Gabapentin for the Management of Agitation

Low, R Aaron; Brandes, Martin

doi:10.1097/00004714-199910000-00020

Cited by 14 publications

(9 citation statements)

References 6 publications

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“…Of the 24 publications that met our criteria for inclusion , 15 contained original data (case reports or case series) , whereas nine were solely reviews of the literature with no original data . One of the 15 papers that contained an original report additionally included a narrative review.…”

Section: Resultsmentioning

confidence: 99%

Gabapentin and pregabalin to treat aggressivity in dementia: a systematic review and illustrative case report

Supasitthumrong

Bolea-Alamañac

Asmer

et al. 2019

Brit J Clinical Pharma

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AIMSThe prevalence of dementia is rising as life expectancy increases globally. Behavioural and psychological symptoms of dementia (BPSD), including agitation and aggression, are common, presenting a challenge to clinicians and caregivers. METHODSFollowing PRISMA guidelines, we systematically reviewed evidence for gabapentin and pregabalin against BPSD symptoms of agitation or aggression in any dementia, using six databases (Pubmed, CINHL, PsychINFO, HealthStar, Embase, and Web of Science). Complementing this formal systematic review, an illustrative case of a patient with BPSD in mixed Alzheimer's/vascular dementia, who appeared to derive benefits in terms of symptom control and functioning from the introduction of gabapentin titrated up to 3600 mg day À1 alongside other interventions, is presented. RESULTSTwenty-four relevant articles were identified in the systematic review. There were no randomized trials. Fifteen papers were original case series/case reports of patients treated with these compounds, encompassing 87 patients given gabapentin and six given pregabalin. In 12 of 15 papers, drug treatment was effective in the majority of cases. The remaining nine papers were solely reviews, of which two were described as systematic but predated PRISMA guidelines. Preliminary low-grade evidence based on case series and case reviews suggests possible benefit of gabapentin and pregabalin in patients with BPSD in Alzheimer's disease. These benefits cannot be confirmed until well-powered randomized controlled trials are undertaken. Evidence in frontotemporal dementia is lacking. CONCLUSIONGabapentin and pregabalin could be considered for BPSD when medications having stronger evidence bases (risperidone, other antipsychotics, carbamazepine and citalopram) have been ineffective or present unacceptable risks of adverse outcomes.British Journal of Clinical Pharmacology Br J Clin Pharmacol (2019) 85 690-703 690 Gabapentin and pregabalin in dementia treatment Br J Clin Pharmacol (2019) 85 690-703 691 Nomenclature of targets and ligandsKey protein targets and ligands in this article are hyperlinked to corresponding entries in the http://www. guidetopharmacology.org, the common portal for data from the IUPHAR/BPS Guide to PHARMACOLOGY [90], and are permanently archived in the Concise Guide to PHARMA-COLOGY 2017/18 [91].

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Section: Resultsmentioning

confidence: 99%

Gabapentin and pregabalin to treat aggressivity in dementia: a systematic review and illustrative case report

Supasitthumrong

Bolea-Alamañac

Asmer

et al. 2019

Brit J Clinical Pharma

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“…Anticonvulsant agents with sites of action on GABAergic neurons such as valproate, phenytoin, carbamezepine, topiramate, lamotrigine and gabapentin increase cerebral GABA concentration. As a result, in the past decade, the effects of these pharmacological agents on human aggression have been investigated in pharmacological studies (Haas et al 1997;Low and Brandes 1999;Goff et al 2001).…”

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confidence: 99%

“…The favorable pharmacokinetic properties and safety profile also make gabapentin easy to use in highrisk populations, including individuals with a history of alcohol and substance abuse (McLean 1994). Recent clinical data suggests that gabapentin can be used in the treatment of aggressive behavior (Ryback and Ryback 1995;Low and Brandes 1999;Herrmann et al 2000;Biancosino et al 2002); there are no data currently available with respect to the effects of gabapentin on human aggressive behavior under controlled experimental conditions.…”

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confidence: 99%

Acute effects of gabapentin on laboratory measures of aggressive and escape responses of adult parolees with and without a history of conduct disorder

et al. 2004

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“…To date, there are only case reports of patients with BPSD treated with gabapentin. [144][145][146][147][148] In an open label prospective series, 12 patients were treated with gabapentin for up to eight weeks with an average dose of 900 mg/day. In this antipsychotic-refractory group of mixed dementias there were no significant changes in behavioral scale scores overall, though two patients were rated as much improved and three as minimally improved.…”

Section: Anticonvulsantsmentioning

confidence: 99%

Recommendations for the Management of Behavioral and Psychological Symptoms of Dementia

Herrmann

2001

Can. J. Neurol. Sci.

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Suppl. 1 -S96 serious problem that they encountered, rating it more frequently as a serious problem than the memory disturbance itself. The significance of BPSD was recently endorsed by both the United States A l z h e i m e r's A s s o c i a t i o n 6 and the International Psychogeriatric Association 1 as research priorities. The phenomenology and prevalence of BPSD have beenThe behavioral and psychological symptoms of dementia (BPSD) include delusions, hallucinations, misidentifications, agitation, wandering, pacing, restlessness, disinhibition, apathy, negativism, emotional lability, depression, anxiety, sleep disturbance and sexually inappropriate behaviours.1 While not included as diagnostic criteria for dementia by DSM-IV 2 or the NINCDS-ADRDA, 3 behaviours such as paranoia, depression, euphoria and apathy were recognized by Alzheimer in the initial description of the illness that bears his name. 4 Historically, the focus on BPSD began only recently, prompted by an early study by Rabins et al,5 who interviewed caregivers of patients with dementia. While these behaviours were noted in 50-90% of patients, caregivers considered physical aggression the most ABSTRACT: Background: The behavioral and psychological symptoms of dementia (BPSD) are common, serious problems that impair the quality of life for both patient and caregiver. In order to provide recommendations based upon the best available evidence, a qualitative literature review was performed. Methods: A search of the English language medical literature published between 1966 and 2000 was performed. The quality of the studies was assessed by considering the subjects, trial design, analysis and results. Final recommendations were based upon the quality of available evidence. Results: The management of BPSD begins with a thorough assessment to search for underlying causes of behaviour change. Concomitant medical illness should be treated and sensory impairment ameliorated. Nonpharmacological approaches should be instituted prior to medication use. These interventions include music, light, changes in level of stimulation and specific behavioral techniques. Antipsychotics are the best studied pharmacological intervention for agitation and aggression and have demonstrated modest but consistent efficacy. Antidepressants such as trazodone and selective serotonin re-uptake inhibitors, as well as anticonvulsants such as carbamazepine and valproic acid have also demonstrated efficacy. Benzodiazepines can be used for short-term treatment as p.r.n. agents when necessary. Pharmacotherapy must be monitored closely for both effectiveness and side effects, with consideration of medication withdrawal when appropriate. Conclusion: The management of BPSD can significantly improve the quality of life for the patient and caregiver. Their assessment and management are essential components of the treatment of dementia.RÉSUMÉ: Recommandations pour la prise en charge des symptômes comportementaux et psychologiques de la démence. Introduction: L e s symptômes comportementaux et ...

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Gabapentin for the Management of Agitation

Cited by 14 publications

References 6 publications

Gabapentin and pregabalin to treat aggressivity in dementia: a systematic review and illustrative case report

Gabapentin and pregabalin to treat aggressivity in dementia: a systematic review and illustrative case report

Acute effects of gabapentin on laboratory measures of aggressive and escape responses of adult parolees with and without a history of conduct disorder

Recommendations for the Management of Behavioral and Psychological Symptoms of Dementia

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