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Showing content with the highest reputation since 07/09/2020 in all areas

  1. 1 point
    Welcome to the PCSS Forums!
  2. 1 point
    #1. Dosing of gabapentanoids should be tid or qid. Half life ~ 6 hours. There are now 2 long acting gabapentins and a long acting pregabalin formulations. These are more expensive and would probably require a prior authorization. Concerns over misuse of gabapentanoids should be managed in a similar paradigm as misuse of other medications. Urine testing would require sending to lab as I don't know of a point of care immunoassay for gabapentanoids. #2. I don't have any informed advice on the suicide issue as it relates to gabapentanoids. #3. I presented a study comparing lorazepam to gabapentin in an outpatient alcohol withdrawal study(attached). I do not believe there have been publications specifically addressing prevention of seizures in the alcohol withdrawal syndrome. Benzodiazepines remain the first line drug class in treating alcohol withdrawal. Alcohol_Withdrawal_Acute_Myrick.pdf
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    Hello, This sounds like it may have been a urine gabapentin test (Quest ref range < 1000 ng/mL) versus a serum gabapentin test (result peak ranges 2.7 - 4.1 mcg/mL and 4.0 - 8.5 mcg/mL for single vs multiple doses of 900 - 1800 mg/day). If the urine specimen tested was very concentrated, this would cause a higher ng/mL result. Unless you're just looking for the unexpected/expected presence of gabapentin, a serum gabapentin test would be the better one to order for a more accurate level. I hope this is helpful to someone if not the original poster.
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    Dr. Andrew Saxon provided this response: If OUD is being treated with buprenorphine in the context of chronic pain, the buprenorphine dosage can be optimized to help with the pain. Typically, that would require a dosage of 8 mg tid or qid. For some patients with OUD and chronic pain, methadone maintenance is a better option since methadone is a full agonist. Neither of these medications have serious interactions with lithium In regard to other possibilities, although non-steroidal anti-inflammatory medications do interact with lithium, lithium is not a contraindication to their use. Since they can elevate lithium levels, one simply has to monitor the patient and obtain serum lithium levels to make sure lithium levels remain in the therapeutic range. So NSAIDS are one option and can be combined with acetaminophen for even more robust pain control. It is now fairly clear that antidepressants can be safely used in bipolar patients who are on a mood stabilizer such as lithium. Thus, tricyclic antidepressants like nortriptyline or SNRIs like duloxetine which can help with chronic back pain are another option. If the pain has a neuropathic component, gabapentenoids or baclofen are other options that can be safely used with lithium. Of course, behavioral interventions like cognitive-behavioral therapy also show benefit for chronic pain. It is understood that this form of treatment may be out of reach if there is no trained therapist available or for patients who do not have insurance.
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