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CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
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Ezocgabine or retigabine, an antiepileptic drug of remarkable efficacy, has revolutionized the management of seizures. It is a potassium channel activator, explicitly targeting the family of Q subtype potassium channels. It enhances the transmembrane potassium currents, regulating neuronal excitability. This action stabilizes the resting membrane potential, a pivotal factor in mitigating the hyperexcitability that characterizes epilepsy.
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Gabapentin-induced delirium and dependence.

Stefan P Kruszewski1, Richard P Paczynski, David A Kahn

  • 1MD & Associates, Harrisburg, PA, USA. jronayne@spkmd.com

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Gabapentin abuse can lead to substance dependence and toxic delirium, even when prescribed for psychiatric conditions. Withdrawal symptoms may resemble benzodiazepine withdrawal, highlighting potential GABA-related mechanisms.

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Published on: May 16, 2019

Area of Science:

  • Neuroscience
  • Psychiatry
  • Pharmacology

Background:

  • Gabapentin (Neurontin) is FDA-approved for epilepsy and post-herpetic neuralgia.
  • It is frequently prescribed off-label for psychiatric conditions despite limited evidence.

Observation:

  • A 38-year-old male physician developed substance intoxication delirium and dependence from high self-administered gabapentin doses.
  • The patient had been prescribed lower doses combined with buspirone and bupropion for depression and anxiety.

Findings:

  • This case demonstrated gabapentin dependence and abuse, characterized by toxic delirium, intense cravings, and prolonged withdrawal.
  • Withdrawal symptoms were notably similar to benzodiazepine withdrawal, suggesting shared GABA-related mechanisms.

Implications:

  • The findings highlight the potential for gabapentin abuse and dependence, particularly in psychiatric patients.
  • Heightened caution is advised for off-label gabapentin prescriptions in vulnerable populations.
  • Further research into gabapentin's neurobiological effects and withdrawal syndromes is warranted.