痛性周围神经病-培训课件.ppt

经研究表明加巴喷丁可能主要通过3条途径发挥抗神经痛的作用 * 普瑞巴林 2004年 FDA批准用于治疗糖尿病性神经痛和带状疱疹性神经病. It is a structural, but not functional, analogue of GABA. It acts as a ligand of the alpha2-delta subunit, a protein associated to the voltage-dependent calcium channels. Modulation of these channels decreases calcium entry into nerve endings, resulting in a decreased release of several excitatory neurotransmitters.  Pregabalin had a linear pharmacokinetics with little variability between the different subjects. It does not bind to plasma proteins, has no liver metabolism, and is excreted trough the kidneys. Few interactions with other drugs may be expected based on these characteristics. Pregabalin in the treatment of neuropathic pain Biegstraaten M, van Schaik IN. Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Neurologie, Meibergdreef 9, 1105 AZ Amsterdam. Ned Tijdschr Geneeskd. 2007 Jul 14;151(28):1561-5.  Pregabalin is increasingly being used for the treatment ofneuropathic pain, often as the first-line choice. The question is, however, whether this choice is based on evidence. Seven trials have been published on the effect ofpregabalin in patients with postherpetic neuralgia and painful diabetic neuropathy. These trials more frequently report a 50% reduction in pain in pregabalin treated patients than in patients treated with placebo (number needed to treat 4.3). Dizziness and somnolence are the most frequent adverse events of pregabalin. The number needed to harm for adverse events leading to discontinuation of treatment varies from 3.7 to 113.1 in these studies. Pregabalin has not been compared head-to-head with other drugs commonly used for neuropathic pain.  Indirect comparison reveals the effectiveness of pregabalin is comparable with that of carbamazepin, tramadol, and gabapentin; pregabalin is possibly less effective than amitriptylin. However, taking into account its price and the lack of clinical experience and evidence, using pregabalin a