokubili kuthuthukiswe ukulawula ukugwinya, lezi zidakamizwa ziye zaqashelwa njengezinkinga ezibuhlungu ezibuhlungu futhi zivame ukuba zenziwe ukuze zilulaze izinhlobo ezihlukahlukene zobuhlungu obungapheli nokungahambi kahle.
I-GABA, efinyeleleka ku-gamma-aminobutyric acid, i-neurotransmitter engavimbelayo, esakazwa kulo lonke i-cortex yocerebral, noma ungqimba lwangaphandle lobuchopho obhekene nokusebenza okuphezulu kobuchopho. I-GABA idlala indima emisebenzini ehlukahlukene yobuchopho, kuhlanganise nokulawulwa kwemoto nombono kanye nokulawulwa kokukhathazeka nobuhlungu.
Nakuba ekuqaleni kwakuhloselwe ukuhambela i-GABA receptors ebuchosheni, ama-gabapentinoids awabopheli ku-GABA receptors. Ngaphezu kwalokho, azibopheli ekutholeni i-cannabinoid, i-opioid, noma i-benzodiazepine receptors noma. Nakuba indlela yalezi zidakamizwa engakacaciswanga ngokugcwele, kubonakala sengathi lezi zidakamizwa zenza izidakamizwa nokuhlukunyezwa kwemiphumela ngokuphindaphindiwe. Noma kunjalo, i-gabapentinoids iphela ekukhuleni kwe-GABA nokugxila kwe-glutamate ingqondo ebuchosheni.
I-Neurontin ne-Lyrica babelana ngamaphrofayli afanayo okuxilisayo, bobabili bakhuliswa izinso futhi abahlanganyeli nezinye izidakamizwa (okungukuthi, ingozi encishisiwe yokusebenzisana kwezidakamizwa). Umehluko oluphawulekayo phakathi kwalezi zidakamizwa yi- bioavailability yabo, noma inani lemithi empeleni eyenza libe yi-circulation.
Ngokuqondile, i-Lyrica inempilo ephakeme ye-bioavailabilty kunokwenziwa kwe-Neurontin futhi ifinyelela ngokushesha futhi ibe namandla kakhulu. Lo umehluko uye wabangela ezinye izazi ukuba zithinte ukuthi i-Lyrica inamandla okuhlukunyezwa okuphezulu, futhi ama-akhawunti anecdotal asekela lesi sizathu. Noma kunjalo, uma kuthathwa isisindo esanele, zombili izidakamizwa ziyashesha ukwenza ngokuphumelelayo, futhi zombili zixhashazwa futhi zisebenzise kabi.
Ukusetshenziswa Kwemitholampilo yaseNeurontin naseLyrica
I-gabapentinoids ifana nomunye emiphumeleni yabo yomtholampilo.
Amaphilisi e-Neurontin, ama-capsules, kanye nezixazululo zomlomo avunyelwe yi-FDA ukuze (1) aphathe ukutholwa okuyingxenye futhi (2) aphathe i-neuralgia yokulandelana, noma isithwathwa.
EYurophu, iNeurontin ivunyelwe ukwelashwa ubuhlungu be-neuropathic.
I-Lyrica ivunywe yi-FDA ukuphatha (1) i-neuralgia yokuthutha, (2) isifo sikashukela se-peripheral neuropathy, (3) i-fibromyalgia, kanye (4) nokuqothulwa. EYurophu naseJapane, iLyrica ivunyelwe ukwelapha ubuhlungu be-neuropathic kanye ne-generalized disorder disorder.
I-Neurontin ayithathwa njengezinto ezilawulwa nguhulumeni wase-US, futhi izidakamizwa ziphephile kunezinye i-anticonvulsants. Le phrofayela yokuphepha ekhungathekile isuse ukusetshenziswa kwelebuli ye-Neurontin naphezu kokuswela ukuhlolwa kwamakliniki ukusekela ukusetshenziswa okunjalo.
Phakathi kuka-83% namaphesenti angu-95 we-Neurontin yokuthengisa ngaphandle kwelebuli. Nazi ezinye ze-off-label ezisetshenziswayo ze-Neurontin:
- Utshwala, i-benzodiazepine, i-marijuana ne-opioid yokuhoxiswa kwesifo
- Ukukhathazeka ngokweqile
- Isifo se-bipolar
- Isifo sezinhlungu zesifundazwe esiyinkimbinkimbi
- I-neuropathy ye-diabetes
- Ukushisa okushisayo
- I-Migraine ikhanda
- I-neipathy neuropathy
- Ukuphazamiseka kokuhamba kwesikhathi kwesigungu sokulala
- I-syndrome yezinyawo ezingapheli
- I-neuralgia ye-Trigeminal
Nakuba i-DEA ihlukanisa iLyrica njengesidakamizwa seSheduli V, ekhombisa amandla angaphansi kakhulu okuhlukumezeka, kuseyizinto ezilawulwayo. Leli qiniso lihambisana neqiniso lokuthi i-Lyrica iyabiza kakhulu kunokuba i-Neurontin ichaze ukuthi kungani i-Neurontin isetshenziswe kabanzi kakhulu.
Okokugcina, odokotela abaningi bazobeka uNeurontin esikhundleni seLyrica ngoba iNeurontin ishibhile kakhulu. I-Lyrica iyindlela yokwelapha ebiza kakhulu. Ngenxa yokuthi kokubili imithi inemiphumela efanayo, kungcono ukuhamba ngenketho engabizi.
Ukuhlukumeza kwe-Neurontin kuchazwe
Ukusebenzisa kabi kabi izidakamizwa nokusebenzisa kabi izidakamizwa kukhona izinto ezihlukene, futhi umehluko usezinhloso.
Ngokusho kwe-FDA: "Uma umuntu ethatha imithi yokwelapha yomthetho ngenhloso ngaphandle kwesizathu obekiwe, noma uma lowo muntu ethatha isidakamizwa engazange abekwe kuye, lokho kungukusebenzisa kabi izidakamizwa."
Ukusebenzisa kabi izidakamizwa kuyindlela ekhethekile yokusebenzisa kabi izidakamizwa. Kwenzeka uma abantu bethatha izidakamizwa ukuze baqonde "phezulu," noma bazwe ukuzwa komzimba. Ngokuqondene neNeurontin neLyrica, lokhu kuthokoza kuye kwachazwa ngezindlela ezahlukene futhi kukhumbuza imiphumela ye-opioids, i-benzodiazepines, kanye nama-psychedelics.
Odokotela abaningi banikezela i-Neurontin yazo zonke izinhlobo zezinto, kuhlanganise nobuhlungu, izimo zengqondo, nokukhathazeka kokusetshenziswa kwezidakamizwa; Abaningi balaba odokotela cishe abaqapheli ukuthi lokhu kusetshenziswa kabi kwezidakamizwa. Ngenxa yokuthi isakazwa kakhulu ngobuningi, futhi eshibhile futhi kulula ukubeka ngaphezu kweLyrica-okuyisidakamizwa esilawulwayo-i-Neurontin isibe yisidakamizwa esivame kakhulu sokuhlukumeza abantu abafuna ukuphakama kwayo okusheshayo okusheshayo. Ngaphezu kwalokho, abantu abanezinkinga zokusetshenziswa kwezidakamizwa kanye nokugula kwengqondo bangase bahlukumeze lezi zidakamizwa. Ngamanye amazwi, i-Neurontin ivame ukuqondiswa kubantu ababonisa ukuvama okuphezulu kokuhlukunyezwa.
Akuwona wonke umuntu ohlukumeza i-Neurontin-futhi ejwayelekile eLyrica-anemigomo yale mithi. Ukuchithwa yibhizinisi elikhulu kulabo abadayisa izidakamizwa, kanti lezi zidakamizwa zenza indlela yazo eya emigwaqweni. Kuphela kwamaphesenti angu-40 namaphesenti angu-65 abantu abasebenzisa kabi futhi abahlukumezayo nge-Neurontin banemigomo yomuthi.
Umbiko wango-2012 walinganiselwa ukuthi imithi yeLyrica neNeurontin yande ngamaphesenti angu-350 nangamaphesenti angu-150, ngokulandelana, esikhathini esiyiminyaka emihlanu edlule.
Inothi, abanye abantu ababekiwe uNeurontin bavele basebenzise kabi lesi sidakamizwa ngomzamo wokuzitholela izimpawu. Abanye abantu basebenzise kabi lesi sidakamizwa njengendlela yokuzilimaza. Ngaphezu kwalokho, abantu basebenzisa kabi izidakamizwa ngenkathi behlukumeza ezinye izinto, njenge-opioids, utshwala, ne-benzodiazepines.
Ngonyaka we-2010, ucwaningo lwaqala okokubonisa ukuthi ubungozi bokuxhashazwa kweLyrica. Ngokulandelayo, i-European Union yanezela le mithi ohlwini lwazo izinto zokuzilibazisa ezingokwenyama. Phakathi kuka-2010 no-2016, izifundo ezingaba ngu-12 ziye zahlola ukuxhashazwa okungenzeka kweNeurontin naseLyrica.
Nazi ezinye izinto eziqondile ezihlobene nokuhlukunyezwa kwe-Neurontin ne-Lyrica nokusebenzisa kabi kabi. Lezi zitholakele zitholakala ezifundweni zamuva.
- Ucwaningo olulodwa lubonisa ukuthi ukuhlukunyezwa kweNeurontin naseLyrica phakathi kwabantu abahlala e-UK abaneminyaka engama-16 no-59 ubudala yi-1.1% namaphesenti angu-0.5, ngokulandelana. Ngokwalolu cwaningo, izinga lokuhlukunyezwa kwe-cannabis ngamaphesenti angu-28.1 nokuhlukunyezwa kwe-cocaine ngamaphesenti angu-8.1. Ngamanye amazwi, kubantu abangenayo izidakamizwa zokusetshenziswa kwezidakamizwa noma ukugula ngengqondo, inani lokuhlukunyezwa kwe-gabapentinoid liphansi kuneleminye imithi yendabuko.
- Phakathi kwabantu abanezifo ze-opioid, amazinga we-Neurontin ukuxhashazwa ayephakathi kwamaphesenti angu-15 namaphesenti angu-22. Nakuba, izinga likaLyrica elihlukumezayo phakathi kwamalungu walesi sibalo sasihluka kakhulu: phakathi kwamaphesenti amathathu namaphesenti angu-68. Ngokuvamile, abantu abanezinkinga zokusetshenziswa kwezidakamizwa kubonakala behlukumeza ama-gabapentinoids kumazinga afana nezinye izidakamizwa zendabuko.
- Phakathi kwamaMelika abasebenzisa kabi i-opioids, izinga lokuhlukunyezwa kwe-Neurontin laliphindwe kabili lokuhlukunyezwa kwe-amphetamine nokuthi lilingana ne-clonazepam (uhlobo lwe-benzodiazepine) kabi.
- EScotland, amaphesenti angu-22 abantu abaya emitholampilo ye-methadone baxhaphaza i-Neurontin.
- Ucwaningo luka-2015 lubonise ukuhlukunyezwa kokuzijabulisa kweNeurontin njengoba kwanda ngokushesha. Ngokukodwa, kube nokwanda kwezingu-2950 kwamaphesenti okuhlukunyezwa kusukela ngo-2008.
- Ukusetshenziswa kwezidakamizwa zokusetshenziswa kwezidakamizwa kazwelonke kubonisa ukuthi iLyrica inqunywe ngamanani aphakeme kakhulu kunokunconywa, okungaholela ekuhlukunyezweni.
- Ucwaningo oluthile lubonisa ukuthi labo abasebenzisa kabi i-gabapentinoids bavame ukuba abesilisa abasha (30-ish) kanye nemali engenayo ephansi. Kodwa-ke, idatha ngokuphathelene nobulili nokuhlukunyezwa iyaxabana.
- Ngokusekelwe kwirekhodi lombiko wecala "elikhishwe ekuhlolweni kwekota okudonswa kwezidakamizwa
ephethwe yisampula kazwelonke yokusebenzisa umthetho kanye nama-ejensi alawulayo ahlanganyela ekuphenyweni kwezidakamizwa, "I-Buttram kanye nozakwethu bathola ukuthi amanani okunciphisa aphakanyiswa amacala angama-zero ezinyangeni ezimbili zokuqala zika-2002 aphezulu kwamaphesenti angu-0.027 kubantu abayi-100 000 ekugcineni ngekota ka-2015. - Ukususwa kwe-Neurontin kubonakala sengathi kuvamile emajele ase-US.
Imiphumela Eminye Kunokwesaba
Ngaphandle kokuzijabulisa, abantu abasebenzisa kabi i-gabapentinoids e-supratherapeutic, noma ngaphezulu kunezinyathelo eziphakanyisiwe, futhi bahlathulule nezinye imiphumela ezibandakanya okulandelayo:
- Ukuqukethwe
- Ukuphumula
- Ukuhlukaniswa
- Ukuthuthukiswa komphakathi
- Uzwela
- Ukuziphatha okungavinjelwe
- I-hallucinations yomsindo nokubukwayo
Okuphawula, le miphumela ibonakala ihlukahluka ngokusekelwe ekubekezeleni kanye nomthamo. Ukwengeza, ukuyeka ngokungazelelwe ama-gabapentinoids kungabangela ekuhoxisweni okusikisela kokuthembela ngokomzimba. Ngaphezu kwalokho, ukuhoxiswa kwabantu abasuka kuma-gabapentinoids nakho kungabhekana nezifiso ezingqondweni.
Izingozi ze-Gabapentinoid Overdose
Uma lisetshenziswe njengoba kunqunyiwe, i-Neurontin neLyrica ziphephile kakhulu. Imiphumela emibi ivame ukuba mnene futhi ihlanganisa ukulala, ukungaboni kahle, i-ataxia, isizungu, nokukhathala.
Ngokungafani nezinye izidakamizwa zokuhlukumeza, ngisho noma ngaphezulu, ama-gabapentinoids asabangela imiphumela emibi kuphela, njengengcindezi ephakeme yomsindo wegazi, izinga lokushaya kwenhliziyo elinyukayo, neminye imiphumela emibi efana nalabo abonwa emithethweni yokwelapha. Ukudlula ngokweqile kwe-Gabapentinoid akudingi ukufakwa esibhedlela futhi akukho okufa okubangelwa ukudlula ngokweqile kuye kwabikwa. Abantu abadlula ngokweqile bavame ukubuyela emuva kokuqala emva kwamahora angu-10 wokungenisa.
Indima Abadokotela Abadlala Ngayo
Kungaba lula kakhulu ukubeka icala lokuhlukunyezwa kwe-gabapentinoid, ukusetshenziswa kabi, nokuxhomeka emagameni okubeka odokotela. Ngokuqinisekile, le mithi ingumuthi odokotela kuphela futhi ngaleyo ndlela ingabuyiselwa emuva odokotela ngokwabo; Kodwa-ke, kumelwe siqonde isimo esingenakuphikwa abahlinzeka lapho isiguli sigxuma ubuhlungu obukhulu nobuhlungu obuhambisana nobuhlungu obungapheli.
Ngokwesibonelo, kuvamile iziguli ezine-neuropathic nezinye izinhlobo zobuhlungu obungapheli nokungazizwa ukuzwa ubuhlungu obungamethusa umuntu ngaphandle kwemibandela. Uma umuntu engena ehhovisi likadokotela ekhononda ngokushisa emikhawulweni yawo, imizwa yokuhamba "egumbini" nokunye, odokotela abanalo okuncane okumele baphathe ngayo lezi zimpawu ezimbi, kanti iNeurontin noma iLyrica yiyona ndlela kuphela yokukhetha okusebenzayo.
Odokotela kufanele bahlale bebheke izibonakaliso ukuthi isiguli sisisebenzisa kabi kabi noma sisebenzisa kabi izidakamizwa noma sihlela ukuhlanganyela ekudakiseni kubandakanya okulandelayo:
- Iziguli ezinezinkinga zokugula ngengqondo noma izidakamizwa kufanele zihlolwe ngokucophelela ekuhlukunyezweni noma ekunciphiseni.
- Izinkomba zokuhlukumeza zihlanganisa isiguli esicela iNeurontin noma i-Lyrica ngokuqondile, ngokulinganisa okuphezulu kunokuba kunqunyiwe, noma ngemigomo eminingi ngesikhathi esifushane.
- Odokotela kufanele baqiniseke ukuthi iziguli "azithengi udokotela" noma zithola imithi eminingi evela kubahlinzeki abaningi. Isizathu esivamile sokuziphatha okunjalo ukuthi izidakamizwa "zalahleka" noma "zibiwe."
- Udokotela kufanele acabangele ukwenza isikrini semithi yomchamo (UDS) kwizigameko ezisolakala ukuthi zenzeke. Uma lezi ziguli zithola imithi ye-gabapentinoids kodwa lezi zidakamizwa azitholakali emcinini, khona-ke lezi zidakamizwa kungenzeka zenzelwe imigwaqo.
Izwi elivela
Nakuba kuphakama, ukuxhashazwa kweNeurontin naseLyrica kusathinta kuphela abambalwa beziguli, futhi ikakhulukazi labo abasetshenziselwa ukuhlukunyezwa, njengabantu abanokwethenjelwa kwe-opioid. Ngaphezu kwalokho, ngisho nasezikhungweni zokudlula ngokweqile, imiphumela yale mithi ngokuvamile imnene futhi ihamba isikhathi eside-ukukhala kude nezimpikiswano zokuxhomeka kwe-opioid, utshwala, ne-benzodiazepine (izimo lezi zidakamizwa ezivame ukusetshenziselwa ukuphatha).
Uma wena noma othandekayo uthatha lezi zidakamizwa ngenxa yobuhlungu obungapheli noma ubuhlungu, futhi lezi zidakamizwa zinikeza ukukhululeka, ke lezi zidakamizwa zisetshenziswa njengoba kuhloswe. Kodwa-ke, ukuze unciphise ingozi yokuhlukunyezwa, kubalulekile ukuthi uhlolwe ngokucophelela ngudokotela wakho futhi uthathe lezi zidakamizwa kuphela ezinyangeni ezinconywayo. Ukuqonda ukuthi basebenza kanjani bangasiza. Futhi, ungathathi lezi zidakamizwa ukuze uthole "phezulu," ungaxube lezi zidakamizwa utshwala, i-benzodiazepines, i-opioids, noma ezinye izidakamizwa zokuhlukunyezwa, futhi unganiki noma uthengise lezi zidakamizwa kwabanye.
Uma nonke ninemibuzo mayelana nemithi kadokotela oyithathayo-ikakhulukazi imithi yokuhlukunyezwa okungenzeka-sicela ubuze udokotela wakho. Udokotela wakho angathatha isikhathi ukuxoxa ngezingozi nezinzuzo zanoma yimiphi imithi oyimisiwe. Ngaphezu kwalokho, ungabuye ubuze imithi yakho mayelana nemithi oyimisiwe. Njengesiguli, kunelungelo lakho ukwaziswa ngemithi oyithathayo.
> Imithombo:
> Ukulwa nokusetshenziswa kabi kabi nokuhlukumeza izidakamizwa ezibhalwe phansi: Q & A no Michael Klein, Ph.D. NgoJulayi 28, 2010. www.fda.gov.
> I-Evoy KE, i-Morrison MD ne-Saklad SR. "Ukuhlukumeza nokusebenzisa kabi i-Pregabalin ne-Gabapentin." Izidakamizwa . 2016.
> I-Mack A. Ukuhlolwa kobufakazi bokungaxhunywanga kwe-Label Ukusetshenziswa kwe-Gabapentin. I-Journal of Managed Care Pharmacy . 2003; 9: 559-568.
> Smith RV, Havens JR, noWalsh SL. "Ukusebenzisa kabi i-Gabapentin, ukuhlukunyezwa nokuhlukunyezwa: ukubuyekezwa okuhlelekile." Ukulutha . 2016; 111: 1160-1174.
> I-Tcheremissine, i-OV, ne-Bestha DP. Ukuhlukunyezwa kwe-Gabapentin Kwisineke Nge-Moorbid Mood kanye nokusetshenziswa kwezidakamizwa. Ukwakhiwa kwe-Neuroscience Clinic . 2016; 13: 13-14.