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Zanardi R, Carminati M, Fazio V, Maccario M, Verri G, Colombo C. Add-On Treatment with Passiflora incarnata L., herba, during Benzodiazepine Tapering in Patients with Depression and Anxiety: A Real-World Study. Pharmaceuticals (Basel) 2023; 16:ph16030426. [PMID: 36986524 PMCID: PMC10056302 DOI: 10.3390/ph16030426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Chronic and inappropriate benzodiazepine intake represents an important health and social concern worldwide. The aim of our study was to investigate the effectiveness of P. incarnata L., herba, in reducing benzodiazepine misuse in a real-world population of depressed and anxious patients in a long-term treatment with benzodiazepines. We conducted a retrospective naturalistic study on 186 patients undergoing benzodiazepine downtitration, 93 with the addition of a dry extract of P. incarnata L., herba (Group A), and 93 without any add-on treatment (Group B). Regarding the benzodiazepine dosage variation in the two groups, a repeated measure ANOVA showed a significant effect of time (p < 0.001), group (p = 0.018), and time x group interaction (p = 0.011). We found a significantly higher rate, i.e., of 50%, reduction in Group A vs. Group B at 1 month (p < 0.001) and at 3 months (p < 0.001) and complete benzodiazepine discontinuation at 1 month (p = 0.002) and at 3 months (p = 0.016). Our findings suggest the role of P. incarnata as an effective add-on treatment during benzodiazepine tapering. These findings highlight the need for further studies to better investigate the promising properties of P. incarnata in the management of such a relevant clinical and social issue.
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Affiliation(s)
- Raffaella Zanardi
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Clinical Neurosciences, Mood Disorder Unit, IRCCS San Raffaele Institute, 20127 Milan, Italy
- Correspondence:
| | - Matteo Carminati
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Valentina Fazio
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Melania Maccario
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Greta Verri
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Cristina Colombo
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Clinical Neurosciences, Mood Disorder Unit, IRCCS San Raffaele Institute, 20127 Milan, Italy
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Abstract
Benzodiazepine and related sedative use has been increasing. There has been a growing number of unregulated novel psychoactive substances, including designer benzodiazepines. Benzodiazepines have neurobiological and pharmacologic properties that result in a high potential for misuse and physical dependence. Options for discontinuing long-term benzodiazepine use include an outpatient benzodiazepine taper or inpatient withdrawal management at a hospital or detoxification facility. The quality of evidence on medications for benzodiazepine discontinuation is overall low, whereas cognitive behavioral therapy has shown the most benefit in terms of behavioral treatments. Benzodiazepines may also have significant adverse effects, increasing the risk of overdose and death.
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Affiliation(s)
- Linda Peng
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Addiction Medicine Section, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L475, Portland, Oregon 97239, USA.
| | - Kenneth L Morford
- Department of Internal Medicine, Section of General Internal Medicine, Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, ES Harkness A, Room 417A, New Haven, Connecticut 06510, USA
| | - Ximena A Levander
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Addiction Medicine Section, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L475, Portland, Oregon 97239, USA. https://twitter.com/XimenaLevander
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Tambon M, Ponté C, Jouanjus E, Fouilhé N, Micallef J, Lapeyre-Mestre M. Gabapentinoid Abuse in France: Evidence on Health Consequences and New Points of Vigilance. Front Psychiatry 2021; 12:639780. [PMID: 33613345 PMCID: PMC7886797 DOI: 10.3389/fpsyt.2021.639780] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Gabapentinoid drugs (gabapentin and pregabalin) are widely used worldwide for epileptic and pain disorders. First signals of gabapentinoid abuse occurred in the last decade. This study aims to describe clinical characteristics of gabapentinoid use related disorders and health consequences in France. Materials and Methods: We designed a multisource investigation reviewing data reported to the French Addictovigilance Network (FAN) with pregabalin and gabapentin from 2010 to 2019. Information was obtained through the analysis of Spontaneous Reports (SRs) notified by health professionals and the pharmacoepidemiological surveys OSIAP (suspicious prescriptions forms indicators of potential abuse), OPPIDUM (observation of illicit drugs and misuse of psychotropic medications), DRAMES (death related to prescription drugs and other substances), and DTA (toxic deaths due to analgesics). Results: Over 2010-2019 period, were collected: (i) 265 SRs (258 pregabalin; 7 gabapentin); (ii) 816 forged prescription forms (805 pregabalin, 10 gabapentin, 1 involving both drugs); (iii) 145 cases of gabapentinoid use in people who use drugs (121 pregabalin; 24 gabapentin) and (iv) 31 cases of gabapentinoid-related deaths (25 pregabalin; 6 gabapentin). Risk factors of gabapentinoid abuse were opioid use disorders or psychiatric history, but cases of primary abuse in subjects without any substance abuse history were observed. Adverse outcomes concern almost exclusively pregabalin, with coma, dyspnea, convulsion, and conduction disorders. Treatment demands increased from 10.6% in 2018 to 23.1% in 2019, with pregabalin cited as the first substance leading to addictological care in the 2019 OPPIDUM survey. Gabapentinoid-related deaths increased over time. Pregabalin has become the first drug mentioned in forged prescriptions in 2019 (23.8% of OSIAP), while it ranked at the 15th position in 2017 (2.6%). Discussion: This study shows the importance of addictovigilance monitoring for gabapentinoids. Addictovigilance data helped to make visible the gabapentinoid-abuse related health harms (hospitalization for serious neurologic, psychiatric or cardiac effects, requests for addictological support and deaths) and to confirm the intrinsic abuse potential of pregabalin. These data highlight new points of vigilance considering observed primary abuse. At this point in France, the risk of abuse and related complications is very apparent with pregabalin. Still, it is identical to that observed elsewhere with gabapentin.
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Affiliation(s)
- Marine Tambon
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
| | - Camille Ponté
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
| | - Emilie Jouanjus
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, Toulouse, France
| | - Nathalie Fouilhé
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie-Pharmacosurveillance, CHU Grenoble-Alpes, Grenoble, France
| | - Joelle Micallef
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France.,CEIP-Addictovigilance PACA Corse, Marseille, France
| | - Maryse Lapeyre-Mestre
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, Toulouse, France.,Centre d'Investigation Clinique 1436, CHU de Toulouse, Toulouse, France
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Fonseca F, Lenahan W, Dart RC, Papaseit E, Dargan PI, Wood DM, Guareschi M, Maremmani I, Auriacombe M, Farré M, Scherbaum N, Torrens M. Non-medical Use of Prescription Gabapentinoids (Gabapentin and Pregabalin) in Five European Countries. Front Psychiatry 2021; 12:676224. [PMID: 33995154 PMCID: PMC8113698 DOI: 10.3389/fpsyt.2021.676224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Non-medical use (NMU) of prescription GABA analogs (pregabalin and gabapentin) has been reported especially in opiate dependent persons. However, by now the prevalence of NMU of gabapentinoids in the general population has not been sufficiently evaluated. The aim of this research paper is to determine the prevalence of prescription GABA analog NMU and associated demographics in five European countries with special detail of Spain. Methods: The RADARS Survey of Non-Medical Use of Prescription Drugs Program (NMURx) is a harmonized series of contemporaneous cross-sectional surveys of adults conducted in multiple countries. NMURx collects data from the general population in each participating country about NMU of prescription drugs, illicit drugs, and associated demographics. NMU was defined as "using a medication without a doctor's prescription or for any reason other than what was recommended by their doctor." Responses from Spain (4Q2017, n=10,062) were analyzed in detail. Comparative data were available from France, Germany, Italy, and UK. Responses were collected using non-probability quota sampling and post-stratification population weighting was applied to reflect the national distributions of adults, based on age, gender, and census region. Rates of NMU and associated demographics were reported as rate of past 90-day NMU per 100,000 adult population with 95% confidence intervals. Results: Germany (1,197 per 100,000 adult population [95% CI: 1,004.3-1,379.1]) and United Kingdom (1,067 per 100,000 adult population [95% CI: 851.3-1,283.2]) presented the highest prevalence of gabapentinoids NMU. In Spain the prevalence of past 90 days GABA analog NMU was: 344.4, 95% (CI 204.8-484.0), with male predominance. Those who non-medically use GABA analogs had a higher prevalence of lifetime chronic pain, lifetime illicit drug use, and previous substance abuse treatment. In Spain, 20% of respondents who ever have used gabapentinoids, reported a lifetime NMU; the prevalence was higher for pregabalin 624 (6.2%) than for gabapentin 444 (4.4%). The main reasons for use were to self-treat pain and other medical conditions. Conclusions: The risk of NMU of gabapentinoids should not be neglected. Subjects with a history of chronic pain and lifetime substance use disorders had an increased risk of NMU of gabapentinoids.
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Affiliation(s)
- Francina Fonseca
- Hospital del Mar, Institut de Neuropsiquiatria i Addiccions (INAD), Barcelona, Spain.,Grup de Recerca en Addiccions, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
| | - William Lenahan
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, United States
| | - Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, United States
| | - Esther Papaseit
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol (HUGTP-Germans Trias i Pujol Research Institute), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Marilena Guareschi
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Lucca, Italy
| | - Icro Maremmani
- Vincent P. Dole Research Group, Santa Chiara University Hospital, University of Pisa, Pisa, Italy
| | - Marc Auriacombe
- Addiction Psychiatry Department, University of Bordeaux, Bordeaux, France.,Addiction Team, Sanpsy Centre National de la Recherche Scientifique (CNRS) USR 3413, Bordeaux, France.,Pôle Addictologie et Filière Régionale, Centre Hospitalier (CH) Charles Perrens and Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Magí Farré
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol (HUGTP-Germans Trias i Pujol Research Institute), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Marta Torrens
- Hospital del Mar, Institut de Neuropsiquiatria i Addiccions (INAD), Barcelona, Spain.,Grup de Recerca en Addiccions, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
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Kwong PPK, Chan EYK, Cheung EYW, Fong SYY, Nip W, Cheung HHK, Yip IPL, Chong KY, Pao RSY, Tam KL, Tang MH, Chan SKC, Mak KY. Consensus statements on the clinical uses of pregabalin for Hong Kong. Asia Pac Psychiatry 2020; 12:e12403. [PMID: 32830438 DOI: 10.1111/appy.12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
To facilitate the understanding of pregabalin and optimize its clinical usage in Hong Kong, an expert panel (11 psychiatrists, one family physician and one anesthesiologist) experienced in treating anxiety and somatic symptoms was invited to establish a set of consensus statements based on several discussion areas. A non-systematic literature search for relevant articles was conducted. The panelists addressed the discussion areas by sharing their clinical experience and available literature in a couple of meetings. At the last meeting, consensus statements derived from the proceedings were discussed and finalized. A total of 11 statements were ultimately accepted by panel voting based on their practicability of recommendation in Hong Kong. These statements are aimed to act as a practical reference for local clinicians when they consider prescribing pregabalin in different clinical situations.
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Affiliation(s)
- Patrick Po-Keung Kwong
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Eric Yan-Kwong Chan
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Eric Yat-Wo Cheung
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Samson Yat-Yuk Fong
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Wai Nip
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Henry Hon-Kee Cheung
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Isaac Pui-Lam Yip
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - King-Yee Chong
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Ronnie Sze-Yuan Pao
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Ka-Lok Tam
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Man-Ho Tang
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Simon Kin-Cheong Chan
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Ki-Yan Mak
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
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