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We searched the Cochrane Epilepsy Group Specialized Register (September 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 11), MEDLINE (via Ovid) (1946 to September 2015), EMBASE (1974 to September 2015), Pharmline (1978 to September 2015), Reprotox (1983 to September 2015) and conference abstracts (2010-2015) without language restriction.
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Ex vivo studies assessed the influence of polarity, applied current (0.064-0.32 mA) and subdermal concentration (0.5-20 μg/mL) on the recovery of gabapentin. These experiments were carried out in vertical Franz diffusion cell for a period of 3 h using rat skin. In vivo experiments examined the versatility of this method to extract gabapentin from the subdermal region following intravenous administration of gabapentin (30 mg/kg) in rat model.
Gabapentin was used for the treatment of term and preterm infants with suspected visceral hyperalgesia caused by a variety of neurologic and gastrointestinal morbidities. Improved feeding tolerance and decreased irritability were seen, as well as decreased usage of opioids and benzodiazepines. Adverse events occurred with abrupt discontinuation of this medication.
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AW was associated with poorer baseline performance on 4 of 8 measures, and individuals with higher baseline AW who received the gabapentin and flumazenil combination demonstrated greater improvement on a measure of response inhibition than those with lower AW or those who received a combination of placebos. Improvement in response inhibition during the first week and medication group interacted in their effect on subsequent drinking, such that improvement predicted greater abstinence only among individuals who received gabapentin and flumazenil. Improvement on other neurocognitive measures was neither differentially impacted by medication or baseline AW nor related to subsequent drinking.
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Acquired nystagmus occurs frequently in patients with multiple sclerosis and is often the cause of illusory motion of the environment (oscillopsia), and blurring of vision. Based primarily on the beneficial effect of gabapentin on acquired pendular nystagmus (APN), a GABAergic mechanism in controlling nystagmus has been hypothesised. If increasing GABA concentrations in the CNS are critical for the treatment of nystagmus, then a selective GABAergic drug should be highly successful. However, as gabapentin is not a selective GABAergic agent, vigabatrin, a "pure" GABAergic medication, and gabapentin, were compared in a single blind cross over trial in eight patients with definite multiple sclerosis. Patients were randomly assigned to begin with gabapentin (1200 mg daily) or vigabatrin (2000 mg daily). Neuro-ophthalmological and electro-oculographic (EOG) evaluations were performed four and three times, respectively. Treatment efficacy was based on improving visual acuity and EOG indices (amplitude or frequency of nystagmus, or both) by at least 50% of pretreatment values. Three out of eight patients dropped out due to adverse effects. In the remaining five patients gabapentin improved symptomatic pendular or gaze evoked jerk nystagmus in four. Three patients decided to continue gabapentin therapy. Importantly, vigabatrin proved useful in only one out of five patients, suggesting that gabapentin effectiveness may be related to additional non-GABAergic mechanisms of action. Interaction with cerebral glutamate transmission by inhibition of NMDA receptor might be an alternative hypothesis for the therapeutic action of gabapentin.
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We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, CINAHL, PsycINFO (August 2008) and WHO ICTRP Search Portal. We handsearched reference lists of reviews and included articles, reviewed conference proceedings and contacted experts.
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Thirty cocaine-dependent subjects (DSM-IV criteria) were enrolled in an 8-week, open-label trial of 1,200 mg/day of gabapentin in divided doses. Urine drug screens, subjective measures of craving, and cocaine use interviews were conducted at each weekly visit.
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We randomly allocated 86 patients scheduled for lower limb surgery under spinal anesthesia into two equal groups that received either gabapentin 1200 mg or placebo 2 h before operation in a prospective, double-blind manner. All patients received an intrathecal injection of 15 mg of 0.5% isobaric bupivacaine and 0.2 mg preservative-free morphine. Pruritus was evaluated at 3, 6, 9, 12, and 24 h after intrathecal morphine administration.
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It can be concluded that OCBZ can successfully be administered to patients with hepatic porphyria and focal epilepsy who did not respond to treatment with GBP.
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A review of PubMed for articles published through December 2009 using the keywords: 'irritable bowel syndrome', 'therapeutics', 'antidiarrhoeals', 'laxatives', 'loperamide', 'dietary fibre', 'psyllium', 'calcium polycarbophil', 'bulking agents', 'lubiprostone', 'antidepressant agents, tricyclics' and its representative entities, 'serotonin reuptake inhibitors' and its representative entities, 'dicyclomine', hyoscyamine', 'peppermint oil', 'parasympatholytics' and its representative entities, 'rifaximin', 'pregabalin', 'gabapentin', 'clonidine', 'octreotide', 'atropine' and 'probiotics' is provided. Placebo-controlled trials were evaluated for the strength of evidence supporting the efficacy of each medication for explicit IBS symptoms. The efficacy of each medication for the symptoms of abdominal pain, bloating, stool form, mucus, urgency, feeling of incomplete evacuation, flatulence, frequency, or borborgymi and overall symptoms are reported by IBS subtype.
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One hundred and one articles were identified meeting the study inclusion criteria. Coverage varied by newspaper. The Wall Street Journal had the most coverage on the topic (45%), and USA Today and Chicago Tribune had the least coverage (5%). Overall, most of the stories sampled were deemed to have a negative tone in coverage (77%), focusing mainly on lawsuits against drug companies for promoting their drugs for off-label uses. Pfizer's Neurontin(®) (Pfizer Inc., New York, NY 10017, USA) and Johnson & Johnson's Retin-A(®) (Orthoneutrogena, Los Angeles, CA 90045, USA) received the most media attention.
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No comparison between drugs was possible. One CNS AE was significantly more frequent for levetiracetam, two for zonisamide and gabapentin, three for lamotrigine and four for pregabalin and topiramate.
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Desipramine (100 mg/day) and duloxetine (60 mg/day) appear to be more cost effective than gabapentin or pregabalin for treating painful diabetic neuropathy. The estimated value of duloxetine relative to desipramine depends on the assumptions made in the statistical analyses of clinical trial data.
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This model found pregabalin to be cost-effective in treating patients with severe fibromyalgia.
Participants experienced a significant reduction in both depressive and manic symptoms.
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Eight trials with 962 women were included in the analysis, but only four trials were of high quality. All the trials were small. We carried out subgroup analysis for different drugs within the same group and for high versus low doses of the same drug. However, the relatively few studies (one to two trials) and numbers of women (40 to 136) limits the reliability of these subgroup analyses.Due to limited data available no conclusions can be made regarding the safest and the most effective form of oral analgesia for post-caesarean pain. Further studies are necessary.
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A total of 1,152 articles were screened and 25 articles were reviewed. Fourteen articles found a reduced incidence of post-operative delirium using pharmacological agents: eight with antipsychotics, two with statins, one with melatonin, one with dexamethasone, one with gabapentin, and one with diazepam. However, study designs, methodological issues, or authors' interpretations raise questions on these conclusions.
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Anorgasmia is the inability to reach orgasm during sexual intercourse, and, although it is believed that around 90% of anorgasmia problems are related to psychological issues, the use of serotoninergic drugs, including antidepressants and atypical antipsychotics, is a common cause of situational anorgasmia. Pregabalin is a new antiepileptic drug, structurally related to gabapentin, and commonly used as adjunctive therapy for partial epilepsy and treatment of neuropathic pain in adults. Herein, we describe three men with epilepsy, who experienced severe anorgasmia after pregabalin add-on treatment.
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Random assignment of subjects to receive adjunctive treatment with either gabapentin (900 mg/day) or placebo under double-blind conditions.
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We found 13 cases of myoclonus. All patients had refractory epilepsy and were taking other antiepileptic drugs (AEDs). Six patients had a severe chronic static encephalopathy; five patients had no medical diagnosis other than seizures. Ten patients developed multifocal myoclonus. Three patients developed focal myoclonus, contralateral to their epileptic focus. Two patients had an exacerbation of preexistent myoclonus. An EEG performed during myoclonus on three patients showed no correlate. The myoclonus tended to persist as long as GBP was maintained, whereas discontinuance of GBP resulted in rapid cessation of the myoclonus. In all cases the myoclonus was subtle and did not significantly interfere with daily activities.
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Hidradenitis Supprurativa is a painful dermatological condition. Although the pain of HS has unique aspects, the pain of HS pain shares common elements with essential pain, fibromyalgia, and pure neuropathic pain syndromes. Futhermore, depression plays an important role in the pain of HS. This paper reviews the potential for use of nonsteroidal anti-inflammatory drug (NSAIDS), acetaminophen, celecoxib, gabpentin, pregabalin, and the serotonin and norepinephrine reuptake inhibitors (SNRIs), duloxetine and venlafaxine, for treating HS related pain. No studies exist for pain control in HS. Initially, the pain of HS is treated medically e.g. oral rifampin and clindamycin or adalimumab to decrease inflammation, but an analysis of pain medications to treat the pain of HS merits its own discussion and treatment algorithm. First-line HS pain treatments include: topical analgesics and oral NSAIDs, such as celecoxib (Celebrex®), and acetaminophen. If these are inadequate, which is common, the less expensive gabapentin (Neurontin®) 400-1200 mg TID or the more expensive (Lyrica®) pregabalin 50-100mg BID can be added for synergistic effect. In my experience, HS patients prefer pregabalin, which induces less drowiness than gabapentin. If these combinations are inadequate, an SNRI can be added. Of SNRIs, duloxetine (Cymbalta®) 30-120 mg, given QD or divided BID, is most optimal. I have used gabapetin or pregabalin in combination with duloxtine effectively. Venlafaxine (Effexor®), 75 mg-375mg (divided into BID or TID dosing), or in extended release form Venlafaxine ER (Effexor ER®) (37.5mg-375mg daily) can be combined with pregalin or gabapetin. Venlafaxine's cardiovascular side effects and lesser effectiveness serves HS patients less well then duloxetine, in my experience. An advantage of duloxetine and venlafaxine is that they can be used to treat the depression often associated with HS. If prolonged use of opiates is required, patients should be referred to a pain specialist.
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A 72-year-old man presented with a chronic illness constituted by muscle rigidity affecting his lower limbs, trunk and neck, either spontaneous or triggered by stimuli, together with a spastic paraparesis, manual amyotrophy and pseudobulbar syndrome. The electrophysiologic study showed continuous motor unit activity integrated by normal motor unit potentials. Biochemical and imaging results were normal. These data suggest the diagnosis of idiopathic progressive encephalomyelitis with rigidity. Following administration of gabapentin (2000 mg daily), muscle rigidity and electromyographic continuous motor unit activity were suppressed. Transient drowsiness was the only side effect. The authors have tried to relate these findings to those found in the literature.
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The objective of the present study was to investigate the effects of the antiepileptic drugs, gabapentin and phenytoin, on sperm morphology in Wistar rats. Groups (n=5) of rats were treated with cyclophosphamide (20 mg/day), gabapentin (16, 25, 32 mg/day) and phenytoin (3.5, 5.5, 7 mg/day) for five consecutive days. 14 and 35 days after the last exposure, sperm morphology was evaluated by standard procedure. Gabapentin and phenytoin did not induce significant changes in sperm morphology. The results suggest that phenytoin and gabapentin are not germ cell mutagens in males, and do not appear to adversely affect male fertility.
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Recent data indicate the possibility of P-glycoprotein involvement in drug resistance in patients diagnosed with epilepsia. It was demonstrated that P-glycoprotein is expressed in the endothelial cells of the blood-brain barrier, and in neurons and glial cells isolated from the epileptogenic brain tissue. The glycoprotein functions as an efflux pump, thus limiting penetration of antiepileptic drugs (phenytoin, carbamazepine, phenobarbital, gabapentin, felbamate, topiramate, lamotrigine) to the site of action. A naturally occurring MDR1 polymorphism has been described and correlated with potential clinical effects. The C3435T polymorphism was found to significantly correlate with the function of MDR1 and the expression of P-glycoprotein. This polymorphism consists of a C-to-T exchange at position 3435 in exon 26 of the MDR1 gene. Individuals with the TT genotype had significantly lower P-glycoprotein expression than those with the CC and CT genotype. Because C3435T does not change the amino acid sequence and is not located at a promotor position in the MDR1 gene, it is unlikely that this polymorphism directly influences P-glycoprotein expression. However, a strong association between the C3435T and G2677 (A, T) allele was revealed. Since G2677 (A, T) in exon 21 is a missense mutation, it is likely to be causative for differences in P-glycoprotein expression. Finding out the relationship between MDR-1 gen polymorphism and drug-resistant epilepsia may lead to the effective treatment of epilepsia by application of P-glycoprotein inhibitors.
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A 61-year-old man presented following ingestion of 24 g of theophylline SR (300 mg/kg), 240 mg of diazepam and 2 g of gabapentin. He required intubation and developed a supraventricular tachycardia treated with esmolol, but suffered no seizures. Serum theophylline concentration peaked at 636 μmol/L (55-110) at 9.5 h post-ingestion. Intermittent haemodialysis was performed for 4 h and resulted in a theophylline extraction ratio of 0.57 with elimination half-life of 2.3 h. SLED was subsequently performed on two occasions for 7 h. Theophylline extraction ratio ranged from 0.46 (half-life 5.3 h during the first cycle) to 0.61 (half-life 10.6 h during the second cycle). After cessation of SLED, elimination half-life was 26 h. The patient made an uneventful recovery.