■Phenibut是一种不受调节的补充剂,主要用作γ-氨基丁酸B型受体激动剂。当停止使用时,使用phenibut会导致依赖性和随后的戒断。苯丙胺戒断会导致严重的症状,如谵妄,幻觉,和癫痫发作。本系统综述的目的是描述无症状戒断的自然史,并总结文献中发表的治疗策略。
■使用系统评价和荟萃分析清单的首选报告项目进行系统评价。包括英语同行评审的文章或人类会议摘要,描述停止使用后的现象戒断。数据库(Ovid/MEDLINE,WebofScience,和ScienceDirect),并搜索了所收录文章的参考文献。病例报告使用JoannaBriggs研究所的病例报告关键评估清单进行评估。患者人口统计学和关键结果,包括戒断特征和治疗特征,由六名独立审查员收集到预定义的数据收集表中。
■搜索结果产生了515篇文章,其中包括25篇文章。所有文章均为病例报告或发表的会议摘要。所有病例(100%)均涉及男性患者,中位年龄为30岁,(四分位距23.5-34年,范围4天-68年)。在经历戒断之前的每日平均苯丁鱼剂量为10g(四分位数范围4.75-21.5g,范围1-200克)。停药前使用phenibue的最短持续时间(每天2-3g)为一周。戒断症状在最后一次注射后两小时内出现。16名患者(64%)在医疗保健接触的前24小时内报告了戒断严重程度的进展。报告了两名患者(8%)的癫痫发作,6名患者(24%)插管,11名患者(44%)入住重症监护病房。单独使用苯丙胺和使用多物质合并症的患者的戒断模式和结果相似。戒断治疗策略差异很大。只有3例(12%)是门诊管理的,所有3例都采用了逐步减少的策略。所有接受药物辅助禁欲的患者均因症状管理而入院,并接受了作用于γ-氨基丁酸受体的药物。最常用的药物是苯二氮卓类药物,报告了17例(68%)。19名患者(76%)需要至少两种药物治疗来控制症状。巴氯芬用于15例(60%),主要与γ-氨基丁酸A型激动剂(15例中的12例)联合使用,或在苯丁胺锥度期间作为单一疗法(15例中的2例)。两名患者在门诊使用巴氯芬单药治疗,在使用多种药物初始稳定后,报告不良反应。一名患者出现癫痫发作,另一名患者出现反复戒断症状,回到使用phenibut,并被送往医院接受苯二氮卓类药物戒断症状治疗。
■此评论受到一些限制。由于物品选择的手动性质,相关文章可能没有包括在内。由于整个数据集由病例报告组成,因此可能存在出版物偏见。由于病例报告的异质性,因此很少获得特定治疗策略的结果和有意义的结论。那些报告仅使用苯但实际上使用多种物质的人是可能的。用户认为他们正在服用的酚类药物的剂量可能与未管制产品中存在的剂量不同。
■异常戒断似乎有一定的严重程度。重要的是要认识到,接受禁欲禁欲的患者在早期戒断期间可能会出现进行性症状恶化。所有已发表的突发性禁欲病例均入院治疗。苯二氮卓类药物或巴比妥类药物与辅助巴氯芬似乎是中度至重度戒断最常用的药物。在有或没有辅助的γ-氨基丁酸激动剂治疗的情况下,通过缓慢的苯丙胺逐渐减少的门诊治疗可能是成功的。然而,没有标准的治疗方法,并与专家协商(例如,毒理学家,成瘾专家)建议有管理戒断综合征的经验。有必要进行重要的研究,以开发分诊戒断的方法(例如,严重程度评分,住院与门诊管理),并制定最佳治疗方案。
UNASSIGNED: Phenibut is an unregulated supplement that acts primarily as a gamma-aminobutyric acid type B receptor agonist. Use of phenibut can lead to dependence and subsequent withdrawal when use is stopped. Phenibut withdrawal can cause severe symptoms such as delirium, hallucinations, and seizures. The purpose of this systematic
review is to characterize the natural history of phenibut withdrawal and summarize treatment strategies published in the literature.
UNASSIGNED: A systematic
review was conducted using the preferred reporting items for systematic reviews and meta-analyses checklist. English language peer-reviewed articles or conference abstracts in humans describing phenibut withdrawal after cessation of use were included. Databases (Ovid/MEDLINE, Web of Science, and Science Direct) and references of included articles were searched. Case reports were appraised using the Joanna Briggs Institute critical appraisal checklist for case reports. Patient demographics and key outcomes, including withdrawal characteristics and treatment characteristics, were collected into a predefined data collection sheet by six independent reviewers.
UNASSIGNED: Search results yielded 515 articles of which 25 were included. All articles were case reports or published conference abstracts. All of the cases (100 percent) involved male patients and the median age was 30 years, (interquartile range 23.5-34 years, range 4 days-68 years). The median daily phenibut dose prior to experiencing withdrawal was 10 g (interquartile range 4.75-21.5 g, range 1-200 g). The shortest duration of phenibut use (2-3 g daily) prior to withdrawal was one week. Withdrawal symptoms occurred as quickly as two hours after the last phenibut dose. Sixteen patients (64 percent) reported progression of withdrawal severity within the first 24 hours of healthcare contact. Seizures were reported in two patients (8 percent), intubation in six patients (24 percent), and intensive care unit admission in 11 patients (44 percent). Withdrawal patterns and outcomes were similar in those using phenibut alone and those with comorbid polysubstance use. Withdrawal treatment strategies varied widely. Only three cases (12 percent) were managed outpatient and all three utilized a phenibut tapering strategy. All patients undergoing medication-assisted abstinence were admitted inpatient for symptom management and received a drug that acts on gamma-aminobutyric acid receptors. The most commonly used medication was a benzodiazepine, reported in 17 cases (68 percent). Nineteen patients (76 percent) required at least two drug therapies to manage symptoms. Baclofen was used in 15 cases (60 percent), primarily in conjunction with gamma-aminobutyric acid type A agonists (12 of 15 cases) or as monotherapy during a phenibut taper (two of 15 cases). Two patients using baclofen monotherapy outpatient, after initial stabilization with multiple drug classes, reported adverse effects. One patient had a seizure and the other experienced recurrent withdrawal symptoms, returned to using phenibut, and was admitted to a hospital for withdrawal symptom management with benzodiazepines.
UNASSIGNED: This
review is subject to several limitations. Due to the manual nature of article selection, it is possible relevant articles may not have been included. As the entire data set is comprised of case reports it may suffer from publications bias. Outcomes and meaningful conclusions from specific treatment strategies were rarely available because of the heterogeneous nature of case reports. It is possible those reporting only phenibut use were actually using multiple substances. The doses of phenibut a user believed they were taking may be different from what was present in the unregulated product.
UNASSIGNED: Phenibut withdrawal appears to have a range of severity. It is important to recognize that patients undergoing phenibut abstinence may have progressive symptom worsening during early withdrawal. All published cases of abrupt phenibut abstinence were admitted inpatients for symptom management. Benzodiazepines or barbiturates with adjunctive baclofen appear to be the most commonly used drugs for moderate to severe withdrawal. Outpatient management via slow phenibut tapers with or without adjunctive gamma-aminobutyric acid agonist therapy may be successful. However, there is no standard treatment, and consultation with experts (e.g., toxicologists, addiction specialists) experienced in managing withdrawal syndromes is recommended. Significant study is warranted to develop methods of triaging phenibut withdrawal (e.g., severity scoring, inpatient versus outpatient management) and creating optimal treatment regimens.