The efficiency of a carbamazepine–mianserin combination scheme in opiate detoxification

Abstract

A recent comparative randomized double-blind study has suggested the utility of a carbamazepine/mianserin combination as a treatment for opiate withdrawal. The aim of the present study was to explore the feasibility and efficiency of this combination under naturalistic conditions. Five hundred and fifty mostly polysubstance abusing patients treated with a standardized scheme combining carbamazepine and mianserin were assessed with regard to deviations to the protocol, used co-medications and retention in treatment. Three hundred and sixty three patients (66.0%) received the carbamazepine/mianserin combination as specified by the standardized protocol. In 350 patients (63.7%) the whole 10 days was completed. The most frequently used p.r.n. medications were for anxiety (47.5%) and insomnia (54.5%). The treatment of opiate withdrawal with a carbamazepine/mianserin combination scheme in an inpatient setting seems to be feasible and applicable with few adaptations to most patients, and may represent an interesting treatment option for multidrug users.

Topiramate in Opiate Withdrawal-Comparison with Clonidine and with Carbamazepine/Mianserin

“…On the other hand, the fact that 7/10 patients on the carbamazepine/mianserin combination, and 9/10 patients on clonidine required dosage reductions may lead to the question of excessive initial doses. However, the carbamazepine/ mianserin dosing scheme was identical to the procedure used in the study reported by Bertschy et al (21), which we subsequently have found to be applicable in every day practice (22). The dosage regime used in our inpatient unit can be considered to be in the medium dose range compared to previously published studies (40), which generally began with 0.1-0.2 mg/dose (0.15 in our patients), increasing to a maximum of around 1 mg/day (0.6 in our clonidine-scheme).…”

“…The two treatments did not differ in the intensity of the withdrawal, according to the rate of retention in treatment, symptoms and psychic distress. We have recently assessed the efficiency of the carbamazepine/mianserin combination under naturalistic conditions in 550 patients, and found a completion rate of 63% (22).…”

Management of chronic abdominal wall pain: A one-year

“…Carbamazepine is an antiepileptic agent that is generally used as a third-line treatment for neuropathic pain 28 . Carbamazepine stabilizes presynaptic neuronal membranes by inhibiting sodium channels, resulting in a reduction of neurotransmitter release and action potential conductance in nociceptive fibers 29 . Carbamazepine can also potentiate GABA receptors 30,31 , interrupt the glutamatergic function via N-methylD-aspartate receptors, and block calcium channel-modulated central sensitization, which is related to its anti-nociceptive, but not its anticonvulsant effects 32, 33 .…”