加巴喷丁已被广泛用于治疗带状疱疹后神经痛,周围神经病变,癫痫症,酒精使用障碍(AUD),酒精戒断,和失眠。虽然通常耐受性良好,据报道,加巴喷丁会导致严重的生理依赖和戒断。在这种情况下,逐渐减少加巴喷丁构成了重大的临床挑战,迄今为止,关于应对这一挑战的公开信息很少。这种情况突出了严重加巴喷丁依赖和戒断的患者需要以患者为中心的缓慢锥度。我们提出了一个32岁的女性有效治疗AUD1,200毫克每日剂量的加巴喷丁,他们发展了加巴喷丁依赖和严重戒断。认识到她对加巴喷丁停药后不耐受,采用BRAVO方案的框架启动了一项锥形计划.平均而言,她将加巴喷丁的每日剂量每月减少100毫克,直到达到300毫克。然后逐渐减少至每月20-30mg剂量减量。最后100毫克,她每一到两周减少5毫克,减少到60毫克,这时她停用了加巴喷丁.整个锥化过程耗时18个月。BRAVO协议概述了一种安全和富有同情心的策略。最初是为阿片类药物开发的,适用于苯二氮卓类药物,布拉沃协议的使用为加巴喷丁锥形提供了一个框架。对于加巴喷丁治疗导致严重依赖和戒断的患者,BRAVO协议提供了一种实用的,以患者为中心的锥形框架。
Gabapentin has been widely used to manage post-herpetic neuralgia, peripheral neuropathy, seizure disorders, alcohol use disorder (AUD), alcohol withdrawal, and insomnia. Although usually well tolerated, gabapentin has been reported to cause severe physiologic dependence and withdrawal. Tapering gabapentin in this context poses a significant clinical challenge, with little published information to date on meeting this challenge. This
case highlights the need for patient-centered slow tapers in patients with severe gabapentin dependence and withdrawal. We present a 32-year-old female effectively treated for AUD with 1,200 mg daily dose of gabapentin, who developed gabapentin dependence and severe withdrawal. Recognizing her intolerance to gabapentin withdrawal after a brief accidental pause of medication, a
taper plan was initiated using the framework of the BRAVO Protocol. On average, she reduced daily gabapentin dose by 100 mg per month until she reached 300 mg. The
taper then slowed to 20-30 mg dose decrements per month. For the last 100 mg, she tapered down at 5 mg decrements every one to two weeks to 60 mg, at which point she discontinued gabapentin. The entire
taper process took eighteen months. The BRAVO protocol outlines a safe and compassionate strategy. Originally developed for opioids and adapted to benzodiazepines, the use of the Bravo Protocol provides a framework for a gabapentin
taper. For patients in whom gabapentin treatment leads to severe dependence and withdrawal, the BRAVO Protocol provides a practical, patient-centered framework for tapering.