Mioclonías positivas y negativas en paciente con enfermedad renal crónica / Positive and negative myoclonus in a patient with end stage renal disease

Introducción: Las mioclonías son contracciones musculares paroxísticas de corta duración o pérdida abrupta del tono muscular, denominadas mioclonías positivas y negativas, respectivamente. Se presenta un caso clínico de mioclonías positivas y negativas generalizadas y se pretende describir los múltiples mecanismos fisiopatológicos y etiologías que lo desencadenan. Presentación del caso: Hombre de 35 años, con diabetes mellitus tipo 1 complicada con enfermedad renal diabética en hemodiálisis, desarrolló una bacteriemia asociada a catéter por Staphylococcus aureus y presentó mioclonías positivas y negativas. Se identificaron como posibles desencadenantes la uremia, la infección y los fármacos con potencial promioclónico; el hallazgo incidental de una lesión isquémica en núcleo caudado no explicaba la semiología encontrada en el paciente. Se hizo el control y retiro de todos los factores promioclónicos enunciados, junto a manejo farmacológico con levetiracetam, y con ello se logró el control de los síntomas. Discusión: Los pacientes con enfermedad renal crónica son susceptibles a la acumulación de productos tóxicos de tipo guanidinas, que tienen potencial para producir mioclonías. Además, las infecciones, el uso de fármacos con potencial promioclónico y lesiones estructurales como las isquemias corticales son etiologías que deben considerarse en el diagnóstico diferencial. El mayor impacto en los síntomas se observa con el control del factor desencadenante, y, en caso de persistir, la terapia farmacológica proporciona buenos resultados. Conclusión: Las mioclonías son trastornos del movimiento relativamente comunes en la enfermedad renal crónica. La identificación del desencadenante es crucial para su manejo junto al uso de fármacos con actividad antimioclónica.

Introduction: Myoclonus are paroxysmal muscle contractions of short duration or abrupt loss of muscle tone, called positive and negative myoclonus respectively. A clinical case of generalized positive and negative myoclonus is presented and the aim is to describe the multiple pathophysiological mechanisms and etiologies that trigger it. Case presentation: A 35-year-old man with type 1 diabetes mellitus complicated by diabetic kidney disease on hemodialysis developed catheter-associated bacteremia due to Staphylococcus aureus and presented positive and negative myoclonus. Uremia, infection, and drugs with pro-myoclonic potential were identified as possible triggers; The incidental finding of an ischemic lesion in the caudate nucleus did not explain the semiology found in the patient. The control and removal of all the pro-myoclonic factors mentioned was carried out, along with pharmacological management with levetiracetam, thus achieving control of the symptoms. Discussion: Patients with chronic kidney disease are susceptible to the accumulation of guanidine-type toxic products, which have the potential to produce myoclonus. Furthermore, infections, the use of drugs with pro-myoclonic potential and structural lesions such as cortical ischemia are etiologies that should be considered in the differential diagnosis. The greatest impact on symptoms is observed with the control of the triggering factor and if it persists, pharmacological therapy provides good results. Conclusion: Myoclonus are relatively common movement disorders in chronic kidney disease. Identification of the trigger is crucial for its management along with the use of drugs with anti-myoclonic activity.

Pregabalin and gabapentin for chronic low back pain without radiculopathy: a systematic review / Pregabalina e gabapentina para dor lombar crônica sem radiculopatia: uma revisão sistemática

Abstract Background Chronic low back pain (CLBP) is a global health problem, and gabapentin and pregabalin are often used in the treatment of patients without associated radiculopathy or neuropathy. Therefore, determining their efficacy and safety is of enormous value. Objective To examine the efficacy and safety of using gabapentin and pregabalin for CLBP without radiculopathy or neuropathy. Methods We performed a search on the CENTRAL, MEDLINE, EMBASE, LILACS, and Web of Science data bases for clinical trials, cohorts, and case-control studies that evaluated patients with CLBP without radiculopathy or neuropathy for at least eight weeks. The data were extracted and inserted into a previously-prepared Microsoft Excel spreadsheet; the outcomes were evaluated using the Cochrane RoB 2 tool, and the quality of evidence, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results Of the 2,230 articles identified, only 5 were included, totaling 242 participants. In them, pregabalin was slightly less efficacious than amitriptyline, the combination of tramadol/acetaminophen, and celecoxib, and pregabalin added to celecoxib showed no benefit when compared to celecoxib alone (very low evidence for all). On the other hand, although one study with gabapentin did not support its use in a general sample of patients with low back pain, another found a reduction in the pain scale and improved mobility (moderate evidence). No serious adverse events were observed in any of the studies. Conclusion Quality information to support the use of pregabalin or gabapentin in the treatment of CLBP without radiculopathy or neuropathy is lacking, although results may suggest gabapentin as a viable option. More data is needed to fill this current gap in knowledge.

Resumo Antecedentes Dor lombar crônica (DLC) é um problema de saúde global, e a gabapentina e a pregabalina são frequentemente utilizadas no tratamento de pacientes sem radiculopatia ou neuropatia associada. Por isso, determinar sua eficácia e segurança é de enorme valor. Objetivo Examinar a eficácia e segurança do uso de gabapentina e pregabalina no tratamento da DLC sem radiculopatia ou neuropatia. Métodos Realizamos uma pesquisa nas bases de dados CENTRAL, MEDLINE, EMBASE, LILACS e Web of Science por ensaios clínicos, coortes e estudos de caso e controle que avaliassem pacientes com DLC sem radiculopatia ou neuropatia por pelo menos oito semanas. Os dados foram extraídos e inseridos em uma planilha previamente elaborada no programa Microsoft Excel; os desfechos foram avaliados com a ferramenta RoB 2 tool da Cochrane, e a qualidade das evidências, pelo sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados Dos 2.230 artigos identificados, apenas 5 foram incluídos, com um total de 242 participantes. Neles, a pregabalina foi ligeiramente menos eficaz do que a amitriptilina, a combinação de tramadol/acetaminofeno, e o celecoxibe, assim como a pregabalina adicionada ao celecoxibe não mostrou benefício em comparação ao uso isolado de celecoxibe (evidência muito baixa para todos). Quanto à gabapentina, embora um estudo não respalde seu uso para uma amostra geral de pacientes com lombalgia, outro encontrou redução na escala de dor e melhora da mobilidade (evidência moderada). Nenhum evento adverso grave foi observado nos estudos. Conclusão Há carência de informações de qualidade que sustentem o uso de pregabalina ou gabapentina no tratamento da DLC sem radiculopatia ou neuropatia, embora resultados possam sugerir que a gabapentina é uma opção viável. Mais dados são necessários para preencher essa atual lacuna no conhecimento.

Evaluation of anxiolytic effect of combination of tramadol with gabapentin and pregabalin in Wistar rats

Background: Anxiety is a widespread disorder that approximately 18% of the population experience at some stage in their lives. Pain is a common stimulus that induces anxiety in both animals and human beings. Combination of drugs with good anti-anxiety and analgesic effect can be used for the treatment of chronic pain induced anxiety, post-operative, and procedure-related pain-induced anxiety. Aims and Objectives: The study was conducted to evaluate the anxiolytic activity of combination of gabapentin with tramadol, pregabalin with tramadol compared to standard fluoxetine, in elevated plus maze (EPM) and light-dark arena (LDA) models of anxiety in Wistar albino rats. Materials and Methods: Twenty-four male or female albino Wistar rats from Central Animal House, MRMC, Kalaburagi, were utilized. Fluoxetine 10 mg/kg, gabapentin 30 mg/kg, tramadol 30 mg/kg, and pregabalin 30 mg/kg were used. Eddy’s hot plate method used for inducing anxiety. EPM and LDA models were used to study the effect of drugs in reducing the pain and anxiety. Results: The present study showed that the exposure to hot plate induces pain, creates anxiety, and reduces locomotor and explorative activity among the rats when exposed to hot plate. There was reduction in anxiety after drug administration, in fluoxetine and gabapentin with tramadol groups with >75% increase in entry into the light chamber or open arm at least once or more during the time period of 5 min when compared to hot plate post-exposure readings. Whereas in pregabalin and tramadol group, it was observed that 25% increase in entry of rats into open arm at least once during the time period of 5 min and 25% decrease in entry of rats into light chamber as compared to those rats after exposure to hot plate. Conclusion: Our study has demonstrated that tramadol, pregabalin, and gabapentin have got analgesic as well as anti-anxiety effects in rats when given in combination. All these experimental data, together with the previous experimental studies and the results reported in this work, suggest that combination of these drugs could be more effective in treating anxiety-related disorders such as chronic pain, pain-induced anxiety, post-operative, and procedure-related pain-induced anxiety with minimal side effects. Further dose ranging studies and models might be necessary to better understand the effects of these drugs in combination.

A comparative study on efficacy and safety of tablet duloxetine 60 mg and tablet gabapentin 300 mg among patients with diabetic polyneuropathy – A randomized double-blind study

Background: Diabetic peripheral neuropathy is defined as the presence of symptoms and signs of peripheral nerve damage among patients with diabetes, after ruling out other potential causes. Diabetic neuropathies are one among the most common long-term complications of diabetes. About 60% of diabetic patients are affected by neuropathy. Aim and Objectives: This study aims to study the efficacy and safety of tablet duloxetine 60 mg and tablet gabapentin 300 mg among patients with diabetic polyneuropathy. Materials and Methods: This study was randomized, comparative, double-blind parallel group study which was conducted for a period of 6 months. Sixty patients with diabetic polyneuropathic pain were randomly allocated into two groups. One group received duloxetine 60 mg and other group received gabapentin 300 mg. Efficacy was assessed using visual analog scale (VAS), short form of McGill pain questionnaire, and patients global impression of change score. Safety was assessed using adverse drug reaction profile. Results: In the duloxetine group, the mean VAS score at the baseline was 54.97 ± 6.75, and at 3 months, it was 20.07 ± 5.32 which was statistically significant. In the gabapentin group, the mean score at baseline was 53.57 ± 7.85, and at 3 months, it was 26.57 ± 4.39 which was also statistically significant. The difference between the baseline and 3rd month mean McGill score in both groups was statistically significant. Conclusions: We found that both duloxetine 60 mg once daily and gabapentin 300 mg once daily are effective in the treatment of diabetic polyneuropathic pain. However, duloxetine 60 mg once daily is more efficacious than gabapentin 300 mg once daily in the treatment of diabetic neuropathic pain. Both the drugs are well tolerated but gabapentin is better tolerated than duloxetine.

A Comparative Study to Analyze the Effect of Gabapentin with Amitriptyline Versus Pregabalin with Amitriptyline in Neuropathic Pain in Cancer Patients Undergoing Palliative Care

Introduction: Antiepileptics and antidepressant medications are known for managing neuropathic pain. We aim to compare the effects of pregabalin with low‑dose amitriptyline and gabapentin with low‑dose amitriptyline in managing neuropathic pain in cancer patients undergoing palliative care. Materials and Methods: We conducted our study on 160 cancer patients who were having neuropathic pain and were undergoingpalliative care treatment in our institute. It was a hospital‑based, randomized, tertiary cancer center‑based observational study. After taking approval from the institutional ethics committee and taking written informed consent from patients, the patients were divided into two groups and the effect of medicines on incidence of neuropathic pain was observed; the incidence of burning sensation and the incidence of adverse effects of medications were also analyzed. Statistical analysis was done using paired t‑test and SPSS version 20 software. Results: The onset of relief in pain was earlier in the pregabalin group as compared to the gabapentin group. There was more reduction in a burning sensation in the pregabalin group as compared to the gabapentin group. The incidence of headaches was the same in both groups. Nausea and vomiting were more in the pregabalin group but the overall difference in adverse effects was not statistically significant (P > 0.05) Conclusions: In the management of neuropathic pain in cancer patients who are undergoing palliative care, a combination of pregabalin with amitriptyline was found to be more effective in pain relief than gabapentin with amitriptyline.

Comparison of efficacy of Gabapentin versus Pregabalin in patients of painful diabetic peripheral neuropathy – A randomized, open label, and parallel group study

Background: Diabetes is a form of chronic illness requiring a collective treatment approach such as glycemic monitoring, self-management, education, and adequate support to prevent the occurrence of acute complications. One of the most frequently occurring complication in Type 2 diabetes has been diabetic peripheral neuropathy (DPN) or distal symmetrical polyneuropathy. Newer anticonvulsants such as Gabapentin and Pregabalin have been proven beneficial in patients with peripheral neuropathic pain. Aims and Objectives: The aim of the study was to compare the efficacy of Gabapentin and Pregabalin in relieving the pain in patients of DPN. Materials and Methods: This is an open label, randomized, multi-dose, two treatment, single-period, single-center, parallel study comparing Gabapentin and Pregabalin for efficacy in patients suffering with DPN using visual analog scale, daily sleep interference score, patient’s global impression of change, and clinician’s global impression of change. Results: One hundred patients were randomized into two groups and the treatment started as and when they reported to the hospital. Statistical analysis was done in SPSS version 23 and intent to treat principle is employed for analysis. Results were distributed in demographics and treatment comparison. Decreased sleep interference and global impression of change reported during first visit, in which participants under Pregabalin group had better improvement score comparing Gabapentin group alone was found statistically significant (P < 0.05). Conclusion: Our study revealed that Pregabalin is found to be more efficacious when compared to Gabapentin among Type 2 diabetes mellitus patients with painful peripheral neuropathy. Hence, we conclude that Pregabalin provided significant improvement in pain relief and other perspectives.

Efficacy of opioids and non-opioid analgesics in the treatment of post procedure pain of burned patients: a narrative review

Abstract Introduction Burns are a common trauma that cause acute severe pain in up to 80% of patients. The objective of this narrative review is to evaluate the efficacy of opioids, non-steroidal anti-inflammatory drugs, paracetamol, gabapentinoids, ketamine, and lidocaine in the treatment of acute pain in burn victims. Methodology The databases explored were PubMed, Embase, ClinicalTrials, and OpenGrey. The included randomized, controlled clinical trials assessed the analgesic efficacy of these drugs on hospitalized patients, had no age limit, patients were in the acute phase of the burn injury and were compared to placebo or other analgesic drugs. Studies describing deep sedation, chronic opioid use, chronic pain, and patients taken to reconstructive surgeries were excluded. The Jadad scale was used to evaluate quality. Results Six randomized controlled clinical trials (397 patients) that evaluated the analgesic efficacy of fentanyl (n = 2), nalbuphine (n = 1), ketamine (n = 1), gabapentin (n = 1), and lidocaine (n = 1) to treat post-procedural pain were included. Fentanyl, nalbuphine, and ketamine were effective, while lidocaine was associated with a slight increase in reported pain and gabapentin showed no significant differences. Two studies were of high quality, one was of medium high quality, and three were of low quality. No studies on the efficacy of NSAIDs or paracetamol were found. Conclusion Evidence of efficacy is very limited. Fentanyl, nalbuphine, and ketamine seem to be effective for controlling acute pain in burn patients, whereas gabapentin and lidocaine did not show any efficacy.

Preoperative Anxiety Among Cardiac Surgery Patients and Its Impact on Major Adverse Cardiac Events and Mortality– A Randomized, Parallel?Group Study

Background:Patients undergoing elective cardiac surgery often experience pre?operative anxiety. Preoperative anxiety influences surgical outcome. There are very few studies which have assessed the impact of clonidine and Gabapentin in the treatment of anxiety especially in Indian populations and its implications on major adverse cardiac events (MACE) and 30 days mortality. Materials and Methods: Adult patients aged 18 to 80 years old who were scheduled to have an elective coronary artery by?pass graft (CABG) were included in the study.Those who satisfied the inclusion criteria were given either Gabapentin (800 mg) or Clonidine (300 mcg) 90?120 minutes before the induction. State trait anxiety inventory (STAI) was used to assess anxiety in baseline and taking just before operating room. The primary endpoint was a reduction in the STAI associated with the study drug, while the secondary endpoint was the incidence of MACE in the perioperative period (30 days), which included composite episodes of non?fatal cardiac arrest, chaotic rhythm, acute myocardial infarction, congestive heart failure, cardiac arrhythmia, angina, and death. Results: A total of 75 patients were considered for the statistical analysis. The demographic and clinical features of the study participants were similar in both groups. Nearly 75?80% of participants had severe anxiety in the preoperative period while 10?20% had moderate anxiety. While both the drugs showed a reduction in the anxiety levels, the clonidine group fared better (statistically insignificant). The incidence of MACE was similar in both groups. Conclusion:The preoperative anxiety levels were high among cardiac surgery patients.Both clonidine and gabapentin were equally effective in reducing the levels of preoperative anxiety. Preoperative STAI scores in the range of 32?53 is not associated with MACE and 30?day mortality among cardiac surgery patients.

The Effect of Neuromodulatory Drugs on the Intensity of Chronic Pelvic Pain in Women: A Systematic Review / Efeito de neuromoduladores na intensidade da dor pélvica crônica em mulheres: Revisão sistemática

Abstract Objective: To evaluate the effect of neuromodulatory drugs on the intensity of chronic pelvic pain (CPP) in women. Data sources: Searches were carried out in the PubMed, Cochrane Central, Embase, Lilacs, OpenGrey, and Clinical Trials databases. Selection of studies: The searches were carried out by two of the authors, not delimiting publication date or original language. The following descriptors were used: chronic pelvic pain in women OR endometriosis, associated with MESH/ENTREE/DeCS: gabapentinoids, gabapentin, amitriptyline, antidepressant, pregabalin, anticonvulsant, sertraline, duloxetine, nortriptyline, citalopram, imipramine, venlafaxine, neuromodulation drugs, acyclic pelvic pain, serotonin, noradrenaline reuptake inhibitors, and tricyclic antidepressants, with the Boolean operator OR. Case reports and systematic reviews were excluded. Data collection: The following data were extracted: author, year of publication, setting, type of study, sample size, intervention details, follow-up time, and results. Data synthesis: A total of 218 articles were found, with 79 being excluded because they were repeated, leaving 139 articles for analysis: 90 were excluded in the analysis of the titles, 37 after reading the abstract, and 4 after reading the articles in full, and 1 could not be found, therefore, leaving 7 articles that were included in the review. Conclusion: Most of the studies analyzed have shown pain improvement with the help of neuromodulators for chronic pain. However, no improvement was found in the study with the highest statistical power. There is still not enough evidence that neuromodulatory drugs reduce the intensity of pain in women with CPP.

Resumo Objetivo: Avaliar o efeito de drogas neuromoduladoras na intensidade da dor pélvica crônica em mulheres. Fontes de dados: As buscas foram realizadas nas bases de dados PubMed, Cochrane Central, Embase, Lilacs, OpenGrey e Clinical Trials. Seleção dos estudos: As buscas foram realizadas por dois dos autores, não delimitando data de publicação ou idioma de publicação. Foram usados os seguintes descritores: chronic pelvic pain in women OR endometriosis, associated with MESH/ENTREE/DeCS: gabapentinoids, gabapentin, amitriptyline, antidepressant, pregabalin, anticonvulsant, sertraline, duloxetine, nortriptyline, citalopram, imipramine, venlafaxine, neuromodulation drugs, acyclic pelvic pain, serotonin, noradrenaline reuptake inhibitors e tricyclic antidepressants, com o operador booleano OR. Relatos de caso e revisões sistemáticas foram excluídos. Coleta de dados: Foram extraídos os seguintes dados: autor, ano de publicação, local de origem, tipo de estudo, tamanho da amostra, detalhes da intervenção, tempo de seguimento e resultados. Síntese dos dados: Foram encontrados 218 artigos, sendo 79 deles excluídos por serem repetidos, restando 139 artigos para análise, dos quais 90 foram excluídos na análise dos títulos, 37 após a leitura do resumo e 4 após a leitura dos artigos na íntegra, e 1 não foi encontrado, restando, então, 7 artigos que foram incluídos na revisão. Conclusão: A maioria dos estudos analisados mostrou melhora da dor crônica com auxílio de neuromoduladores. No entanto, nenhuma melhora foi encontrada no artigo com maior poder estatístico. Ainda não há evidências suficientes de que drogas neuromoduladoras reduzam a intensidade da dor pélvica crônica em mulheres.

Comparative efficacy of 600 mg oral gabapentin and 300 mcg oral clonidine in attenuation of pre-operative anxiolysis and hemodynamic response to endotracheal intubation and laryngoscopy

Background: Endotracheal intubation and laryngoscopy are harmful stimulus, which can trigger unwanted cardiovascular conditions such as hypertension, dysrhythmia, and tachycardia. Various drugs have been used to attenuate the cardiovascular response. Drugs such as clonidine and Gabapentin are in extensive usage to stabilize the hemodynamic responses. Aim and Objectives: The aim of the study was to assess the efficacy of 600 mg oral Gabapentin and 300 mcg oral clonidine in attenuating pre-operative anxiolysis and hemodynamic response to endotracheal intubation and laryngoscopy. Materials and Methods: This prospective randomized study consists of 100 cases between the age group 21 and 65 years posted for elective surgery under general anesthesia. The study cases were randomly divided into two groups. Group 1 (n = 50) administered with 600 mg oral Gabapentin and Group 2 (n = 50) administered with 300 mcg oral clonidine. The baseline and pre-operative hemodynamic parameters and levels of sedation score and anxiety scores were recorded. Results: The total duration of intubation was 26.53 min in Group 1 and 26.86 min in Group 2. The systolic blood pressure, diastolic blood pressure, mean heart rate, mean arterial pressure, sedation score, and anxiety score were comparable between the two study groups and the mean difference between the two study groups was statistically significant (P < 0.05). Conclusion: Both study drugs had similar significant anxiolysis and sedation scores. However, 300 ?g oral clonidine has better hemodynamic stability to laryngoscopy and intubation than 600 mg oral gabapentin.

Paroxetine alone versus paroxetine combined with gabapentin in patients with somatoform disorders / 中国医师杂志

Objective:To compare the efficacy and safety of paroxetine alone and paroxetine combined with gabapentin in patients with somatoform disorder (SFD).Methods:From July 2018 to December 2020, 108 adult patients with SFD were prospectively selected from the psychological clinic of Jining First People′s Hospital. All patients were divided into the control group (52 cases) and the observation group (56 cases) according to the random number table method. The control group only received paroxetine, and the observation group received paroxetine combined with gabapentin for 12 weeks. Before treatment, at the end of treatment and at the 3-month follow-up after treatment, the levels of anxiety, depression and quality of life in the two groups of SFD patients were assessed by Symptom Checklist 90 (SCL-90), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and the Short Form-36 Health Survey (SF-36), respectively. Adverse event during treatment was recorded with Treatment Emergent Symptom Scale (TESS). At the end of treatment and at the 3-month follow-up after treatment, the therapeutic efficacy was evaluated with the patient′s Global Impression of Change (GIC).Results:At the end of treatment, GIC scores of the control group and the observation group were 3 (2-4) and 2 (1.25-3) respectively ( Z=2.081, P=0.037), and the treatment efficiency (GIC score ≤3) was 65.4%(34/52) and 83.9%(47/56), respectively, with a statistically significant difference (χ 2=4.945, P=0.026). Compared with that before treatment, the SCL-90, HAMA and HAMD scores of the two groups at the end of treatment were significantly reduced (all P<0.05); the SCL-90 somatization and anxiety factor scores of the observation group were lower than those of the control group (all P<0.05), and the HAMA somatization anxiety score of the observation group at the end of treatment was lower than that of the control group ( P<0.05). Compared with that before treatment, the scores of physical health and mental health in the two groups at the end of treatment and 3 months follow-up after treatment were significantly increased (both P<0.05), but there was no significant difference between the two groups (both P<0.05). There was no statistical difference in the total incidence of adverse events between the two groups ( P=0.085), but the incidence of vertigo in the observation group was significantly higher than that in the control group (χ 2=4.405, P=0.036). Conclusions:Paroxetine combined with gabapentin can further increase the effective rate of paroxetine treatment and improve the anxiety of SFD patients, but it has no significant impact on the quality of life, and has the potential risk of increasing dizziness, lethargy and other adverse reactions.

Therapeutic drug monitoring of gabapentin: the applicability in patients with neuropathic pain

Abstract Gabapentin is an antiepileptic drug prescribed for several neuropathic pain conditions. This study aimed to evaluate gabapentin (GAB) trough plasma concentration range and the applicability of therapeutic drug monitoring in patients with neuropathic pain. Fifty-three patients with neuropathic pain, aged 20 to 75, received gabapentin as treatment for at least 7 days. Gabapentin plasma concentration was sampled before GAB administration and quantified by liquid chromatography with a UV detector. GAB trough plasma concentration ranged between 0.40 and 11.94 µg/mL in patients with chronic neuropathic pain. No differences were observed in terms of GAB plasma concentrations between responsive and non-responsive patients. Our data suggest that the reference ranges suggested in the literature for patients with epilepsy should not be used for patients with neuropathic pain. Therapeutic drug monitoring of GAB was shown to be an important tool to assess treatment adherence.

Gabapentin alleviates myocardial ischemia-reperfusion injury through the PI3K-AKT signaling pathway / 中华急诊医学杂志

Objective:To evaluate the effect of gabapentin on myocardial ischemia-reperfusion injury and its mechanism.Methods:Sixty male clean SD rats, aged 10 weeks and weighing 250 g~300 g, were divided into 5 groups ( n=12) with 12 rats in each group by random number table method: Sham group, myocardial ischemia reperfusion group (group I/R), gabapentin group (group Gap), LY294002 group (group LY) and gabapentin +LY294002 group (group Gap +LY). The model of myocardial ischemia reperfusion injury was established by ligation of the left anterior descending coronary artery for 30 min and reperfusion for 120 min. Heart rate (HR), mean arterial pressure (MAP) and the rate pressure product (RPP) were recorded at baseline before ischemia (T 0) for 30 min (T 1) and reperfusion for 120 min (T 2) to evaluate hemodynamic changes during ischemia and reperfusion; The frequency of PVCs and VT/VF were recorded to evaluate the occurrence of arrhythmias during ischemia/reperfusion. TTC staining was used to detect myocardial infarction area. And the protein expression levels of PI3K and Akt in myocardial tissue were detected by Western blotting. Results:Compared with group I/R, the myocardial infarction area, PVCs and VT/VF times, and the protein expression levels of PI3K and p-Akt were significantly increased in group Gap ( P<0.05). Compared with group Gap, the area of myocardial infarction, the number of PVCs and VT/VF, and the protein expression of PI3K and p-Akt were significantly decreased in the group Gap +LY ( P<0.05). Conclusions:Gabapentin can alleviate myocardial ischemia-reperfusion injury, and its mechanism is related to the activation of PI3K-AKT signaling pathway.

Simple and rapid HPLC-UV methods for gabapentin quantification in human plasma and urine: applicability in pharmacokinetics and drug monitoring

Aim: We aimed to develop methods to determine gabapentin (GAB) in biological samples using high-performance liquid chromatography (HPLC) with application in pharmacokinetics and therapeutic drug monitoring. Methods: Simple, rapid and efficient HPLC-UV methods to quantify GAB in human plasma and urine were developed and validated for clinical analysis of GAB. The 1-fluoro-2,4-dinitrobenzene (FDNB) was used as derivatization agent. For plasma samples, protein precipitation using acetonitrile was performed, before the derivatization reaction. Urine samples were cleaned-up by liquid-liquid extraction with dichloromethane:n-butanol (1:1, v/v) after derivatized. Amlodipine besilate was used as internal standard (IS). Results: Gabapentin and IS were resolved on LiChrospher® C18 RP column and a mixture of 50 mM sodium phosphate buffer (pH 3.9):methanol (27:73, v/v) as mobile phase, at 1.2 mL/min. The methods used small sample volumes, 100 and 50 µL of plasma and urine, respectively. Linearity was obtained in the interval of 0.2-14 µg/mL in plasma and 2-120 µg/mL in urine. Both methods showed to be selective, without carry-over effect, precise, accurate and stable in different conditions. GAB plasma concentration in patients receiving 600 to 3600 mg/day of GAB ranged between 0.40 to 11.94 µg/mL at steady-state. Conclusions: The methods described in this study were simple, rapid and fulfill all validation requirements. They were easily and successfully applied for population pharmacokinetics and therapeutic drug monitoring of GAB in patients with chronic pain.

Gabapentin treatment in olanzapine-induced restless legs syndrome： a case report / 四川精神卫生

The purpose of this study is to suggest the physicians using olanzapine to strengthen the recognition and treatment of restless leg syndrome （RLS） in clinical practice. In this paper， one patient with schizophrenia suffered from RLS during olanzapine administration， which was characterized by unpleasant sensory disturbances in bilateral lower extremity at night， intense urges to move legs， and inability to sleep. After taking gabapentin， the above symptoms were significantly improved.

Eficácia e segurança de Pregabalina, Gabapentina, Memantina, Amitriptilina, treinamento físico com exercícios em solo ou aquáticos para tratamento de Fibromialgia: revisão rápida de evidências / Effectiveness and safety of Pregabalin, Gabapentin, Memantine, Amitriptyline, exercises on land or aquatic exercises for Fibromyalgia treatment: rapid evidence review

Tecnologia: Pregabalina, drogas não-opioides disponíveis no SUS, treinamento físico no solo ou em meio aquático. Indicação: Tratamento da fibromialgia. Pergunta: Há diferenças de eficácia e segurança entre a Pregabalina e as outras drogas não opioides ou terapias disponíveis no SUS para tratamento da dor crônica relacionada à fibromialgia? Métodos: Levantamento bibliográfico foi realizado nas bases eletrônicas PUBMED e Cochrane Database, seguindo estratégias de buscas predefinidas, com busca adicional na página eletrônica da Comissão Nacional de Incorporação de Tecnologias em Saúde. Avaliou-se a qualidade metodológica das revisões sistemáticas com Assessing the Methodological Quality of Systematic Reviews versão 2 (AMSTAR-II). Resultados: Foram selecionadas e incluídas 6 revisões sistemáticas. Conclusão: A afirmação de eficácia da Gabapentina, Amitriptilina e Memantina para tratamento da fibromialgia é pouco confiável, pois as evidências são de nível 3, provenientes de ensaios clínicos de baixa qualidade metodológica. Pregabalina é eficaz para reduzir a dor em curto prazo (risco absoluto é 50%, nível 1 de evidência), mas não em longo prazo. O treinamento físico, relatado como única estratégia eficaz para tratamento da fibromialgia nas diretrizes do SUS, não tem efeito clinicamente importante sobre a dor

Technology: Pregabalin, non-opioid drugs available in Brazilian Public Health System, aquatic exercise or exercise on land. Indication: Treatment of fibromyalgia. Question: Are there differences in efficacy and safety between Pregabalin and other non-opioid drugs or therapies available in the SUS for the treatment of chronic pain related to fibromyalgia? Methods: A bibliographic survey was carried out in the electronic databases PUBMED and Cochrane Database, following pre-defined search strategies, with an additional search on the website of the National Commission for the Incorporation of Health Technologies. The methodological quality of systematic reviews was evaluated with Assessing the Methodological Quality of Systematic Reviews version 2 (AMSTAR-II). Results: Six systematic reviews were selected and included. Conclusion: There is not confidence about effectiveness of Gabapentin, Amitriptyline and Memantine for fibromyalgia treatment (level 3 of evidence, from clinical trials of low methodological quality). Pregabalin, in the short term, is effective for reducing pain (absolut risk is 50%, level 1 of evidence), but not in the long term. Physical training, reported as the only effective strategy for treating fibromyalgia in Brazilian Public Health System guidelines, has no clinically important effect on pain.

Use of gabapentin in management of postoperative pain after crosslinking / Uso da gabapentina no manejo da dor pós-operatória do crosslinking

ABSTRACT Objective: The objective was to evaluate the efficacy of gabapentin in the management of neuropathic pain in patients with keratoconus, who were treated with fast (10 minutes) epi-off corneal crosslinking (CXL). Methods: This was a prospective, double-blind, randomized study. The sample comprised patients with bilateral progressive keratoconus, aged 12 years or older, who underwent a bilateral epi-off corneal CXL (fast - 10 minutes) procedure. One group was given placebo orally, and the other group received gabapentin 600 mg orally, both preoperatively. The visual analogue scale (VAS) was applied to record postoperative pain up to 48 hours after procedure. The study was conducted at the Belotto Stock Centro Oftalmológico, in the city of Joaçaba, Santa Catarina, Brazil, from June 2018 to September 2019. Results: At no point in the study significant differences were observed between groups, in terms of pain intensity measured by means of the VAS questionnaire, or of opioid use (Paco®), though opioid consumption was 21% lower in the group receiving gabapentin. Conclusion: We concluded gabapentin has no efficacy in postoperative pain control after epi-off corneal CXL (fast - 10 minutes). Although there was no statistically significant difference, the group that received gabapentin suffered less pain, resulting in lower opioid consumption. UTN number: U1111-1256-0330.

RESUMO Objetivo: Avaliar a eficácia do uso da gabapentina no manejo da dor neuropática em pacientes portadores de ceratocone submetidos ao tratamento de crosslinking corneano epi-off fast de 10 minutos. Métodos: Tratou-se de pesquisa prospectiva, duplo-cega, randomizada. A amostra foi composta de pacientes com ceratocone progressivo bilateral, a partir dos 12 anos de idade, submetidos ao procedimento de crosslinking corneano acelerado epi-off fast de 10 minutos bilateral. Um grupo recebeu placebo via oral e o outro, gabapentina 600mg, via oral, ambos no pré-operatório. A Escala Visual Analógica foi aplicada para registrar a dor pós-operatória até 48 horas após o procedimento. A pesquisa foi realizada no período de junho de 2018 a setembro de 2019 em um centro oftalmológico. Resultados: Não foram observadas diferenças estatísticas significativas para ambos os grupos, tanto na intensidade da dor medida pela Escala Visual Analógica, como na redução do uso do opioide (Paco®), em qualquer horário analisado durante um período de 48 horas. No entanto, houve redução de 21% no consumo de opioides pelo grupo que fez uso da gabapentina. Conclusão: A gabapentina não demonstrou eficácia no controle da dor no pós-operatório do crosslinking corneano epi-off fast de 10 minutos. No entanto, observou-se que, mesmo não havendo diferença estatisticamente significativa, houve diminuição da dor no grupo em que foi usada a gabapentina, resultando na redução do consumo de opioides. Número UTN: U1111-1256-0330.

The efficacy of alpha-lipoic acid and/or gabapentin on the oxidant-antioxidant system in patients with diabetic polyneuropathy

Background: Diabetic peripheral sensorimotor polyneuropathy is the most common complication seen in patients with diabetes mellitus (DM). Oxidant system plays a crucial role in its physiopathology. We investigated the changes in the serum levels of total antioxidant status (TAS), total oxidant status (TOS), paraoxonase-1 (PON1) and oxidative stress index (OSI) to evaluate the antioxidant efficacy of alpha lipoic acid (ALA) and/or gabapentin in patients with diabetic polyneuropathy (DPN).Methods: Sixty-three type 2 DM patients with diabetic polyneuropathy (DPN) were enrolled in the study. Patients with DPN were divided into four groups in terms of their treatment: Group 1 consisted of treatment-naive patients; patients treated with ALA, gabapentin or combination of ALA and gabapentin comprised groups 2, 3, and 4, respectively. The patients received the medications for at least six weeks.  Serum levels of TAS, TOS, PON1 and OSI were analyzed.Results: No significant difference was observed between the groups according to the oxidative stress parameters studied.Conclusions: The use of ALA and/or gabapentin in patients with DPN did not significantly affect the oxidative stress parameters, including TAS, TOS, PON1, and OSI.

Review: Does Gabapentin Relieve Opioid, Cannabis and Methamphetamine Addictions? / Revisión: ¿La Gabapentina Alivia las Adicciones a los Opiáceos, el Cannabis y las Metanfetaminas? / Revisão: A Gabapentina Reduz o Vício em Drogas Opiáceas, em Cannabis e em Metanfetaminas?

Abstract The study reviews the suitability of using Gabapentin for treating opioid, cannabis and methamphetamine use disorders. This revision consists of 61 biographical references based on a PubMed database search (January of 1983-May of 2018). Gabapentin displayed respectively 50% and 66.7% of success for treating methamphetamine dependence and opioid withdrawal symptoms. Furthermore, a few research studies have reported Gabapentin's efficacy for alleviating cannabis dependence (two studies), and cannabis withdrawal symptoms (one study). Similarly, a single study reported Gabapentin reduction of opioid consumption during the detoxification process. Based on the revision, we can conclude that: (a) Gabapentin is useful for treating opioid withdrawal symptoms, (b) additional studies are necessary for elucidating the effectiveness of Gabapentin for treating methamphetamine dependence, cannabis dependence and its withdrawal symptoms, and (c) more studies are necessary to confirm the efficacy of Gabapentin in reducing opioid consumption during detoxification.

Resumen El trabajo revisa 61 referencias bibliográficas, producto de una búsqueda en la base de datos PubMed (enero de 1983 a mayo de 2018), con el fin de determinar si la Gabapentina es adecuada para el tratamiento de trastornos derivados del uso de opiáceos, cannabis y metanfetaminas. El éxito de la Gabapentina para tratar la dependencia a las metanfetaminas y los síntomas de abstinencia de opiáceos fue de 50% y 66.7%, respectivamente. Algunas investigaciones han informado la eficacia de la Gabapentina para aliviar la dependencia al cannabis (dos estudios) y los síntomas de abstinencia del cannabis (un estudio). Un solo estudio reportó que la Gabapentina redujo el consumo de opiáceos, durante el proceso de desintoxicación. La revisión nos permite concluir que (a) la Gabapentina es útil para tratar los síntomas de abstinencia de los opiáceos, (b) se necesitan más estudios para esclarecer la efectividad de la Gabapentina para tratar la dependencia a las metan-fetaminas, al cannabis y los síntomas de abstinencia, y (c) se requieren más estudios para confirmar la eficacia de la Gabapentina para reducir el consumo de opiáceos durante la desintoxicación.

Resumo A partir de uma busca na base de dados PubMed (janeiro de 1983 a maio de 2018), são revisadas 61 referências bibliográficas a fim de determinar se a gabapentina é adequada para tratar transtornos derivados do uso de opiáceos, cannabis e metanfetaminas. O sucesso do uso da gabapentina para tratar a dependência das metanfetaminas e dos sintomas de abstinência de opiáceos foi de 50% e 66,7%, respectivamente. Algumas pesquisas relatam a eficácia da gabapentina para aliviar a dependência de cannabis (dois estudos) e dos sintomas de abstinência de cannabis (um estudo). Somente um estudo relatou que a gabapentina reduzia o consumo de opiáceos durante o processo de desintoxicação. A revisão nos permite concluir que: (a) a gabapentina é útil para tratar os sintomas de abstinência dos opiáceos, (b) é necessário mais estudos para esclarecer a efetividade da gabapentina para tratar a dependência das metanfetaminas, da cannabis e dos sintomas de abstinência e (c) são necessários mais estudos para confirmar a eficácia da gabapentina para reduzir o consumo de opiáceos durante a desintoxicação.

Antidiabetic effect of Pterocarpus marsupium seed extract in gabapentin induced diabetic rats

Background: Type 2 diabetes mellitus is the most common type of diabetes. Diabetes mellitus is a leading cause of morbidity and mortality among Indian population and all over the world with more than hundreds of millions of patients worldwide. Pterocarpus marsupium is a medicinal plant used in Ayurvedic system of medicine to control blood sugar and strong antidiabetic. The purpose of this study was to assess the hypoglycemic effect of the ethanolic extract of Pterocarpus marsupium seeds in diabetic rats.Methods: The present work was designed to evaluate the anti-hyperglycaemic activity of Pterocarpus marsupium seed extract (100 mg/kg and 200 mg/kg) on gabapentin induced hyperglycaemia in wistar albino rats. Blood glucose level, serum triglycerides, total cholesterol, HDL cholesterol and LDL cholesterol were evaluated in gabapentin induced diabetic rats. The results of the test drug were compared with the standard drug.Results: Ethanolic seed extract of Pterocarpus marsupium at 100 mg/kg and 200 mg/kg had significantly reduced the blood glucose level compared to disease control rats on day 1, 7, 14 and 21. Pterocarpus marsupium shows significant decrease in triglycerides levels, serum cholesterol levels, LDL levels and increased HDL levels, total protein levels compared to the disease control group.Conclusions: In conclusion, the present study shows that the ethanolic seed extract of Pterocarpus marsupium has potential antidiabetic action in gabapentin induced diabetic rats and the effect was found to be more similar to the standard drug metformin.