Tambon Marine, Montarnal Berenice, Lepetit Marianne, Lapeyre-Mestre Maryse
Service de Pharmacologie médicale et clinique, CHU de Toulouse, Université de Toulouse, Toulouse, France.
Centre d'investigation clinique CIC 1436, Service de pharmacologie médicale et clinique, CHU de Toulouse, Université de Toulouse, Toulouse, France.
Expert Opin Drug Saf. 2023 Mar;22(3):183-194. doi: 10.1080/14740338.2023.2193397. Epub 2023 Mar 28.
Respiratory depression and opioid-related death are reported when opioids are associated with gabapentinoids. Meta-analyses of randomized clinical trials investigating efficacy and safety of such association failed to assess these risks because of the lack of data. The aim of this systematic review was to investigate the risk of respiratory depression or death during this combination in the scientific literature, including case reports or series, observational studies, and clinical trials.
PubMed®, Web of Science®, Embase®, and Google Scholar® were searched from their inception to December 2021, for original articles in English, French, and German. Data synthesis was done on a narrative approach by type of articles.
The review included 25 articles (4 case reports, 2 cross-sectional, 3 case-control, 14 cohort studies, and 2 clinical trials). Respiratory depression or opioid-related death and co-exposure to gabapentinoids were associated in perioperative setting/chronic pain (odds ratios around 1.3) and in opioid maintenance treatment (hazard ratio 3.4). These findings are in agreement with experimental studies showing that a single dose of gabapentinoid may reverse opioid respiratory tolerance. Because the combination gabapentinoids-opioids is highly prevalent in all clinical context, all health care professionals and patients must be aware of this risk.
据报道，阿片类药物与加巴喷丁类药物联用时会出现呼吸抑制和阿片类药物相关死亡。由于缺乏数据，对研究此类联合用药疗效和安全性的随机临床试验进行的荟萃分析未能评估这些风险。本系统评价的目的是在科学文献中，包括病例报告或系列、观察性研究和临床试验，调查这种联合用药期间呼吸抑制或死亡的风险。
检索了PubMed®、科学网®、Embase®和谷歌学术®自创建至2021年12月的英文、法文和德文原创文章。根据文章类型采用叙述性方法进行数据综合。
该评价纳入了25篇文章（4篇病例报告、2篇横断面研究、3篇病例对照研究、14篇队列研究和2篇临床试验）。在围手术期/慢性疼痛（比值比约为1.3）和阿片类药物维持治疗（风险比3.4）中，呼吸抑制或阿片类药物相关死亡与加巴喷丁类药物的共同暴露有关。这些发现与实验研究一致，实验研究表明单剂量加巴喷丁类药物可能会逆转阿片类药物的呼吸耐受性。由于加巴喷丁类药物与阿片类药物的联合在所有临床环境中都非常普遍，所有医护人员和患者都必须意识到这种风险。
