Evoy Kirk E, Sadrameli Sarvnaz, Contreras Jillian, Covvey Jordan R, Peckham Alyssa M, Morrison Megan D
College of Pharmacy, The University of Texas at Austin, 7703 Floyd Curl Dr., MC 6220, San Antonio, TX, 78229, USA.
School of Pharmacy, Duquesne University, 600 Forbes Avenue, 418D Mellon Hall, Pittsburgh, PA, 15282, USA.
Drugs. 2021 Jan;81(1):125-156. doi: 10.1007/s40265-020-01432-7.
A 2017 systematic review (SR) identified 59 studies examining gabapentinoid (pregabalin and gabapentin) misuse/abuse. Evidence of gabapentinoid misuse/abuse has since grown substantially.
Update previous SR and describe new insights regarding gabapentinoid abuse.
A SR of PubMed was conducted to identify studies published from 7/29/2016-8/31/2020. Four searches were performed using the following terms: "gabapentin [MeSH] OR pregabalin [MeSH] OR gabapentinoid" AND one of the following substance misuse/abuse-related terms: "substance-related disorders [MeSH]", "overdose", "abuse", or "misuse". Clinicaltrials.gov and the Cochrane Library database were searched to identify ongoing studies or similar SRs. Reference lists of included studies were reviewed to identify additional literature. All studies with novel data related to pregabalin and/or gabapentin abuse, misuse, or overdose conducted during the study period were included. Articles not written in English, review articles, and animal studies were excluded.
Fifty-five studies were included (29 [52.7%] from North America, 17 [30.9%] Europe, 6 [10.9%] Asia, and 3 [5.5%] Australia). Forty-six observational studies and 10 case reports/series were included (one manuscript included both). Twenty (36.4%) studied gabapentin only, 18 (32.7%) pregabalin only, and 17 (30.9%) both pregabalin/gabapentin. These studies corroborate findings from the previous SR that gabapentinoids are increasingly abused or misused to self-medicate, that gabapentinoids can produce desirable effects alone but are often used concomitantly with other drugs, and that opioid use disorder is the greatest risk factor for gabapentinoid abuse. While the original SR identified the largest studies having been published in Europe, this review identified several more generalisable US studies that have subsequently been conducted. The most concerning finding was increased evidence of associated patient harm, including increased hospital utilisation and opioid-related overdose mortality risk.
Evidence suggests that gabapentinoid misuse/abuse represents a growing trend that is causing significant patient harm. Prescribers should exercise appropriate caution with use in high-risk populations and monitor for signs of misuse or abuse.
2017年的一项系统评价（SR）纳入了59项研究，这些研究探讨了加巴喷丁类药物（普瑞巴林和加巴喷丁）的滥用情况。自那时起，加巴喷丁类药物滥用的证据大幅增加。
更新之前的系统评价，并描述有关加巴喷丁类药物滥用的新见解。
对PubMed进行系统评价，以识别2016年7月29日至2020年8月31日发表的研究。使用以下检索词进行了四次检索：“加巴喷丁[医学主题词]或普瑞巴林[医学主题词]或加巴喷丁类药物”以及以下与物质滥用相关的检索词之一：“物质相关障碍[医学主题词]”、“过量用药”、“滥用”或“误用”。检索Clinicaltrials.gov和Cochrane图书馆数据库，以识别正在进行的研究或类似的系统评价。对纳入研究的参考文献列表进行审查，以识别其他文献。纳入了研究期间进行的所有与普瑞巴林和/或加巴喷丁滥用、误用或过量用药相关的新数据的研究。排除非英文撰写的文章、综述文章和动物研究。
纳入了55项研究（29项[52.7%]来自北美，17项[30.9%]来自欧洲，6项[10.9%]来自亚洲，3项[5.5%]来自澳大利亚）。纳入了46项观察性研究和10项病例报告/系列研究（一篇手稿同时包含这两种类型）。20项研究（36.4%）仅研究加巴喷丁，18项研究（32.7%）仅研究普瑞巴林，17项研究（30.9%）同时研究普瑞巴林/加巴喷丁。这些研究证实了之前系统评价的结果，即加巴喷丁类药物越来越多地被滥用以进行自我治疗，加巴喷丁类药物单独使用时可产生预期效果，但通常与其他药物联合使用，并且阿片类物质使用障碍是加巴喷丁类药物滥用的最大风险因素。虽然最初的系统评价发现最大的研究发表在欧洲，但本次评价识别出了一些随后进行的更具普遍性的美国研究。最令人担忧的发现是与患者伤害相关的证据增加，包括医院利用率增加和阿片类物质相关的过量用药死亡风险增加。
有证据表明，加巴喷丁类药物的误用/滥用呈上升趋势，正在对患者造成重大伤害。处方医生在高危人群中使用时应适当谨慎，并监测误用或滥用的迹象。
