Caniff Kaylee, Telega Emily, Bostwick Jolene R, Gardner Kristen N
University of Michigan College of Pharmacy, Ann Arbor, MI.
Department of Clinical Pharmacy, University of Mchigan College of Pharmacy, Ann Arbor, MI.
Am J Health Syst Pharm. 2018 Jan 15;75(2):67-71. doi: 10.2146/ajhp160712.
The available evidence for the use of pregabalin as adjunctive therapy in the discontinuation of benzodiazepines is reviewed.
Pregabalin has been studied as an adjunctive pharmacologic treatment for the discontinuation of long-term benzodiazepine use. Unlike carbamazepine, pregabalin has little potential for drug interactions, and its adverse effects are mostly mild and transient. Pregabalin reduces the release of excitatory neurotransmitters by binding to regulatory subunits of voltage-activated calcium channels. The majority of studies evaluated failed to find a significant difference in benzodiazepine discontinuation rates between pregabalin and comparator groups. The long-term efficacy of pregabalin in benzodiazepine discontinuation is also unknown, as patients were only followed for 0-12 weeks after discontinuing the benzodiazepines. Most studies, however, did observe consistent improvement in withdrawal symptoms, anxiety symptoms, and cognitive function with pregabalin use in benzodiazepine discontinuation. Studies varied in design elements, such as whether past benzodiazepine discontinuation attempts occurred, baseline benzodiazepine use characteristics (agent, dose, duration), benzodiazepine discontinuation strategies previously used, and the use of comorbid psychiatric diagnoses and concurrent psychotropics as exclusion criteria. In addition, the literature does not clearly describe whether patients successfully discontinued pregabalin, for which there are reports of substance abuse.
Based on the current available evidence, pregabalin is not recommended for use in benzodiazepine discontinuation, as the majority of studies did not find a significant difference in benzodiazepine discontinuation rates between pregabalin and comparatory groups despite an improvement in withdrawal and anxiety symptoms.
综述普瑞巴林作为辅助治疗用于停用苯二氮䓬类药物的现有证据。
普瑞巴林已被研究作为辅助药物治疗用于停用长期使用的苯二氮䓬类药物。与卡马西平不同，普瑞巴林几乎没有药物相互作用的可能性，其不良反应大多轻微且短暂。普瑞巴林通过与电压激活钙通道的调节亚基结合来减少兴奋性神经递质的释放。大多数评估研究未能发现普瑞巴林组与对照组在苯二氮䓬类药物停药率上有显著差异。普瑞巴林在停用苯二氮䓬类药物方面的长期疗效也未知，因为患者在停用苯二氮䓬类药物后仅随访了0至12周。然而，大多数研究确实观察到在停用苯二氮䓬类药物时使用普瑞巴林，戒断症状、焦虑症状和认知功能有持续改善。研究在设计要素上各不相同，例如既往是否有停用苯二氮䓬类药物的尝试、基线苯二氮䓬类药物使用特征（药物、剂量、持续时间）、先前使用的苯二氮䓬类药物停药策略，以及是否将合并的精神疾病诊断和同时使用的精神药物作为排除标准。此外，文献并未明确描述患者是否成功停用普瑞巴林，有关于药物滥用的报道。
基于目前可得的证据，不推荐使用普瑞巴林来停用苯二氮䓬类药物，因为尽管戒断和焦虑症状有所改善，但大多数研究并未发现普瑞巴林组与对照组在苯二氮䓬类药物停药率上有显著差异。
