I-Neurontin inokusetyenziswa kakubi kakhulu kokusetyenziswa kakubi kunokuba kwakucatshangwe ngaphambili
Kwaphela iminyaka, oogqirha babecinga i-Neurontin (gapapentin) kunye neLyrica (pregabalin) njengeziyobisi ezingenakunokusetyenziswa kakubi. Nangona kunjalo, iqumrhu eliphandleyo lophando libonisa ukuba ezi ziyobisi zihlala zisetyenziswa kakubi kwaye zixhaphazwa.
Kwisifundo seMeyi 2017 esapapashwe kwi- Pharmacoepidemiology kunye noKhuselo lweMithi , i-Buttram kunye nabalobi bezobambisene baqulunqa indlela entsha ephazamisayo. Kukho ukunyuka kwe-Neurontin diversion, kwaye ukuphazamiseka kuhambelana nomkhuhlane we-opioid ochitha amaninzi amaninzi e-United States.
Abantu baphakama kwi-Neurontin kunye ne-opioids (umz., I-hydrocodone ne-oxycodone).
Ababhali benqaku lokufunda balandelayo oku:
Idatha efanelekileyo ibonisa ukuba i-Neurontin isetyenziswa kakubi ngokubambisana ne-opioids yesigxina kunye ne-Neurontin kunye ne-heroin zidibaniswa kwaye zixotshwe kunye. Ukunyanzeliswa komthetho kwabanyathelisi bafumene le ndlela yokusebenzisa iziyobisi ukufaka isandla kwi-Neurontin diversion.
Neurontin naseLyrica
Xa unyango lweengxelo ezibuhlungu ezingapheliyo kunye neempawu zokungahambi kakuhle, i-Neurontin neLyrica zikhethwe ngamachiza athile kunyango lokuqala. Ezi ziyobisi ziphumelela kakhulu ekuphatheni ubuhlungu obungapheliyo ngaphandle kwe-Advil okanye iTylenol. Ngaphezu koko, ukuxhomekeka kwe-opioid yi-bhubhane; Ngako oko, i-opioid efana neNorco okanye i-Vicodin isetyenziselwa kuphela ukunyanga ubuhlungu obukhulu. Ngamanye amazwi, i-Neurontin yomelele kunento onokuyifumana kwivenkile yezilwanyana kwaye unobungozi obuninzi kune-opioids.
(UHerin uhlobo lwe-opioid.)
Indlela i-Neurontin neLyrica esebenza ngayo
I-Neurontin yaqala ukuhlanganiswa ngowe-1977 njengesifaniso seGABA. Phantse kwiminyaka elishumi kamva, uLyrica, umzala wamakhemikhali waseNeurontin, waphuhliswa. I-Neurontin yavunywa yi-FDA ngo-1993. Ngo-2004, uLyrica wenza ukuthengisa.
I-Neurontin neLyrica zibizwa ngokuba yi- gabapentinoids kwaye zenza izinto ezifanayo.
Nangona bobabini bahlakulele ukulawula ukuxhatshazwa, ezi zi yobisi ziye zaqatshelwa njengentlungu ebenzileyo ye-neuromodulators kwaye ijwayele ukumiselwa ukunciphisa iintlobo ezahlukahlukeneyo zentlungu engapheliyo kwaye ingabonakali.
I-GABA, efutshane ne-gamma-aminobutyric acid, iyisifo se-neurotransmitter esivimbayo, esasasazwa kuyo yonke i-cortex ye-cerebral, okanye ingqimba yangaphandle yengqondo ejongene nomsebenzi ophezulu wengqondo. I-GABA idlala indima kwimisebenzi eyahlukeneyo yengqondo, kuquka ukulawulwa kwemoto kunye nombono kunye nokulawulwa kwexhala kunye nentlungu.
Nangona ekuqaleni kwakujoliswe ukuhamba i-GABA receptors kwingqondo, i-gabapentinoids ayibopheli kwi-GABA receptors. Ngaphezu koko, ababopheli kwi-receptor ye-cannabinoid, i-opioid, okanye i-benzodiazepine. Nangona umbane walezi yobisi awunakucaciswa ngokupheleleyo, kubonakala ukuba ezi zi yobisi zenza umxhatshazo kunye neziphumo zentlungu ngokubanzi. Nangona kunjalo, i-gabapentinoids iphela ekunyuseni i-GABA ukugxila kunye nokunciphisa i-glutamate concentrations engqondweni.
I-Neurontin neLyrica babelana ngeeprofayili ezifanayo zetekisi, zombini zixutywa yizintso kwaye azibandakanyeki nezinye iziyobisi (okt, umngcipheko omncinci wokusebenzisana kweziyobisi). Ukwahlukana okuphawulekayo phakathi kwezi zi yobisi kuyingozi yabo, okanye isixa semfuyo esenza ukuba sisasazwe.
Ngokukodwa, iLyrica ine-bioavailabilty ephezulu kunokuba i-Neurontin iphinde ixhamle kwaye ibe namandla. Lo mahluko uye wabangela ezinye iingcali ukuba zenze into yokuba uLyrica unakho ukusetyenziswa kakubi kweziyobisi, kunye neengxelo ze-anecdotal zixhasa le ngcamango. Nangona kunjalo, xa kuthathwa i-dosages ezaneleyo, zombini iziyobisi zikhawuleza ukusebenza kwaye zisebenza kakuhle, kwaye zombini zixhaphazwa kwaye zisebenzise kakubi.
Ukusetyenziswa kwezonyango ze-Neurontin kunye neLyrica
I-gabapentinoids zifana nomnye kwiziphumo zonyango.
Iipilisi ze-Neurontin, iipsulules, kunye nezisombululo zomlomo zivunyiwe yi-FDA ukuya (1) ukuphatha ukutshatyalaliswa okukodwa kunye (2) nokuphatha i-neuralgia ye-post-herpetic, okanye i-shingles.
EYurophu, i-Neurontin ivunyiwe ukuba yonyango lwentlungu e-neuropathic.
I-Lyrica ivunyiwe yi-FDA ukunyanga (1) i-neuralgia ye-post-herpetic, (2) ye-diabetes peripheral neuropathy, (3) i-fibromyalgia, kunye (4) nokuthintela. EYurophu naseJapane, uLyrica uvunyiwe ukuphatha intlungu ye-neuropathic kunye nesifo sokukhathazeka ngokubanzi.
I-Neurontin ayithathwa njengento elawulwa nguRhulumente wase-US, kwaye isichengiselwano sinokuphepha kunezinye i-anticonvulsants. Le projekthi yokukhusela ekhuselekileyo ikhuphe ukusebenzisa i-label ye-Neurontin naphezu kokuxhamla kwezilingo zamachiza ukuxhasa ukusetyenziswa okunjalo.
Phakathi kwama-83 ekhulwini kunye nama-95 ekhulwini le-Neurontin yokuthengisa ngaphandle kwelebuli. Nazi ezinye zokusetyenziswa kweleyile ze-Neurontin:
- Utywala, i-benzodiazepine, i-marijuana, kunye ne-opioid syndrome
- Ukukhathazeka kweengxaki
- Ukuxhuzula
- Inkqubo yesifo seengxaki zengingqi
- I-diabetes neuropathy
- Ukutshisa okushisayo
- Intloko ye-Migraine
- I-peripheral neuropathy
- Ingxaki yokuhamba kwentsholongwane yexesha lokuhamba
- Imilenze yesifo esingenasiphelo
- I-neuralgia yamaTrigeminal
Nangona i-DEA ibeka iLyrica njengeShedyuli V, isichaza ubuninzi bokusetyenziswa kakubi, kusekhona into elawulwayo. Le nyaniso inxulumene nenyaniso yokuba uLyrica iyabiza ngakumbi kunokuba i-Neurontin icacisa ukuba kutheni i-Neurontin ibanzi kakhulu.
Ekugqibeleni, oogqirha abaninzi baya kunika uNeurontin esikhundleni seLyrica kuba i-Neurontin ishibhile. I-Lyrica yonyango elibi kakhulu. Ngenxa yokuba zombini imichiza ineempembelelo ezifanayo, kunengqiqo ukuhamba kunye nenketho ephantsi.
Ukuxhatshazwa kwe-Neurontin
Ukusetyenziswa kakubi kweziyobisi kunye nokusetyenziswa kakubi kweziyobisi zizinto ezifaniyo, kwaye umehluko usezinjongo.
Ngokutsho kwe-FDA: "Xa umntu ethatha imithi yonyango yomthetho ngenjongo ngaphandle kwesizathu sokuba imiselweyo, okanye xa loo mntu ethatha isicatshulwa engazange simiselwe yona, kukusetyenziswa kakubi kweziyobisi."
Ukusetyenziswa kakubi kweziyobisi yindlela ekhethekileyo yokusetyenziswa kakubi kweziyobisi. Kwenzeka xa abantu bethatha iziyobisi ukuze bafumane "ukuphakama," okanye amava evakalelo. Ngokubhekiselele kuNeurontin naseLyrica, le ntetho ichazwe ngeendlela ezahlukeneyo kwaye ikhumbuza imiphumo ye-opioids, i-benzodiazepines, kunye ne-psychedelics.
Uninzi lwamagqirha luchaza i-Neurontin kuzo zonke iintlobo zezinto, kuquka intlungu, izimo zengqondo, kunye neengxaki zokusetyenziswa kweziyobisi; Uninzi lwala magqirha mhlawumbi aluqapheli ukuba leziyobisi ziyakunokusetyenziswa kakubi. Ngenxa yokuba ixhaphake kakhulu ngokubanzi, kwaye ixabiso elincinci kwaye kulula ukuyibeka ngaphezu kweLyrica-eyinto elawulwayo-i-Neurontin ibe yinto exhaphakileyo yokusetyenziswa gadalala ngabantu abafuna ukuphakama kwayo ngokukhawuleza. Ukongezelela, abantu abaneengxaki zokusetyenziswa kweziyobisi kunye nokugula ngengqondo banokusetyenziswa kakubi kwezi zi yobisi. Ngamanye amazwi, i-Neurontin ivame ukunyulwa kubantu ababonisa ukusetyenziswa kakubi kwexesha lokusetyenziswa kakubi.
Akunabo bonke abantu abasebenzisa kakubi i-Neurontin-kwaye kaninzi ngeLyrica-banemiyalelo yale myeza. Ukuchithwa ibhizinisi elikhulu kubathengisi beziyobisi, kwaye ngokuqinisekileyo ezi zi yobisi zenza indlela yezitalato. Kuphela phakathi kwama-40 ekhulwini kunye nama-65 ekhulwini abantu abasebenzisa kakubi kunye nokuxhaphazwa kwe-Neurontin banemimiselo yeziyobisi.
Ingxelo ka-2012 iqikelele ukuba imithi yeLyrica neNeurontin yanda ngamaphesenti angama-350 kunye nama-150 ekhulwini, ngokulandelanayo, kwiminyaka emihlanu edlulileyo.
Ingqalelo, abanye abantu abaye bamiselwe i-Neurontin bamane basebenzise kakubi izilwanyana kwisilingo sokuzithobela iimpawu. Abanye abantu baphinde basebenzise kakubi isibisi njengendlela yokuzilimaza. Ngaphezu koko, abantu basebenzisa kakubi iilisi ngelixa bexhaphaza ezinye izinto, njenge-opioids, utshwala, kunye ne-benzodiazepines.
Ngo-2010, uphando lwaqala lubonakalisa umngcipheko wokusetyenziswa kakubi kweLyrica. Emva koko, iYurophu YaseYurophu yongezelela le nkunkuma kwiluhlu lwayo lwezinto zokuzonwabisa eziphuculisayo. Phakathi ko-2010 kunye no-2016, malunga nobuninzi beephando ezimbini baye bahlola ukusetyenziswa kakubi kwe-Neurontin naseLyrica.
Nazi ezinye iinkcukacha ezithile ezihambelana nokusetyenziswa kakubi kwe-Neurontin naseLyrica kunye nokusetyenziswa kakubi. Ezi ziphumo zifumene kwizifundo zakutshanje.
- Olunye uphando lubonisa ukuba ukusetyenziswa kakubi kwe-Neurontin kunye neLyrica phakathi kwabantu abahlala e-UK abaneminyaka eliphakathi kwe-16 no-59 ubudala yimpesenti ye-1.1 kunye ne-0.5 ekhulwini, ngokulandelana. Ngokolu cwaningo, izinga lokusetyenziswa kakubi kwe-cannabis lingama-28.1 ekhulwini kunye nokusetyenziswa kakubi kwe-cocaine ngamaphesenti angu-8.1. Ngamanye amagama, kubantu abangenayo ingxaki yokusetyenziswa kweziyobisi okanye izifo zengqondo, iirhafu ze-gabapentinoid zonyango ziphantsi kunezo ezinye izidakamizwa zendabuko.
- Phakathi kwabantu abaneengxaki ze-opioid, iirhafu ze-Neurontin zisebenzise kakubi ziphakathi kwe-15 neepesenti ezingama-22. Nangona, isantya seLyrica esisebenzise kakubi phakathi kwamalungu alinganayo sahlula ngokubanzi: phakathi kwama-3 ekhulwini kunye nama-68 ekhulwini. Ngokubanzi, abantu abaneengxaki zokusetyenziswa kweziyobisi babonakala bexhaphaza i-gabapentinoids kumazinga afana namanye amayeza endabuko.
- Phakathi kwabakwaMerika abasebenzisa kakubi i-opioids, izinga lokusetyenziswa kakubi kwe-Neurontin laliphindwe kabini le-amphetamine kunye nokulingana ne-clonazepam (uhlobo lwe-benzodiazepine) kakubi.
- EScotland, iipesenti ezingama-22 zabantu abaya kwiiklinikhi ze-methadone zasebenzisa kakubi i-Neurontin.
- Ucwaningo luka-2015 lubonise ukusetyenziswa kakubi kwe-Neurontin ngokunyuka ngokukhawuleza. Ngokukodwa, bekukho ukwanda kweepesenti ezingama-2950 kokusetyenziswa kakubi ku-2008.
- I-National-utilization usetyenziso lweziyobisi zibonisa ukuba uLyrica unqunywe kwii-dose eziphezulu kunokuba zinconywe, ezinokubangela ukusetyenziswa kakubi.
- Ezinye iingcamango zibonisa ukuba abo baphatha kakubi i-gabapentinoids bavame ukuba ngabafana abesilisa (30-ish) kunye ne-income-income. Nangona kunjalo, iinkcukacha malunga nokusetyenziswa kwezesini kunye nokusetyenziswa kakubi ziphikisana.
- Ngokusekelwe kwimeko yengxelo yenkcazelo "esetyenziswe kwiphononongo yenyanga ye-drug adress
igqitywe ngumzekelo wesistim wokunyanzeliswa komthetho kunye nee-arhente zolawulo ezibandakanyeka kuphando lokuphambanisa izidakamizwa, "I-Buttram kunye nabalingane bafumene ukuba amazinga okunciphisa aphakanyisiwe avela kwiimeko zero kwikota yokuqala yokuqala ka-2002 ukuya kumaqela angama-0.027 ngabantu abayi-100,000 ekugqibeleni ngekota ka-2015. - Ukuchithwa kwe-Neurontin kubonakala kuqhelekileyo kwiintolongo zase-US.
Iimpembelelo Eminye Kunomdla
Ukongeza kwi-excited, abantu abasebenzisa kakubi i-gabapentinoids kwi-supratherapeutic, okanye ngaphezulu kuneendlela ezinconywayo, baphinde bachaze ezinye iziphumo eziquka oku kulandelayo:
- Qiniseka
- Ukuphumla
- Dissociation
- Ukuphuculwa kwentlalo
- Uvelwano
- Ukuziphatha okungenakuvinjelwa
- Iimvalo ezibonakalayo nezibonwayo
Ingqalelo, le miphumo ibonakala ihluka ngohlobo lokunyamezela kunye neqondo. Ukongezelela, ukuyeka ngokukhawuleza kwe-gabapentinoids kunokubangela ukuhoxisa ukuxhomekeka kokuxhomekeke emzimbeni. Ukongezelela, abantu abahoxayo kwi-gabapentinoids nabo banokukwazi ukukhupha ingqondo.
Ingozi yeGabapentinoid Overdose
Xa zisetyenziswe njengoko kuchaziwe, i-Neurontin neLyrica zikhuselekile kakhulu. Iimiphumo ezimbi ziba nobubele kwaye ziquka ukulala, ukungabikho komzimba, i-ataxia, utywala kunye nokukhathala.
Ngokungafani nezinye iziyobisi zokusetyenziswa gadalala, nangona xa kuninzi, i-gabapentinoids isenza nje iziphumo ezintle, ezifana nokunyuka kwengcinezelo yegazi, ukunyuka kwezinga lentliziyo, kunye nezinye iziphumo ezimbi ezifana nezo zibonwe kwizifo zokwelapha. I-gabapentinoid overdose ngokuqhelekileyo ayifuni ukulaliswa esibhedlele kwaye akukho ukufa okubangelwa ukugqithisa. Abantu abagqithiseleyo bavame ukubuyela kwisiseko emva kweeyure ezili-10 zokungenisa.
Indima Abadokotela Abadlalayo
Kuya kuba lula kakhulu ukubeka ityala lokusetyenziswa kakubi kwe-gabapentinoid, ukusetyenziswa kakubi, kunye nokuxhomekeka kwinqanaba lokumisela oogqirha. Ngokuqinisekileyo, la mayeza ayimithi-kuphela kwaye ngaloo ndlela unako ukulandelwa kumagqirha ngokwawo; Nangona kunjalo, kufuneka siqonde isimo esingenakukhutshwa ngababoneleli abakhona xa isigulane sikhalazela intlungu enzima kunye nentlungu engenazo iintlungu ezingapheliyo.
Ngokomzekelo, ziqhelekileyo kwizigulane ezine-neuropathic kunye nezinye iintlobo zentlungu engapheliyo kunye nokukhathazeka ukuva ubunzima obuya kumothusa umntu ngaphandle kweemeko. Xa umntu engena kwiofisi yelokuba ekhononda ngokutshisa emiphelweni yazo, iimvakalelo zokuhamba "ngeglasi" kunye nokunye, oogqirha abananto encinci yokuphatha le mpawu eyoyikekayo, kwaye i-Neurontin okanye iLyrica yiyo kuphela yindlela efanelekileyo yokukhetha.
Oogqirha kufuneka bajonge imiqondiso yokuba isigulane sisisebenzisa kakubi okanye sisebenzisa kakubi la machiza okanye siceba ukubandakanya ukuphazamiseka kuquka oku kulandelayo:
- Izigulane ezineengxaki zokugula ngengqondo okanye ukusetyenziswa kwezidakamizwa kufuneka zijongwe ngokukhawuleza ukusetyenziswa kakubi okanye ukuphazamiseka.
- Izibonakaliso zokuhlukunyezwa zibandakanya isigulane sifuna i-Neurontin okanye i-Lyrica ngokukodwa, malunga neendleko eziphezulu kunokuba zimiselwe, okanye imimiselo emininzi ngexesha elifutshane.
- Oogqirha kufuneka baqinisekise ukuba izigulane azinjalo "zithengisa ugqirha" okanye zifumana imimiselo emininzi evela kubaboneleli abaninzi. Isizathu esiqhelekileyo sokuziphatha oko kukuba izidakamizwa "zalahleka" okanye "zibiwe."
- Ugqirha kufuneka acinge ukuba enze isikrini se-urine (UDS) kwizigulana ezikhankanywe ngokuphambuka. Ukuba ezi zi gulane zifumana imiyalelo ye-gabapentinoids kodwa ezi ziyobisi azifumaneki kumchamo, ke ezi ziyobisi zenzelwe izitalato.
ILizwi
Nangona ekunyuseni, ukusetyenziswa kakubi kwe-Neurontin neLyrica kusasaza nje kuphela kwincinci yezigulane, kwaye ngokukodwa abo baxhatshazwa kakubi, njengabantu abanexhomekeke kwi-opioid. Ngaphezu koko, nakwiimeko zokudlula ngaphezulu, iziphumo zala mayeza aqhelekileyo kwaye aphelile-ukukhala ngokukhawuleza kwiimpembelelo ze-opioid, utywala kunye ne-benzodiazepine kuxhomekeka (iimeko eziqhelekileyo zisetyenziselwa ukunyanga).
Ukuba wena okanye othandekayo uthabatha la mayeza ngenxa yentlungu engapheliyo okanye engaxhamliyo, kwaye ezi ziyobisi zibonelela ukukhulula, ke ezi nkunkuma zisetyenziselwa njengoko zenzelwe. Nangona kunjalo, ukunciphisa umngcipheko wokusetyenziswa kakubi, kubalulekile ukuba uhlolwe ngokugqithiseleyo ngugqirha wakho kwaye uthathe la mayeza kuphela kwii-dosages ezicetywayo. Ukuqonda indlela abasebenza ngayo kunokunceda. Kwakhona, ungathathi la mayeza ukuba "uphakame," ungaxubeki la mayeza kunye notywala, i-benzodiazepines, i-opioids, okanye ezinye iziyobisi zokusetyenziswa kakubi, kwaye unganiki okanye uthengise la mayeza kwabanye.
Ukuba nonke unemibuzo malunga neyeza lokunyanga oza kuthatha-ingakumbi imichiza kunye nokusetyenziswa kakubi-nceda ucele ugqirha wakho. Ugqirha wakho angathatha ixesha lokuxoxa ngeengozi kunye neenzuzo zaliphi na amayeza oyalelwe. Ukongezelela, unokuzibuza nekhemistiki yakho malunga namayeza enqunywe ngawo. Njengesigulane, unelungelo lokukwaziswa ngamachiza owathathayo.
> Imithombo:
> Ukulwa nokusetyenziswa kakubi kunye nokusetyenziswa kakubi kweziyobisi ezibhalwe ngokuchanekileyo: I-Q & A kunye noMichael Klein, Ph.D. Julayi 28, 2010. www.fda.gov.
> Evoy KE, Morrison MD kunye neSaklad SR. "Ukusetyenziswa kakubi nokusetyenziswa kakubi kwe-Pregabalin neGabapentin." Iziyobisi . 2016.
> I-Mack A. Ukuhlolwa koBungqina bokusetyenziswa kweTayibhile yeGabapentin. Umbhalo we-Managed Care Pharmacy . 2003; 9: 559-568.
> Smith RV, Havens JR, noWalsh SL. "Gabapentin kakubi, ukuphathwa kakubi kunye nokuphambuka: ukuphononongwa ngokufanelekileyo." 2016; 111: 1160-1174.
> ITcheremissine, i-OV kunye ne-Bestha DP. I-Gabapentin Ukusetyenziswa kakubi kwiMonde kunye ne-Comorbid Mood kunye ne-Disorders Use of Disorders. Ukulungiswa kweeNzululwazi zeCliniki . 2016; 13: 13-14.