Pregabalin zur Reduktion von Opiatentzugssymptomen

Zusammenfassung

Wir berichten über die Entzugsbehandlung eines 43 Jahre alten abstinenzmotivierten opiatabhängigen Patienten mit Pregabalin. Während der Behandlung wurden in unserer Abteilung Serum und Urin des Patienten auf Pregabalin untersucht. Der Patient versuchte einen Absetzversuch von Heroin während einer konkomitanten Medikation mit 300 mg Pregabalin und konnte damit alle Entzugssymptome beherrschen sowie auch weitere Opiatrückfälle mit Heroin und auch Opioidrückfälle mit Buprenorphin erfolgreich mit Pregabalin behandeln. Dieser Fall gibt erste Hinweise, dass Pregabalin bei Opiatabhängigen im Entzug einen Einfluss auf Entzugssymptome haben könnte.

Abstract

Pregabalin is a substance which modulates monoamine release in “hyper-excited” neurons. It binds potently to the α2-δ subunit of calcium channels. Pilotstudies on alcohol- and benzodiazepine dependent patients reported a reduction of withdrawal symptoms through Pregabalin. To our knowledge, no studies have been conducted so far assessing this effect in opiate dependent patients. We report the case of a 43-year-old patient with Pregabalin intake during opiate withdrawal. Multiple inpatient and outpatient detoxifications from maintenance replacement therapy with Buprenorphine in order to reach complete abstinence did not show success because of extended withdrawal symptoms and repeated drug intake. Finally he disrupted his heroine intake with a simultaneously self administration of 300 mg Pregabaline per day and was able to control the withdrawal symptoms. In this time we did control the Pregabalin level in serum and urine in our outpatient clinic. In the course the patient reported that he could treat further relapse with opiate or opioids with Pregabalin successful. This case shows first details for Pregabalin to relief withdrawal symptoms in opiate withdrawal.

Schlüsselwörter

Pregabalin - Opiatabhängigkeit - Opioidabhängigkeit - Entzug - Fallbericht

Keywords

Pregalin - opiate dependency - opioide dependency - withdrawal - case report

• Literatur

• 1 Bannister K, Sikandar S, Bauer CS et al. Pregabalin suppresses spinal neuronal hyperexcitability and visceral hypersensitivity in the absence of peripheral pathophysiology. Anesthesiology 2011; 115: 144-152
• 2 Baidya DK, Agarwal A, Khanna P et al. Pregabalin in acute and chronic pain. Anaesthesiol Clin Pharmacol 2011; 27: 307-314
• 3 Baldwin D, Woods R, Lawson R et al. Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis. BMJ 2011; 342: d1199 doi:
• 4 Mittal M, Pasnoor M, Mummaneni RB et al. Retrospective chart review of duloxetine and pregabalin in the treatment of painful neuropathy. Int J Neurosci 2011; 121: 521-527
• 5 Waszkielewicz AM, Gunia A, Słoczyńska K et al. Evaluation of Anticonvulsants for Possible Use in Neuropathic Pain. Curr Med Chem 2011; 18: 4344-4358
• 6 Martinotti G, di Nicola M, Frustaci A et al. Pregabalin, tiapride and lorazepam in alcohol withdrawal syndrome: a multi-centre, randomized, single-blind comparison trial. Addiction 2010; 105: 288-299
• 7 Bobes J, Rubio G, Terán A et al. Pregabalin for the discontinuation of long-term benzodiazepines use: An assessment of its effectiveness in daily clinical practice. Eur Psychiatry 2012; 27: 301-307
• 8 Biermann D. Harte Drogen, harter Weg. Pharmazeutische Zeitung 2007; 51: 4778-4779
• 9 Rubio G, Bobes J, Cervera G et al. Effects of Pregabalin on Subjective Sleep Disturbance Symptoms during Withdrawal from Long-Term Benzodiazepine Use. Eur Addict Res 2011; 17: 262-270
• 10 Hermann D, Klages E, Welzel H et al. Low effects of non-opioid drugs on opiate withdrawal symptoms. Addiction biology 2005; 10: 165-169
• 11 Schwan S, Sundstrom A, Stjernberg E et al. A signal for an abuse liability for pregabalin results from the Swedish spontaneous adverse drug reaction reporting system. Eur J Clin Pharmacol 2010; 66: 947-953
• 12 Grosshans M, Mutschler J, Hermann D et al. Pregabalin abuse, dependence, and withdrawal: a case report. Am J Psychiatry 2010; 167: 869
• 13 Bundesärztekammer. Arzneimittelkommission der deutschen Ärzteschaft: Aus der UAW-Datenbank Abhängigkeitspotenzial von Pregabalin (Lyrica^®). Dtsch Arztebl 2011; 108: A-183 / B-143 / C-143