Combination Of Gabapentin Research Articles

Patterns of Neonatal Co-Exposure to Gabapentin and Common Drugs of Abuse Observed in Umbilical Cord Tissue

Abstract Background Gabapentin is a structural analogue of gamma-aminobutyric acid approved by the U.S. Food and Drug Administration (FDA) for the treatment of postherpetic neuralgia and partial-onset seizures. Gabapentin is thought to have low abuse potential and is currently not scheduled as a controlled substance by the Drug Enforcement Administration (DEA). However, recent reports indicate that gabapentin is increasingly being abused by people with opioid use disorder in an attempt to potentiate the euphoric effects from opioids and other CNS depressants. (1) In 2018, Gabapentin was the sixth most commonly prescribed medication in the United States with 67 million prescriptions dispensed. (2) The frequency of non-prescribed gabapentin misuse reported at a reference laboratory increased by 40% between 2017 and 2018. (3) It is now recognized that combination of Gabapentin with opioids and other CNS depressants increases risk of respiratory depression. (4) Of particular concern are reports showing prolonged and more severe neonatal abstinence syndrome in infants with prenatal co-exposure to gabapentin and opioids. (5) Method This retrospective study evaluated the positivity rates of 13,609 umbilical cord tissues submitted for newborn drug testing at ARUP Laboratories. The umbilical cord drug detection assay is designed to detect 49 specific drugs and drug metabolites from commonly abused drug classes including opioids, stimulants, sedative-hypnotics and hallucinogens. Reverse phase liquid chromatography coupled with triple quadrupole mass spectrometry was used for semi-quantitative measurement of the drug analytes and metabolites. Results A positive result for at least one of the measured drugs or drug metabolites was found in 3,891 (29%) out of the 13,609 analyzed umbilical cord tissues. Norbuprenorphine had the highest positivity rate (874, 6%) followed by Amphetamine (764, 6 %) and Morphine (683, 5%). Gabapentin had a positivity rate of 2% with 302 positive results. Of the 302 positive Gabapentin samples, 216 (72%) also had a positive result for at least one other drug or drug metabolite. Co-positivity with Gabapentin was highest for Norbuprenorphine (105, 35%) followed by Amphetamine (41, 14%). The median Gabapentin concentration in umbilical cord tissues that were co-positive for Norbuprenorphine and Amphetamine is 3,762 ng/g (range = 13 - 40,997 ng/g) and 1,045 ng/g (range = 15 - 40,997 ng/g) respectively. Discussion This retrospective data analysis show that there is high neonatal co-exposure rate to Gabapentin and Buprenorphine / Norbuprenorphine. Buprenorphine is a partial mu-opioid receptor agonist and co-medication with Gabapentin might be used as a strategy to enhance the feeling of euphoria from Buprenorphine in pregnant women undergoing opioid substitution therapy.

The clinical significance of gabapentin in combination with opioids in controlling outbreak of pain in cancer patients.

e24142 Background: This study compared the pain relief effects of opioids combined with gabapentin and opioids alone after an outbreak of pain in patients with opioid-tolerant cancer pain to explore better cancer pain management. Methods: A total of 60 patients with moderate and severe cancer pain from September 2016 to April 2017 in the Department of Oncology of the Fourth Hospital of Hebei Medical University. They were randomly divided into two groups when they experienced an outbreak of pain, only oxycodone hydrochloride sustained-release tablets group (A group) 30 cases and gabapentin capsule combined with oxycodone hydrochloride sustained-release tablets group (B group) 30 cases, The degree of pain relief before and after treatment, the consumption of oxycodone hydrochloride sustained-release tablets, quality of life scores and adverse reactions, and nighttime sleep time were compared between the two groups. Results: 1. The NRS score in group B after treatment was significantly lower than that in group A after treatment (1.83±0.46 vs. 2.30±0.75). There was a statistically significant difference (P < 0.05). 2. The consumption of oxycodone hydrochloride sustained-release tablet in group B was lower than that in group A (19.000±6.074 vs. 25.667±10.063). There was statistical significance (P = 0.003). 3. The quality score was higher than before, and the quality of life score in group B was higher than that in group A (P < 0.05). 4. The main adverse reactions in both groups were constipation, nausea, vomiting and dizziness. The incidence was 86.67% vs. 50.00%、33.33% vs. 23.33%, 20.00% vs. 16.67%, respectively, there was no significant difference (P > 0.05). The nighttime sleep time of both groups was higher than that before treatment (6.017±0.636 vs. 5.167±0.735, 6.433±0.583 vs. 5.167±0.661). 5. The nighttime sleep time of Group B was longer than that of Group A after treatment (6.433±0.583 vs. 6.017±0.636). The difference was statistically significant (P < 0.05). Conclusions: Opioids combined with gabapentin are superior to opioids alone in the treatment of cancer pain with analgesic efficacy, improved quality of life, reduced opioid consumption, adverse drug reactions, and effective night time sleep.

Combination Therapy of Gabapentin and N-Acetylcysteine Against Posttraumatic Epilepsy in Rats.

Traumatic brain injury (TBI) is a major public health problem worldwide that is associated with increased mortality and morbidity. Posttraumatic epilepsy (PTE) is one of the sequelae of TBI. The aim of this study was to investigate the role of N-acetylcysteine (NAC) as an adjuvant on the efficacy of levetiracetam (LEV) and gabapentin (GBP) in PTE model encouraged by pentylenetetrazol (PTZ) after mild-TBI in male Sprague-Dawley rats. Mild-TBI was performed by the weight-drop method in male Sprague-Dawley rats. PTE model was developed by injecting PTZ (30+15+15mg/kg, 30min intervals, i.p.) 7days after head trauma. After the development of posttraumatic seizures, the rats were treated with NAC (100mg/kg), LEV (50mg/kg), GBP (100mg/kg), NAC+LEV and NAC+GBP intraperitoneally for 14days. Seizures related to PTE were scored by video-EEG recording. Motor performance of the animals was also evaluated in the rotarod test. 50mg/kg LEV and 100mg/kg GBP reduced seizures related to PTE. LEV alone (p = 0.009), but the administration of GBP+NAC (p = 0.015) was more effective on PTE-related seizure control. However, GBP+NAC application adversely affected the fall latency in the rotarod test. In terms of trauma-related seizure control, there was no statistically significant difference between the use of prophylactic LEV and symptomatic LEV. LEV alone or the combination of GBP with NAC provides more effective seizure control in the PTE facilitated by PTZ. On the other hand, the use of prophylactic LEV did not have any extra effect on posttraumatic seizure development and control.

Combination of Gabapentin and Vitamin B12 Compared with Gabapentin Monotherapy on Pain Improvement of Diabetic Neuropathy Patients

Diabetic neuropathy is the most common microvascular complication of diabetes mellitus (DM) occurring in 60–70% of the world's DM population, 40% of the DM population in Asia, and 41% of the DM population in Indonesia. The primary treatment of diabetic neuropathy pain in Indonesia is gabapentin and vitamin B12. The study aimed to compare pain improvements in diabetic neuropathy patients. The drug used was a combination of gabapentin and vitamin B12 and gabapentin monotherapy. For the pain degree measurement, we used the visual analogue scale (VAS). This experimental study was a pretest-posttest randomized control trial using a single-blind method at Dr. M. Salamun Air Force Hospital Bandung from March to May 2017. Samples were 44, type two diabetic neuropathy patients. The Mann-Whitney test to compare pain improvement between 2 groups applied. The results indicated there were differences in pain improvement between diabetic neuropathy patients with gabapentin and vitamin B12 combination compare to gabapentin monotherapy (p=0.002). This result showed a synergistic effect of gabapentin as an inhibitor of neurotransmitter and vitamin B12 expenditure as an improvement in peripheral nerve cells. This study concluded that gabapentin and vitamin B12 combination is better in improving pain in diabetic neuropathy patients compared to gabapentin monotherapy. KOMBINASI GABAPENTIN DAN VITAMIN B12 DIBANDING DENGAN MONOTERAPI GABAPENTIN TERHADAP PERBAIKAN NYERI PASIEN NEUROPATI DIABETIK Neuropati diabetik merupakan komplikasi mikrovaskular terbanyak diabetes melitus (DM) yang terjadi pada 60–70% populasi DM di dunia, 40% populasi DM di Asia, dan 41% populasi DM di Indonesia. Pengobatan utama nyeri neuropati diabetik di Indonesia adalah gabapentin dan vitamin B12. Tujuan penelitian ini membandingkan perbaikan rasa nyeri pada pasien neuropati diabetik. Obat yang diberikan adalah kombinasi gabapentin dan vitamin B12 serta monoterapi gabapentin. Pengukuran tingkat nyeri menggunakan visual analogue scale (VAS). Penelitian eksperimental ini adalah pretest-posttest randomized control trial dengan menggunakan metode single-blind yang dilakukan di RSAU Dr. M. Salamun Bandung dari bulan Maret hingga Mei 2017. Sampel berjumlah 44 jenis, dua pasien neuropati diabetik. Sampel berjumlah 44, pasien neuropati diabetik tipe dua. Uji Mann-Whitney dilakukan untuk membandingkan perbaikan nyeri antara 2 kelompok perlakuan. Hasil penelitian menunjukkan terdapat perbedaan perbaikan rasa nyeri pasien neuropati diabetik yang diberi pengobatan kombinasi gabapentin dan vitamin B12 dibanding dengan monoterapi gabapentin (p=0,002). Hasil ini menunjukkan efek sinergis gabapentin sebagai inhibitor neurotransmiter dan vitamin B12 yang berfungsi memperbaiki sel saraf tepi. Simpulan penelitian ini adalah pengobatan kombinasi gabapentin dan vitamin B12 lebih baik dalam memperbaiki rasa nyeri pada pasien neuropati diabetik dibanding dengan gabapentin saja.

Comparative evaluation of the effectiveness of the transdermal therapeutic system with fentanil and gabapentine in head pain therapy

The study was conducted to comparatively evaluate the effectiveness a transdermal therapeutic system with fentanyl and gabapentin in the treatment of headache in patients with non-traumatic subarachnoid hemorrhage. When assessing the intensity of headache in patients, it was found that with severe pain immediately after endovascular occlusion, the use of transdermal fentanyl with dexketoprofen or paracetamol is most acceptable, and the combination of gabapentin with dexketoprofen / paracetamol is better in case of headache in a more delayed period.

A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder.

Studies of the efficacy of gabapentin for treating alcohol use disorder (AUD) have yielded mixed findings. The aims of our study were to estimate gabapentin's effects on six alcohol-related outcomes, test potential moderators, examine publication bias and evaluate the quality of the studies. Meta-analysis of placebo-controlled randomized controlled trials (RCTs). Using PubMed and ClinicalTrials.gov, we selected RCTs of gabapentin's effects on alcohol consumption or a biochemical correlate of it, excluding studies limited to other primary outcomes or that combined gabapentin with other medications. We assessed study quality and used a random-effects model to analyze each outcome measure and the Egger regression test and funnel plots to assess publication bias. We identified seven RCTs of gabapentin that met study criteria. The quality of the studies overall was good, and there was no evidence of publication bias. Four to seven studies contributed to the analysis of the six outcome measures. For all outcome measures the effect estimates were in a direction that favored gabapentin over placebo. However, only for percentage of heavy drinking days was there good evidence of a benefit (g=-0.64, 95% confidence interval=-1.22 to -0.06). Although gabapentin appears to be more efficacious than placebo in treating AUD, the only measure on which the analysis clearly favors the active medication is percentage of heavy drinking days. Additional studies are needed to define more clearly the role of gabapentin in AUD treatment.

Sinomenine facilitates the efficacy of gabapentin or ligustrazine hydrochloride in animal models of neuropathic pain

Management of chronic pain is restricted by the lack of effective tools. This study evaluated the efficacies of sinomenine combined gabapentin or ligustrazine hydrochloride in treating peripheral and central chronic neuropathic pain.The study was conducted in mice with photochemically induced sciatic nerve injury, and in rats with photochemically induced spinal cord injury. For assessing the effectiveness of combined therapy, sinomenine, gabapentin or ligustrazine hydrochloride was injected intraperitoneally (i.p.), and pain behavioral tests were performed.At sub-effective dosages, pre-administration of sinomenine (for 60 min) plus gabapentin or ligustrazine hydrochloride, generated significant anti-allodynic effects in mice or rats with peripheral or central neuropathic pain. However, these effects were abolished when gabapentin or ligustrazine hydrochloride was pre-administered, and then sinomenine was given 60 min later. The combined efficacies of sinomenine and gabapentin or ligustrazine hydrochloride, cannot be blocked or reversed by the naloxone, suggesting the underlying mechanism is not mediated by opioid receptors. Moreover, following repeated treatments, sinomenine and gabapentin combination increased the baseline mechanical threshold, while generating prolonged analgesia, without introducing notable side effects.Sinomenine can enhance the efficacy of gabapentin or ligustrazine hydrochloride in rodent models of peripheral or central neuropathic pain, without introducing tolerance or other notable side effects. Findings of current study suggest that combing sinomenine and gabapentin or ligustrazine hydrochloride could be highly beneficial in neuropathic pain therapies.

Alcohol withdrawal-related outcomes associated with gabapentin use in an inpatient psychiatric facility.

IntroductionLimited evidence exists evaluating the impact of gabapentin in conjunction with benzodiazepines for the management of alcohol withdrawal. A review of outcomes associated with combination gabapentin and benzodiazepine therapy may illuminate new therapeutic uses in clinical practice.MethodsThis retrospective study evaluated the impact of gabapentin on as-needed use of benzodiazepines in inpatients being treated for acute alcohol withdrawal. The treatment cohort consisted of patients prescribed gabapentin while on a symptom-triggered alcohol withdrawal protocol. The control cohort consisted of patients on symptom-triggered alcohol withdrawal protocol without concurrent gabapentin use. Secondary objectives included length of hospital stay, duration on alcohol withdrawal protocol, frequency of complicated withdrawal, and use of additionally prescribed as-needed or scheduled benzodiazepines.ResultsThe gabapentin cohort was on the alcohol withdrawal protocol for a similar duration, compared with the control cohort (median of 4 [interquartile range: 2,6] days vs 3 [2,4] days, P = .09, respectively). Similarly, the gabapentin cohort required a median of 1 [1,2] benzodiazepine dose for alcohol withdrawal symptoms compared with a median of 1 [1,2] dose in the control cohort, P = .89. No significant difference was found between cohorts for as-needed and scheduled benzodiazepine use. Length of stay in hospital was similar between groups.DiscussionThese results suggest that gabapentin use, in conjunction with benzodiazepines, impacts neither the time on alcohol withdrawal protocol or the number of benzodiazepine doses required for withdrawal. Larger, prospective studies are needed to detect if gabapentin alters benzodiazepine usage and to better elucidate gabapentin's role in acute alcohol withdrawal.

Interleukin-1beta in synergism gabapentin with tramadol in murine model of diabetic neuropathy.

Neuropathic pain is a complication of cancer and diabetes mellitus and the most commonly used drugs in the treatment of the diabetic neuropathic pain have only limited efficacy. The aim of this study was to evaluate the role of the biomarker interleukin-1beta (IL-1ß) in the pharmacological interaction of gabapentin with tramadol in a model of diabetic neuropathic pain. CF-1 male mice, pretreated with 200mg/kg i.p. of streptozocin (STZ), were used and at day 3 and 7 were evaluated by the hot plate test and the spinal cord level of IL-1ß was determined. Antinociceptive interaction of the coadministration i.p. of gabapentin with tramadol, in basic of the fixed the ratio 1:1 of their ED50 values alone, was ascertained by isobolographic analysis. Tramadol was 1.13 times more potent than gabapentin in saline control mice, 1.40 times in STZ mice at 3days and 1.28 times in STZ at 7days. The interaction between gabapentin and tramadol was synergic, with an interaction index of 0.30 and 0.22 for mice pretreated with STZ at 3 and 7days. The combination of gabapentin with tramadol reversed the increased concentration of IL-1β induced by STZ in diabetic neuropathic mice. These findings could help clarify the mechanism of diabetic neuropathy.

Synergism between gabapentin-tramadol in experimental diabetic neuropathic pain.

Neuropathic pain is associated with several conditions such as surgery, cancer, and diabetes and can be induced experimentally. Among the drugs used as monotherapy are gabapentin and tramadol. The purpose of this study was to evaluate the coadministration of gabapentin and tramadol, by isobolographic analysis, in three different algesiometric assays in experimental diabetic neuropathic pain induced by streptozocin in mice. In all the behavioral tests, gabapentin or tramadol produced a dose-dependent antinociception and their coadministration resulted in a positive interaction. This effect can be explained by principles of multimodal analgesia, whereby the different mechanisms of action of each drug contribute to the combined effect in a supra-additive manner. The findings of the present study suggest that the combination of gabapentin and tramadol could be a useful strategy for the treatment of pain induced by diabetic neuropathy.

Response to duloxetine and gabapentin combination of a patient who has chronical orchialgia with bilateral tubular ectasia of rete testis and multiple epididymal cysts.

Tubular ectasia of rete testis (TERT) is a rarely seen benign condition of testis which can cause chronic orchalgia. TERT appears as an anechoic lesion in ultrasonography. However magnetic resonance imaging is a more sophisticated diagnostic tool. TERT is commonly associated with epididymal cysts. Generally a conservative treatment approach is preferred. In some cases surgery is required. In our case, 54-year-old male patient had bilateral TERT associated with bilateral multiple epididymal cysts. He had chronic testicular pain which did not respond to first- line conservative treatments. After use of duloxetine (60 mg PO) plus gabapentine (400 mg PO) combination as a second-line conservative treatment, the patient dramatically responded to this treatment. The patients who have chronic testicular pain caused by bilateral TERT and multiple epididymal cysts may be treated with combination of duloxetine (60 mg PO) plus gabapentine (400 mg PO) combination.

A qualitative analysis of gabapentin misuse and diversion among people who use drugs in Appalachian Kentucky.

Gabapentin, an anticonvulsant and analgesic for postherpetic neuralgia, has been thought to have no abuse potential despite numerous published reports to the contrary. Gabapentin has been linked with impaired driving and opioid use, highlighting the need to more fully understand its risk profile. Thirty-three individuals reporting recent nonmedical use of gabapentin were recruited from two ongoing longitudinal studies of drug users in Appalachian Kentucky to participate in focus groups. Four sessions were held (two in the community and two in jail settings), during which participants responded to questions regarding their personal experiences with gabapentin misuse. Focus group participants were similar to other gabapentin users in the larger cohort studies with respect to demographics and drug use behaviors. Overall, the sample reported having initiated gabapentin more than 10 years earlier after having it prescribed for a legitimate, though generally off-label, medical indication (e.g., pain, anxiety, opioid detoxification). Participants reported use of gabapentin in combination with buprenorphine, other opioids, cocaine, and caffeine to produce sought-after central nervous system effects (e.g., muscle relaxation, pain reduction, sleep induction, feeling drunk, and feeling "high"). Focus group responses highlighted the low cost of gabapentin for the purpose of getting high and noted increasing popularity in the community, particularly over the last 2 years. Gabapentin was a prominent drug of abuse in two cohorts of the primarily opioid-using individuals. Providers should be aware of gabapentin's abuse potential, and a reexamination of the need for scheduling is warranted. (PsycINFO Database Record

Postoperative analgesia in the surgical treatment of non-traumatic subarachnoid hemorrhage

The aim of the study was evaluation of headache treatment effectiveness in patients with non-traumatic subarachnoid hemorrhage, after surgical clipping of the aneurysm. The study included 105 patients, depending on the multimodal pain control method used, the following groups were formed: I — dexketoprofen or paracetamol; II — gabapentin plus dexketoprofen or paracetamol; III — Transdermal therapeutic system, the active element of which is fentanyl plus dexketoprofen or paracetamol. The drug of the reserve in all three groups was tramadol. The adequacy of the methods was judged by analgesic ability, using the Visual-Analog scale, and by the degree of influence on the level of consciousness, using of the Richmond Agitation-Sedation Scale. When evaluating the effectiveness of the methods, it was found that the combination of gabapentin and dexketoprofen/paracetamol is the most acceptable for this category of patients.

Multi-kinetics and site-specific release of gabapentin and flurbiprofen from oral fixed-dose combination: in vitro release and in vivo food effect

In this work, a fixed-dose combination of gabapentin and flurbiprofen formulated as multilayer tablets has been designed, developed and studied in vitro and in vivo. The aim was to construct a single dosage form of the two drugs, able to perform a therapeutic program involving three release kinetics and two delivery sites, i.e., immediate release of gabapentin, intra-gastric prolonged release of gabapentin and intestinal (delayed) release of flurbiprofen.An oblong three-layer tablet was manufactured having as top layer a floating hydrophilic polymeric matrix for gastric release of gabapentin, as middle layer a disintegrating formulation for immediate release of a gabapentin loading dose and as bottom layer, an uncoated hydrophilic polymeric matrix, swellable but insoluble in gastric fluids, for delayed and prolonged release of flurbiprofen in intestinal environment. The formulations were studied in vitro and in vivo in healthy volunteers.The in vitro release rate assessment confirmed the programmed delivery design. A significant higher bioavailability of gabapentin administered 30min after meal, compared to fasting conditions or to dose administration 10min before meal, argued in favor of the gastro-retention of gabapentin prolonged release layer. The two drugs were delivered at different anatomical sites, since the food presence prolonged the gastric absorption of gabapentin from the floating layer and delayed the flurbiprofen absorption. The attainment of a successful delayed release of flurbiprofen was realized by a matrix based on a polymers' combination. The combined use of three hydrophilic polymers with different pH sensitivity provided the dosage form layer containing flurbiprofen with gastro-resistant characteristics without the use of film coating.

Combination therapy of levetiracetam and gabapentin against nonconvulsive seizures induced by penetrating traumatic brain injury.

Posttraumatic seizures are a medical problem affecting patients with traumatic brain injury. Yet effective treatment is lacking owing to the limitations of antiepileptic drugs (AEDs) applicable to these patients. In this study, we evaluated the dose-response efficacy of levetiracetam (12.5-100.0 mg/kg) and gabapentin (1.25-25.0 mg/kg) administered either individually or in pairs at fixed-dose ratios as a combination in mitigating posttraumatic nonconvulsive seizures induced by severe penetrating ballistic-like brain injury (PBBI) in rats. Seizures were detected by continuous electroencephalogram (EEG) monitoring for 72 hours postinjury. Animals were treated twice per day for 3 days by intravenous injections. Both levetiracetam (25-100 mg/kg) and gabapentin (6.25-25 mg/kg) significantly reduced PBBI-induced seizure frequency by 44% to 73% and 61% to 69%, and seizure duration by 45% to 64% and 70% to 78%, respectively. However, the two drugs manifested different dose-response profiles. Levetiracetam attenuated seizure activity in a dose-dependent fashion, whereas the beneficial effects of gabapentin plateaued across the three highest doses tested. Combined administration of levetiracetam and gabapentin mirrored the more classic dose-response profile of levetiracetam monotherapy. However, no additional benefit was derived from the addition of gabapentin. Furthermore, isobolographic analysis of the combination dose-response profile of levetiracetam and gabapentin failed to reach the expected level of additivity, suggesting an unlikelihood of favorable interactions between these two drugs against spontaneously occurring posttraumatic seizure activities at the particular set of dose ratios tested. This study was the first attempt to apply isobolographic approach to studying AED combination therapy in the context of spontaneously occurring posttraumatic seizures. Despite the failure to achieve additivity from levetiracetam and gabapentin combination, it is important to recognize the objectivity of the isobolographic approach in the evaluation of AED combination therapy against seizures directly associated with brain injuries.

Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study

BackgroundAs a drug originally introduced for its anticonvulsant effects, gabapentin has been recently shown to be effective in the treatment of nausea and vomiting in various clinical settings. This study compared the antiemetic efficacy of oral gabapentin, intravenous ramosetron and gabapentin plus ramosetron in patients receiving fentanyl-based patient-controlled analgesia after laparoscopic gynecologic surgery.MethodsOne hundred and thirty two patients undergoing laparoscopic gynecologic surgery under general anesthesia were allocated randomly into three groups: group G received 300 mg oral gabapentin 1 h before anesthesia, group R received 0.3 mg intravenous ramosetron at the end of surgery, and group GR received a combination of 300 mg oral gabapentin 1 h before anesthesia and 0.3 mg intravenous ramosetron at the end of surgery. Postoperative nausea, retching, vomiting, rescue antiemetic drug use, pain, rescue analgesic requirements and adverse effects were assessed at 0–2, 2–24 and 24–48 h after surgery. Postoperative nausea and vomiting (PONV) was defined as the presence of nausea, retching or vomiting.ResultsThe incidence of complete response (no PONV and no rescue antiemetics up to 48 h postoperatively) was significantly higher in group GR (26/40, 65%) than group G (16/40, 40%; P = 0.025) and group R (18/44, 41%; P = 0.027), whereas there was no significant difference between group G and group R (P = 0.932). There were no significant between-group differences in the incidence of emetic episodes, use of rescue antiemetics, severe emesis, use of rescue analgesics or any adverse effects. Postoperative pain scores were also similar among groups.ConclusionsThe combination with gabapentin and ramosetron is superior to either drug alone for prevention of PONV after laparoscopic gynecologic surgery.Trial registrationClinicalTrials.gov NCT02617121, registered November 25, 2015.

Evaluation of Gabapentin and Clonidine Use in Children Following Spinal Fusion Surgery for Idiopathic Scoliosis: A Retrospective Review.

Opioids are the mainstay of therapy for pain relief following posterior spinal fusion (PSF) surgery. Various adjunctive medications are being used to augment analgesia and to reduce opioid-related side effects. At our institution, we have sequentially added 2 adjuncts to a standard morphine patient-controlled analgesia (PCA) regimen. The goal of our study was to evaluate pain control and the benefit of gabapentin and the combination of gabapentin and clonidine, whereas morphine PCA was in use in children following PSF surgery. Following Institutional Review Board approval, data were collected retrospectively from the charts of 127 patients who underwent PSF for idiopathic scoliosis. Children were divided into the 3 following groups: group P, morphine PCA only (42 patients), group G, morphine PCA+gabapentin (45 patients), and group C, morphine PCA+gabapentin+clonidine (40 patients). Addition of gabapentin to our regimen improved the outcome, but the addition of transdermal clonidine and gabapentin together were found to be significantly better in some aspects. Children in group G and C used less morphine on postoperative day 1 following surgery, had more PCA demand-free hours, were able to take orals, were able to ambulate sooner, and had a shorter hospital stay than group P. There were no differences in side effects or sedation between the 3 groups. In conclusion, additions of postoperative transdermal clonidine and perioperative oral gabapentin together were found to improve functional outcomes following PSF surgery. Group G and C had reduced opioid use and shorter hospital stay than group P. Addition of these adjuncts together was found to be better since group C patients made fewer PCA attempts to obtain morphine over the first 10-hour period postoperatively and were able to ambulate sooner than group G. The PCA pump usage pattern provides useful information about patient comfort and efficacy of adjunctive medications. Level II-retrospective study.

The choice of treatment tactics dysuric symptoms in patients with overactive bladder

The objective: the aim of the study was to determine the differentiated approach to medicine therapy in the patients with overactive bladder (OAB), depending on the clinical features of the disease progress. Patients and methods. The study involved 87 women with lower urinary tract symptoms, the appropriate criteria for the diagnosis of OAB. It has been found that the pathogenic effect of the antidepressant Mirtazapine therapy in combination with an anticonvulsant Gabapentin in the treatment of OAB is to optimize the reservoir and evacuation function of the bladder. Results. Combination therapy according to the m-anticholinergic Tolterodine and Mirtazapine helps to restore control of urination and an increase in the absolute and relative volume of the bladder, significantly improves urination, without giving rise to obstructive voiding. Conclusion. The study showed the effectiveness of combination of Gabapentin and Phenibut during the treatment of OAB with algic syndrome that marked the end of 6 weeks of cystalgia intensity decrease by 62%.

Investigation of the effects of magnesium orotate in a model of primary generalized seizures

Objective : to investigate the anticonvulsant and neuroprotective effects of magnesium orotate in a rat thiosemicarbazide model of seizures in rats. Material and methods . The investigation was conducted in 112 male albino rats weighing 200 g, in which severe clonic-tonic seizures weresimulated by the convulsant thiosemicarbazide. The anticonvulsant effects against of thiosemicarbazide-induced seizures were evaluated in the following drugs: gabapentin; a combination of gabapentin + magnesium orotate; sodium valproate; a combination of sodium valproate + magnesium orotate; and magnesium orotate. The neurological status, characteristics of seizures, survival rates, body weight, and plasma and red blood cell magnesium concentrations were compared. After completing the animal experiment, the animals were euthanized and the histological characteristics of their brains and nerves were analyzed. Results. Magnesium orotate was ascertained to reduce the severity and duration of thiosemicarbazide-induced seizures, to increase animal survival rates, and to potentiate the anticonvulsant action of gabapentin and sodium valproate. The neurohistological findings showed that the used model of seizures led to ischemic brain damage. Conclusion . It has been concluded that magnesium orotate minimized the level of ischemic damage to nerve cells and contributed to restoration of the morphology of brain tissues after thiosemicarbazide administration.

Antinociceptive interaction of gabapentin with minocycline in murine diabetic neuropathy.

Diabetic neuropathy (DN) is the most common complication of diabetes and pain is one of the main symptoms of diabetic neuropathy, however, currently available drugs are often ineffective and complicated by adverse events. The purpose of this research was to evaluate the antinociceptive interaction between gabapentin and minocycline in a mice experimental model of DN by streptozocin (STZ). The interaction of gabapentin with minocycline was evaluated by the writhing and hot plate tests at 3 and 7days after STZ injection or vehicle in male CF1 mice. STZ (150mg/kg, i.p.) produced a marked increase in plasma glucose levels on day 7 (397.46±29.65mg/dL) than on day 3 (341.12±35.50mg/dL) and also developed neuropathic pain measured by algesiometric assays. Gabapentin produced similar antinociceptive activity in both writhing and hot plate tests in mice pretreated with STZ. However, minocycline was more potent in the writhing than in the hot plate test in the same type of mice. The combination of gabapentin with minocycline produced synergistic interaction in both test. The combination of gabapentin with minocycline in a 1:1 proportion fulfills all the criteria of multimodal analgesia and this finding suggests that the combination provide a therapeutic alternative that could be used for human neuropathic pain management.