Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA.
Drug Saf. 2018 Feb;41(2):213-228. doi: 10.1007/s40264-017-0595-1.
Overuse of gabapentin and/or opioids occurs in a small percentage of patients at > 3-fold labeled dosages. Gabapentin may potentiate opioid effects.
The aim was to assess patient harm, defined as use of inpatient hospital (IPH) or emergency department (ED) services, associated with overuse of gabapentin with or without concomitant overuse of opioids.
Data were sourced from the Truven Health MarketScan Commercial Claims and Encounters database, for the years 2013-2015.
The eligibility criteria were two or more claims (billed encounters) and ≥120 days of treatment with gabapentin and/or opioids.
Cohort identification was based on daily-dosage thresholds of 50 morphine-milligram equivalents and 3600 mg of gabapentin in a 12-month follow-up: (1) no overuse; (2) mild overuse (two or more claims or two or fewer calendar quarters over threshold); and (3) sustained overuse (three or more over-threshold calendar quarters). IPH and ED use were measured for 6 months after the first overuse date (cohorts 2 and 3) or a randomly assigned date (cohort 1). Logistic regression analyses controlled for pre-treatment IPH/ED utilization, indication, addiction diagnosis, concomitant sedative/hypnotic use, and demographics.
All-cause and drug-related IPH/ED utilization increased monotonically with degree of overuse, particularly of more than one medication. Sustained overuse of gabapentin multiplied odds of all-cause IPH by 1.366 [95% confidence interval (CI) 1.055-1.769], drug-related IPH by 1.440 (95% CI 1.010-2.053), and IPH/ED for altered mental status (e.g., euphoria, anxiety) by 1.864 (95% CI 1.324-2.624). Sustained overuse of both medications quadrupled odds of all-cause IPH, drug-related IPH, and IPH/ED for altered mental status or respiratory depression.
Despite modest effects of gabapentin overuse alone, overuse of gabapentin with opioids may increase risk of harm and health-service utilization, supporting calls to make gabapentin a controlled substance in the USA.
在高于标签剂量 3 倍的患者中，小比例的患者会过度使用加巴喷丁和/或阿片类药物。加巴喷丁可能会增强阿片类药物的作用。
本研究旨在评估与加巴喷丁（无论是否同时过度使用阿片类药物）过度使用相关的患者伤害，定义为使用住院（IPH）或急诊（ED）服务。
数据来源于 2013-2015 年 Truven Health MarketScan 商业索赔和就诊数据库。
入选标准为两次或两次以上的索赔（计费就诊），以及使用加巴喷丁和/或阿片类药物治疗 120 天以上。
基于每日剂量阈值 50 吗啡毫克当量和 12 个月随访期间的 3600 毫克加巴喷丁，确定队列识别：（1）无过度使用；（2）轻度过度使用（两次或两次以上的索赔或两个或更少的日历季度超过阈值）；（3）持续过度使用（三个或更多的超阈值日历季度）。在首次过度使用日期（队列 2 和 3）或随机指定日期（队列 1）后 6 个月测量住院和急诊使用情况。逻辑回归分析控制了治疗前住院/急诊使用情况、适应症、成瘾诊断、同时使用镇静/催眠药物以及人口统计学因素。
所有原因和药物相关的住院和急诊使用情况与过度使用程度呈单调递增关系，尤其是使用一种以上药物的情况下。加巴喷丁持续过度使用使所有原因住院的几率增加 1.366 倍（95%置信区间 1.055-1.769），药物相关住院的几率增加 1.440 倍（95%置信区间 1.010-2.053），与精神状态改变（如欣快、焦虑）相关的住院和急诊的几率增加 1.864 倍（95%置信区间 1.324-2.624）。同时使用两种药物会使所有原因住院、药物相关住院和与精神状态改变或呼吸抑制相关的住院和急诊的几率增加 4 倍。
尽管加巴喷丁单独过度使用的影响较小，但加巴喷丁与阿片类药物联合过度使用可能会增加伤害和医疗服务使用的风险，这支持了将加巴喷丁在美国列为受控物质的呼吁。
