Singh Harpreet, Handa Richa, Kak Vivek, Wasilewski Alicja
Internal Medicine, Allegiance Health, Dexter, Michigan, USA
Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA.
Drug Ther Bull. 2019 Aug;57(8):125-127. doi: 10.1136/dtb.2019.228354rep.
The interactions between opioids and gabapentin are more clinically relevant than ever. Prescriptions dispensed for gabapentin increased from 39 million in 2012 to 64 million in 2018 in the USA and are ever increasing. Authors present a challenging case of these interactions. A 58-year-old man presented to the emergency department with acute respiratory failure and altered mental status. He was on high dose opioids and gabapentin as prescription medications. Despite full intensive care support and resolution of his respiratory failure with non-invasive positive pressure ventilation, the patient did not regain consciousness. After ruling out other causes, the diagnosis of gabapentin withdrawal was considered. Gabapentin was administered by a nasogastric tube that quickly resulted in a reversal of his symptoms. We concluded that severe gabapentin withdrawal should be considered in patients on higher doses of gabapentin when it is stopped abruptly. In such patients, gabapentin should be replaced. As most patients are unable to swallow in this situation and intravenous formulation is not available, nasogastric tube can be used for replacement.
阿片类药物与加巴喷丁之间的相互作用在临床上比以往任何时候都更具相关性。在美国，加巴喷丁的处方量从2012年的3900万增加到2018年的6400万，且仍在不断增加。作者介绍了一个关于这些相互作用的具有挑战性的病例。一名58岁男性因急性呼吸衰竭和精神状态改变被送往急诊科。他正在服用高剂量的阿片类药物和加巴喷丁作为处方药。尽管给予了全面的重症监护支持，且通过无创正压通气解决了他的呼吸衰竭问题，但患者仍未恢复意识。在排除其他原因后，考虑诊断为加巴喷丁戒断。通过鼻胃管给予加巴喷丁后，患者症状迅速得到缓解。我们得出结论，当高剂量加巴喷丁突然停药时，应考虑患者出现严重加巴喷丁戒断反应。对于此类患者，应更换加巴喷丁。由于大多数患者在这种情况下无法吞咽，且没有静脉制剂，可使用鼻胃管进行加巴喷丁的替代给药。
