Characterization of hospitalized patients who received naloxone while receiving opioids with or without gabapentinoids.

The Mental Health Clinician Pub Date : 2021-07-16 eCollection Date: 2021-07-01 DOI:10.9740/mhc.2021.07.225
Payal H Desai, Olesya Taylor, Kunal J Shah, Kirk E Evoy, Alyssa M Peckham
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引用次数: 4

Abstract

Introduction Gabapentin and pregabalin (gabapentinoids) can be given with opioids for opioid-sparing and adjuvant analgesic effects. In the context of certain comorbidities and high dosages, coadministration of these agents can lead to respiratory depression or oversedation, necessitating naloxone administration. Methods A retrospective chart review from January 2015 to December 2017 was conducted to include patients who received naloxone and opioids with or without gabapentinoids. Exclusion criteria included pregnancy or having received naloxone in the emergency department, intensive care, or pediatrics units. The primary outcome was to characterize differences between groups regarding comorbidities, history of renal or hepatic dysfunction, history of SUD, opioid tolerance, initiation and dose appropriateness of gabapentinoids, and dose intensity of gabapentinoids and opioids. Secondary outcomes were concomitant CNS depressant use and naloxone episodes for documented respiratory depression. Results Of 126 patients who met inclusion criteria, 36 received opioids and gabapentinoids (gabapentinoid group) and 90 received opioids alone (nongabapentinoid group). There were 136 naloxone episodes between the 2 groups. More than 50% of the naloxone episodes in the gabapentinoid group involved opioids of at least 90 oral morphine mg equivalents. Respiratory depression accounted for 39% and 15.8% of the naloxone episodes in the gabapentinoid and nongabapentinoid groups, respectively. Discussion There may be increased naloxone episodes among patients receiving opioids and gabapentinoids. Future studies are needed to evaluate the incremental risk of respiratory depression and oversedation as it pertains to concomitant medication administration and patient-specific factors.

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接受纳洛酮同时接受阿片类药物加巴喷丁或不加巴喷丁的住院患者的特征
简介:加巴喷丁和普瑞巴林(加巴喷丁类药物)可与阿片类药物一起给予,以达到阿片类药物节约和辅助镇痛作用。在某些合并症和高剂量的情况下,这些药物的共同施用可导致呼吸抑制或过度镇静,需要纳洛酮的施用。方法:对2015年1月至2017年12月接受纳洛酮和阿片类药物联合或不联合加巴喷丁类药物治疗的患者进行回顾性图表回顾。排除标准包括怀孕或在急诊科、重症监护室或儿科接受过纳洛酮治疗。主要结局是描述组间合并症、肾功能或肝功能障碍史、SUD史、阿片类药物耐受性、加巴喷丁类药物的起始和剂量适宜性以及加巴喷丁类药物和阿片类药物的剂量强度的差异。次要结局是伴有中枢神经系统抑制剂的使用和纳洛酮发作的记录呼吸抑制。结果:126例符合纳入标准的患者中,36例接受阿片类药物和加巴喷丁类药物治疗(加巴喷丁类组),90例单独接受阿片类药物治疗(非加巴喷丁类组)。两组共136次纳洛酮发作。加巴喷丁组超过50%的纳洛酮发作涉及至少相当于90毫克口服吗啡的阿片类药物。加巴喷丁和非加巴喷丁组呼吸抑制分别占纳洛酮发作的39%和15.8%。讨论:在接受阿片类药物和加巴喷丁类药物治疗的患者中,纳洛酮发作可能增加。未来的研究需要评估呼吸抑制和过度镇静的增加风险,因为它与伴随的药物管理和患者特异性因素有关。
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