Although the incidence of extrapyramidal reactions associated with metoclopramide has been reported to be approximately 0.2%, such reactions are rare in the anesthetic field. Several anesthetic adjuvants, including ondansetron and pregabalin, have also been associated with extrapyramidal side effect. Here, the authors report the case of a 47-year-old patient, previously administered pregabalin and ondansetron, who developed extrapyramidal side effects after a single injection of metoclopramide (10 mg) in a post-anesthesia care unit.
Adjuvants, Anesthesia ; gamma-Aminobutyric Acid ; Humans ; Incidence ; Metoclopramide ; Middle Aged ; Ondansetron ; Pregabalin

Pregabalin is a newly developed synthetic gamma-aminobutyric acid (GABA) that is approved for the treatment of fibromyalgia and several neuropathy. It has been proven to show analgesic, anxiolytic, anticonvulsant and sleep enhancement effects, which could be applicable in the treatment of a variety of psychiatric disorders. There have been consistent reports that unexplained somatic symptoms (i.e., pain) may be a part of psychiatric disorders such as major depressive disorder (MDD) and anxiety disorders. Previous researches have also suggested the possible therapeutic potential of anticonvulsants as augmentation therapy or monotherapy in the treatment of mood disorders and anxiety disorders. Hence this short perspective tries to prompt and facilitate a shifting of researchers' attention to potential neuropsychotropic drug role of pregabalin to treat a wide range of neuropsychiatric disorders.
Anticonvulsants ; Anxiety Disorders ; Depressive Disorder, Major ; Fibromyalgia ; gamma-Aminobutyric Acid ; Mood Disorders ; Pregabalin

BACKGROUND: Pregabalin is an analog of gamma aminobutyric acid, and selectively interacts with the alpha-2-delta subunit of the voltage dependent calcium channels. The aims of this study were to investigate the analgesic effects of intrathecal pregabalin in rat formalin tests and to compare between the pre-treatment and post-treatment group. METHODS: All experimental animals were randomly divided into pre- and post-treatment groups. In pre-treatment groups, pregabalin (0.003g, 0.01g, 0.03g, 0.1g, n = 6 at each group) was administered through the intrathecal catheter 10 min prior to formalin injection. In post-treatment groups, pregabalin (0.01g, 0.03g, 0.1g, 0.3g, n = 6 at each group) was administered through the catheter 10 min after formalin injection. Formalin (50 ml, 5%) was injected in the left hind paw. We counted the number of flinching as a pain behavior for 60 min to quantify the nociceptive response. RESULTS: The withdrawal responses which were represented by flinching count, were decreased dose dependently in the phase 2, in all groups (pre-treatment and post-treatment group), while there were less analgesic effects and ceiling effects in the phase 1. There was more significant decreasing flinching number in the pre-treatment group than that in the post-treatment group. CONCLUSIONS: Intrathecal pregabalin has preemptive analgesic effect and may be useful in the management of inflammation induced hyperalgesia.
Animals ; Calcium Channels ; Catheters ; Formaldehyde* ; gamma-Aminobutyric Acid ; Hyperalgesia ; Inflammation ; Pain Measurement* ; Rats* ; Pregabalin

Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain and various accompanying symptoms including fatigue, sleep disturbances, and cognitive dysfunction. While the etiology of fibromyalgia is unclear, accumulating data suggest that disordered central pain processing likely plays a role in the pathogenesis of symptoms. Although the 1990 American College of Rheumatology (ACR) classification criteria for FMS were originally developed for research purposes and were not intended for clinical diagnosis, the criteria have become the de facto diagnostic criteria in clinical settings. Recently, an improved clinical case definition for FMS was proposed by ACR in 2010 to overcome several limitations of 1990 ACR criteria. Further studies are needed to assess the acceptance, reliability, and validity of the new criteria in epidemiologic and clinical studies. Many randomized controlled trials and meta-analyses confirm the therapeutic efficacy of pregabalin, duloxetine, and milnacipran, in the treatment of FMS. In view of the currently available evidence, a combination of pregabalin, duloxetine, or milnacipran as pharmacological interventions and aerobic exercise or CBT as non-pharmacological interventions seems most promising.
Cyclopropanes ; Exercise ; Fatigue ; Fibromyalgia ; gamma-Aminobutyric Acid ; Rheumatology ; Thiophenes ; Duloxetine Hydrochloride ; Pregabalin

Baclofen(B-4-chlorphyl-r-amino butyric acid), a centrally acting gamma amino butyric acid (GABA) agonist is a commonly used pharmaceutics for spasticity of spinal cord lesion. It's effect includes activation of GABA recep tor in primary sensory afferent, enhancement of Ranshow cell activity and depression of fusimotor response. It is primarily excreted by glomerullar filtration with a clearance proportional to creatinine clearance. It's popularity is a result of the antispastic effect and the lack of toxic effect on organ. But, transient drowsiness is the most common neurological side effect with therapeutic dose of the drugs. We report here two patients who developed an acute side effects after being treated with relative therapeutic dose of baclofen.
Baclofen* ; Butyric Acid ; Creatinine ; Depression ; Filtration ; gamma-Aminobutyric Acid ; Humans ; Muscle Spasticity ; Sleep Stages ; Spinal Cord

Baclofen is a gamma-aminobutyric acid type B receptor agonist used as an anti-craving agent for treatment of alcohol dependence. It has gained popularity in the recent times because it is well tolerated even in patients with hepatic impairments. Herein we are summarizing the latest literature about baclofen induced hypomania and are reporting a case of baclofen abuse because of its mood elevating property in a patient of alcohol dependence with comorbid major depressive disorder. Literature review and case study of a 36-year-old male with alcohol dependence with comorbid major depressive disorder was prescribed with tablet baclofen as an anti-craving agent along with antidepressant medicines. The patients who did not improve with conventional antidepressant therapy started feeling better in terms of his mood symptoms on taking tablet baclofen. Owing to the mood elevating property he started abusing baclofen. Despite its safety profile in hepatic impairment, one must be very cautious in prescribing baclofen because of its mood altering property which may account for its abuse potentiality.
Adult ; Alcoholism* ; Baclofen* ; Depressive Disorder, Major* ; Depressive Disorder, Treatment-Resistant ; gamma-Aminobutyric Acid ; Humans ; Male

BACKGROUND: The primary site of action of pregabalin, i.e. the alpha-2-delta subunit of the voltage-dependent calcium channel, is located at the dorsal root ganglion and dorsal horn of the spinal cord. Therefore, the epidural administration of pregabalin could have advantages over oral administration. However, the possibility of its neurotoxicity should be excluded before any attempt at epidural administration. We evaluated the neuronal safety of epidurally-administered pregabalin by observing the sensory/motor changes and examining the histopathology of spinal cord in rats. METHODS: Sixty rats of 180-230 g were divided into three groups; 3 mg of pregabalin dissolved in 0.3 ml saline (group P, n = 20), 0.3 ml 40% alcohol (group A, n = 20), or 0.3 ml normal saline (group N, n = 20) was administered epidurally to the rats in each group. Pinch-toe test, motor function evaluation, and histopathologic examination of vacuolation, chromatolysis, meningeal inflammation, and neuritis were performed at the 1st, 3rd, 7th, and 21st day after each epidural administration. RESULTS: All rats enrolled in group P, like those in group N, showed neither sensory/motor dysfunction nor any histopathological abnormality over the 3-week observation period. In contrast, in group A, 80% of the rats showed abnormal response to the pinch-toe test and all rats showed decreased motor function during the entire evaluation period. In addition, all histopathologic findings of neurotoxicity were observed exclusively in group A. CONCLUSIONS: The epidurally administered pregabalin (about 15 mg/kg) did not cause any neurotoxic evidence, in terms of both sensory/motor function evaluation and histopathological examination in rats.
Administration, Oral ; Animals ; Calcium Channels ; gamma-Aminobutyric Acid ; Ganglia, Spinal ; Horns ; Inflammation ; Injections, Epidural ; Neuritis ; Neurons ; Rats ; Spinal Cord ; Pregabalin

Multiple randomized, double-blind, placebo-controlled trials have explored the efficacy of pregabalin for the treatment of generalized anxiety disorder (GAD) and this novel drug was recently approved in Europe. Short-term efficacy of pregabalin as a treatment modality for GAD is well supported by the positive results of several placebocontrolled studies, and most studies confirmed that pregabalin is superior to placebo and comparable with lorazepam, alprazolam and venlafaxine for the treatment of patients with GAD. Especially, pregabalin has a rapid speed of onset combined with equal efficacy in treating both psychic and somatic symptoms of GAD. Additionally, pregabalin has demonstrated potential for the prevention of relapses of GAD. Efficacy in the elderly patients was also shown in a separate placebo-controlled study. Pregabalin has a favorable safety and tolerability profiles relative to benzodiazepines and has minimal potential for drug-drug interactions, abuse and dependence. In the future, research should target further elucidating the efficacy of pregabalin for GAD in relapse prevention, longterm treatment and special populations. Additional studies are needed to guide clinicians in practical issues of how best to use pregabalin as a newer option for the pharmacotherapy of GAD.
Aged ; Alprazolam ; Anxiety ; Anxiety Disorders ; Benzodiazepines ; Cyclohexanols ; Europe ; gamma-Aminobutyric Acid ; Humans ; Lorazepam ; Recurrence ; Pregabalin ; Venlafaxine Hydrochloride

Multiple randomized, double-blind, placebo-controlled trials have explored the efficacy of pregabalin for the treatment of generalized anxiety disorder (GAD) and this novel drug was recently approved in Europe. Short-term efficacy of pregabalin as a treatment modality for GAD is well supported by the positive results of several placebocontrolled studies, and most studies confirmed that pregabalin is superior to placebo and comparable with lorazepam, alprazolam and venlafaxine for the treatment of patients with GAD. Especially, pregabalin has a rapid speed of onset combined with equal efficacy in treating both psychic and somatic symptoms of GAD. Additionally, pregabalin has demonstrated potential for the prevention of relapses of GAD. Efficacy in the elderly patients was also shown in a separate placebo-controlled study. Pregabalin has a favorable safety and tolerability profiles relative to benzodiazepines and has minimal potential for drug-drug interactions, abuse and dependence. In the future, research should target further elucidating the efficacy of pregabalin for GAD in relapse prevention, longterm treatment and special populations. Additional studies are needed to guide clinicians in practical issues of how best to use pregabalin as a newer option for the pharmacotherapy of GAD.
Aged ; Alprazolam ; Anxiety ; Anxiety Disorders ; Benzodiazepines ; Cyclohexanols ; Europe ; gamma-Aminobutyric Acid ; Humans ; Lorazepam ; Recurrence ; Pregabalin ; Venlafaxine Hydrochloride

BACKGROUND: Pregabalin has been shown to have analgesic effect in acute pain models. The primary objective was to examine the efficacy a single dose of pregabalin, would have on morphine consumption following lumbar discectomy. METHODS: With ethical approval a randomized, placebo-controlled prospective trial was undertaken in 32 patients (ASA I-II, 18-65 years) with radicular low back pain for > 3 months undergoing elective lumbar discectomy. Patients received either oral pregabalin 300 mg (PG Group) or placebo (C Group) one hour before surgery. Pain intensity, the accumulative morphine consumption and adverse effects were recorded for 24 hours following surgery. Functional, psychological and quantitative sensory testing were also assessed. RESULTS: Fourteen patients out of the 32 recruited were randomized to receive pregabalin. Morphine consumption was reduced (absolute difference of 42.3%) between groups with medium effect size. (Mann-Whitney; U = 52.5, z-score= 2.84, P = 0.004, r = 0.14). This was not associated with a significant difference in the incidence of adverse effects between the two groups. The median pain intensity (VAS) on movement was not significantly different between groups. CONCLUSIONS: A single pre-operative dose of pregabalin (300 mg) did not result in a reduction in pain intensity compared to placebo in this patient cohort but the significant reduction in morphine consumption suggests that a fixed peri-operative dosing regime warrants investigation.
Acute Pain ; Cohort Studies ; Diskectomy ; gamma-Aminobutyric Acid ; Humans ; Incidence ; Low Back Pain ; Morphine ; Prospective Studies ; Pregabalin