The drug is prescription and requires clear indications for its purpose. Neurontin designate adult patients with neuro-pathological pains. It is also shown as a monotherapy in the treatment of partial cramps, both with the presence of secondary generalization, and without it in patients over 12 years of age. In young children with the same diagnosis, Neurontin is used as an additional means.
Pharmacological Group - Anti-epileptic drugs, Anticonvulsant.
Composition and form of release:
Gabapentin 300 mg, auxiliary substances: lactose; Corn starch; Talc in the Contour box 10 PCs.; In a pack of cardboard 2, 5 or 10 packages.
The main active substance of Neurontin is gabapentin, which has a proven ability to prevent the occurrence of seizures.
Sometimes the beginning of the course of treatment Neurontin also begin gradually-on the first day of 300 mg * Once a day, in the second-300 mg * 2 times a day, the dose of the third day is 300 mg * 3 times a day. In the vast majority of cases the daily dose of 900 mg of Neurontin is standard for adult patients. Sometimes it is increased by indications up to 3.6 and even 4.8 g per day; Do it also gradually, increasing the dosage every day. It is proved that further increase of dosage reduces bioavailability of gabapentin in the body. In this case, the maximum time interval between the methods of Neurontin by the instruction should not exceed 12 hours. Otherwise, seizures may occur.
The drug is produced in the form of tablets and capsules. Neurotic treatment does not require laboratory control. According to medical appointments it can be combined with other anticonvulsant means. For patients with chronic kidney disease may be advisable to reduce the conventional dosage of Neurontin. In the treatment of neurotic should strictly adhere to the prescribed doses and prevent them from exceeding. In overdose drug should immediately consult a doctor. It is also necessary to inform the doctor about other prescribed drugs in order to avoid the negative effects of their interaction.
There is no exact definition of what epilepsy is, which is the impetus to physiological changes in brain function.
However, it is possible to trace pattern among individuals.
- Genetic conditions: Studies combine special genes with the origin of epilepsy. Take some genes that have every chance to produce a person susceptible to being around the area, basic to seizures.
- Each type of injury or head defect can cause epilepsy.
- Brain tumors or strokes also have all the chances to awaken the fallen, and sometimes this is due to people older than 35 years.
- Similar diseases, as well as drug and adenovirusny inflammation, in addition have all the chances to cause epilepsy
- Up to families of traumas have all chances besides to cause to weak formation of a brain that have all chances to serve as a cause to epilepsy. These traumas have all chances to happen with-because of bad feeding, infection at mother or lack of air. Brain smashed paralysis is also able to happen to-because of the data.
- Someone in addition is able to be associated with the formation of disorders, similar to the non-sociability.
Causes of risk:
There are certain reasons that can lead to epilepsy.
- Age is a factor as there is no age limit. The disorder can happen at any age.
- Home history or hereditary causes can incite this disease.
- Head injuries are also caused by epilepsy. No matter what tragedy or head trauma can cause this disorder. It is recommended to wear protection on the head while riding a bicycle.
At an early age, epilepsy can pass by itself, in other cases, treatment is required.
The treatment can be divided into three popular ways:
- Drug treatment, for example, neurontin
- Operational intervention,
- Stimulation of the wandering nerve, electrostimulation and Ketnaya diet.
|How to treat epilepsy|
|Depression, mania, anxiety|
|Anticonvulsant, Anti-Seizure Medication|
|How to overcome neuropathic pain|
Diagnosis and Treatment Epilepsy
Anticonvulsants Drugs in Epilepsy
The application of these drugs buys a variety of types of epilepsy. These include temporal, cryptogenic, focal and idiopathic. Before the use of certain drugs need to learn everything about the complications, because these tools often cause adverse reactions.
Ethosuximide and Trimethadon are used in small convulsions. Clinical experiments have confirmed the rationality of the use of these drugs in children, because they cause the least amount of adverse reactions.
Many drugs are quite toxic, so the search for new remedies does not stop.
- The beclamide.
The main list of anticonvulsants drugs in epilepsy looks like this
It is caused by the following factors:
- We need a long-lasting reception.
- Seizures occur frequently.
- It is necessary to conduct treatment parallel to mental and neurological diseases.
- The number of cases in elderly people is increasing.
The greatest amount of forces in medicine is the treatment of the disease with relapses. Patients have to take medications for long years and they get used to drugs. At the same time, the disease operates against the backdrop of drug use, injections.
The goal of correct prescription of epilepsy drugs is to select the most appropriate dosage that can allow the disease to be controlled. The drug should have a minimum number of side effects.
The period of treatment is individual. The more remission periods are, the more money can be saved by reducing the number of beds-days. The increase of outpatient receptions makes it possible to find the most accurate dosage of medicines against epilepsy.
What drug to take for the treatment of epilepsy
Only one medicinal product is prescribed to persons suffering from epilepsy. This rule is justified by the fact that if you take several medications at once, their toxins can be activated. First, the medicine is prescribed in the smallest dosage to trace the body's reaction. If the drug does not work, the dosage increases.
First of all doctors choose one of the following medications:
- Gas tank;
These tools have confirmed their effectiveness to the maximum.
If for any reason these medicines are not suitable, they are chosen from the second group of drugs.
Preparations of the second stage of choice:
These drugs are popular no different. This is due to the fact that they do not have a proper therapeutic effect, or work with pronounced side effects.
Only the doctor has the right to choose the drug, as well as its dosage. Different composition of drugs acts on a certain type of attacks.
How to take tablets:
Epilepsy is treated long enough, appointing drugs in quite large doses. For this reason, before appointing a particular drug, conclusions are drawn about what is the expected benefit of this treatment, whether the positive effect will override the harm from adverse reactions.
Sometimes a doctor may not prescribe medication. For example, if the consciousness is disconnected shallow, or the attack was in the singular and the first time. Admission of "new" medicines from epilepsy should be carried out in the morning and in the evening, and the break between the admission of the drug cannot be less than twelve hours.
To be sure not to miss the next pill, you can start an alarm clock.
If the doctor recommended taking the Pill three times a day, you can also have an alarm clock for 8, 16 and 22 hours.
If the drug is intolerant, it is necessary to inform the doctor immediately. If the case is heavy, you need to immediately call an ambulance.
Gabapentin (Neurontin) in the treatment of neuropathic pain
In a population, neuropathic pain occurs in 1-1.5% of cases. Today it brings together a whole group of chronic pain syndromes that were previously considered independently. This group includes pain in various mono- and polyneuropathies. Among them, the most frequent pain occurs in diabetic and alcoholic polyneuropathy (25-45%). Postherpetic neuralgia (in the elderly, this complication occurs in 70% of cases of herpes zoster) is also a variant of neuropathic pain. For neuropathic pain
syndrome is a complex regional pain syndrome (local pain with swelling, trophic disorders and osteoporosis), which was previously referred to as reflex sympathetic dystrophy. Typical examples of neuropathic pain are trigeminal neuralgia, phantom pain, post-stroke central pain, pain in multiple sclerosis, syringomyelia, and spinal cord injury. According to different authors, the incidence of neuropathic pain in diabetic polyneuropathy reaches 45%, multiple sclerosis - 28%, syringomyelia - 75%, cerebral stroke - 8%, nerve injury - 5%. Among all patients with neuropathic pain, about 50% are patients with diabetic polyneuropathy. Unfortunately, pain in these patients is often interpreted as vascular or vertebral, which leads to inadequate therapeutic measures.
Nociceptive pains are more often acute, and neuropathic pains are chronic. In certain cases there is a combination of nociceptive and neuropathic components of pain (with compression radiculopathy).
Neuropathic pain has some peculiarities. First of all, it is accompanied by specific sensory disorders. Very characteristic of neuropathic pain is allodynia - the appearance of pain in response to a stimulus, which under normal conditions does not cause pain. In such cases, patients experience severe pain at the slightest touch, sometimes even when the wind blows. There are temperature and mechanical allodynia. Mechanical allodynia is divided into static, which appears when pressure is applied to a fixed point of the skin, and dynamic that occurs when moving stimuli, for example, slight irritation of the skin with a brush or finger.
In case of neuropathic pain, hyperesthesia, hyperalgesia and neuralgia are often observed. When hyperalgesia sensitivity to pain stimulus is significantly higher than expected in normal. In the subjective response to both painful and non-painful stimuli is excessive and often persists for a long time after the cessation of irritation. The phenomenon of neuralgia (trigeminal, postherpetic) is a typical example of neuropathic pain.
The patient may also be disturbed by spontaneous pains arising from the apparent absence of any external influence. They, as a rule, are burning, piercing character. The feeling of tickling, painless tingling, or other similar sensations belong to paresthesias; if these sensations hurt, they are called dysesthesies.
Pathophysiology of neuropathic pain
The pathophysiological mechanisms of neuropathic pain syndrome are complex. Neuropathic pain occurs as a result of impaired interaction between nociceptive and antinociceptive systems as a result of their defeat or dysfunction at various levels of the nervous system. The role of peripheral nerves, roots, the posterior horn of the spinal cord, pain neurotransmitters, glutamate receptors, sodium and calcium channels has been studied the most. Possible mechanisms of pain include spontaneous ectopic activity of damaged axons, sensitization of pain receptors, pathological interactions of peripheral sensory fibers, and hypersensitivity to catecholamines. Much attention is paid to the study of the mechanisms of central sensitization, the phenomenon of "inflation", the lack of antinociceptive descending effects on the posterior horn of the spinal cord (central disingibytsii) [1,7].
The central sensitization of a group of spinal cord neurons is the result of neuronal plasticity activated by primary afferent stimulation. This process is considered crucial in the formation of neuropathic pain syndrome and leads to the development of allodynia.
Voltage-dependent calcium N-channels are located in the surface plate of the posterior horn of the spinal cord and are involved in the formation of neuropathic pain. There is evidence of increased release of neurotransmitters with the activation of N and P types of voltage-dependent calcium channels. The α2δ subunit, which is part of all voltage-dependent calcium channels, is believed to be a target for the anti-allodinic action of gabapentin.
Neuropathic Pain Treatment
Therapy for neuropathic pain is often a difficult task due to the variety of treatments. To combat it, apply non-drug and drug methods. Among non-drug use methods that enhance the activity of antinociceptive systems: acupuncture, transcutaneous electro neurostimulation, spinal cord stimulation, physiotherapy, biofeedback, psychotherapy. Less commonly used are blockades and neurosurgical treatment methods (destruction of the posterior root occurrence zone) that block the flow of afferent nociceptive afferentation. For the pharmacotherapy of neuropathic pain, local anesthetics, opioids, central muscle relaxants, antiarrhythmic drugs, antidepressants and anticonvulsants are used. It should be noted that simple analgesics (paracetamol, aspirin) and nonsteroidal anti-inflammatory drugs (diclofenac, indomethacin, etc.) are not very effective in neuropathic pain and are not used to treat it. This is due to the fact that the main mechanisms of neuropathic pain are not inflammation, but neuronal and receptor disorders, peripheral and central sensitization.
Local anesthetics (lidocaine 5% cream or patch) are used to block peripheral nociceptors; perineural injections of corticosteroids or a combination of corticosteroids and local anesthetics can be used to treat pain with
mononeuropathies and neuromas. Other drugs used in patients with neuropathic pain include central muscle relaxants (baclofen, tizanidine) and opioid analgesics (morphine, codeine, oxycodone, tramadol, dextromethorphan, metodon). Some membrane stabilizing drugs, in particular lidocaine and mexiletin, were sometimes prescribed for the treatment of neuropathic pain in diabetic and alcoholic polyneuropathies. However, frequent side effects limit the use of these agents.
Antidepressants are most commonly used in neuropathic pain, although they cause side reactions (especially tricyclic antidepressants) associated with anticholinergic action, orthostatic hypotension, and heart rhythm disturbances.
Anti-convulsants have been used in the treatment of chronic pain since 1942 (difenin). Carbamazepine was recognized as the drug of first choice in the treatment of trigeminal neuralgia. Information about the effectiveness of valproic acid in neuropathic pain is contradictory and is mainly based on the results of uncontrolled studies and individual clinical cases. Even in the earliest reports, anticonvulsant restrictions were noted in the treatment of pain syndromes. So, their higher efficacy with pain syndrome associated with peripheral lesions was shown, compared with that with central pain. Despite the available data on the positive response of constant pain to anticonvulsants, they still give a more pronounced effect in acute and paroxysmal pain. In addition, anticonvulsants can cause quite serious side reactions (anemia, hepatotoxicity, endocrinopathy, etc.). In general, anti-epileptic drugs may have an effect in cases when other drugs are not beneficial or contraindicated, therefore, further study of anticonvulsants of the new generation in the treatment of pain is fully justified.
The emergence of a new drug gabapentin (Neurontin, "Pfizer") has opened up new perspectives in the treatment of neuropathic pain and many other chronic pain syndromes.
The use of gabapentin in neuropathic pain
Mechanism of action and properties
Gabapentin is a structural analogue of gamma-aminobutyric acid (GABA) and refers to anti-epileptic drugs. In animal experiments, the drug enhances GABA synthesis, has a modulating effect on NMDA receptors, blocks the α2δ calcium channel subunit, reduces the release of monoamines, reduces the synthesis and transport of glutamate, and reduces the frequency of action potentials of peripheral nerves . Probably, the combination of the above mechanisms of action provides a high therapeutic efficacy of gabapentin in various forms of neuropathic pain syndrome.