From the Departments of Psychiatry and Behavioral Sciences (HEJ, REJ, MT), Medicine (DRJ), and Obstetrics and Gynecology (LM), Johns Hopkins University School of Medicine, Baltimore, MD; Reckitt Benckiser Pharmaceuticals Inc. (REJ), Richmond, VA; and the Department of Psychology (KEO), University of Maryland, College Park, College Park, MD.
J Addict Med. 2008 Jun;2(2):103-7. doi: 10.1097/ADM.0b013e31815ca2c6.
Scant scientific attention has been given to examining the need for agonist medication dose changes in the postpartum period. Study objectives were: 1) to determine the need for medication dose adjustments in participants stabilized on buprenorphine or methadone 3 weeks before and 4 weeks after delivery, and 2) to evaluate the need for methadone dose adjustments during the first 7 days in participants transferred from buprenorphine to methadone at 5 weeks postpartum. Participants were opioid-dependent pregnant women who had completed a randomized, double-blind, double-dummy, flexible dosing comparison of buprenorphine to methadone. Participants received a stable dose of methadone (N = 10) or buprenorphine (N = 8) before and 4 weeks after delivery. Buprenorphine-maintained participants were transferred to methadone at 5 weeks postpartum. There were no significant differences predelivery and/or postdelivery between the buprenorphine and methadone conditions in the mean ratings of dose adequacy, "liking," "hooked," and "craving" of heroin or cocaine. Patient response to the conversion from buprenorphine to methadone seems variable. Buprenorphine-maintained participants required dose changes postpartum only after they transferred to methadone. Regardless of type of medication, postpartum patients should be monitored for signs of overmedication.
很少有科学研究关注在产后期间阿片类激动剂药物剂量调整的需求。研究目的是：1）确定在分娩前 3 周和分娩后 4 周稳定使用丁丙诺啡或美沙酮的参与者是否需要调整药物剂量；2）评估在产后 5 周从丁丙诺啡转为美沙酮的参与者在头 7 天内是否需要调整美沙酮剂量。参与者为依赖阿片类药物的孕妇，他们完成了丁丙诺啡与美沙酮的随机、双盲、双模拟、灵活剂量比较。参与者在分娩前和分娩后 4 周接受稳定剂量的美沙酮（N=10）或丁丙诺啡（N=8）。丁丙诺啡维持的参与者在产后 5 周转为美沙酮。在分娩前和分娩后，丁丙诺啡和美沙酮条件下，剂量充足、“喜欢”、“上钩”和“渴望”海洛因或可卡因的平均评分没有显著差异。从丁丙诺啡转换为美沙酮的患者反应似乎各不相同。只有在转为美沙酮后，丁丙诺啡维持的参与者才需要在产后调整剂量。无论使用哪种药物，产后患者都应监测是否有过度用药的迹象。
