在怀孕和产后期间停止服用布普伦诺芬和美沙:全国性队列研究
Chih-Wan Grace Lin1, Brian T Bateman2, Loreen Straub1
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston.
The American journal of psychiatry
|August 27, 2025
概括
与甲相比,开始服用布普伦诺芬的孕妇患有阿片类药物使用障碍更有可能停止治疗. 在这两种治疗中观察到高停药率,强调需要解决保留障碍.
科学领域:
- 产科和妇科
- 药物成
- 药理学
背景情况:
- 在怀孕期间治疗阿片类药物使用障碍 (OUD) 对孕妇和新生儿的结果至关重要.
- 甲和布普伦诺芬是孕妇使用OUD的主要药物.
- 有限的证据表明,在怀孕期间和分娩后的OUD治疗中断率为布普伦诺芬与美沙.
研究的目的:
- 在怀孕期间比较布普伦诺芬和美沙的治疗中止率.
- 评估产后一年内停止治疗的情况.
- 分析基于布普伦诺芬配方 (单独或与纳洛) 的停药情况.
主要方法:
- 一个回顾性队列研究利用全国医疗补助数据.
- 包括孕妇在OUD的第一季度开始服用甲或透布伦诺芬.
- 治疗中断定义为≥60天间隔;使用Cox比例危险回归分析,倾向性得分重叠权重.
主要成果:
- 与甲 (25. 6%) 相比,在怀孕期间停止使用布普伦诺芬的患者的比例更高.
- 与甲 (49. 0%) 相比,布普伦诺芬在产后1年内停止使用的比例更高.
- 与单独使用布普伦诺芬 (1. 14 在怀孕期间, 1. 23 在分娩后) 相比,布普伦诺芬/ 纳洛组合的停止危险比率更高.
结论:
- 与甲相比,孕妇在怀孕早期开始服用布普伦诺芬的可能性更高.
- 对布普伦诺芬和美沙的治疗中断率很高.
- 对于怀孕的OUD患者来说,识别和解决治疗延续障碍至关重要.
相关概念视频
Opioid Analgesics: Synthetic and Semisynthetic Opioids
426
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
426
Opioid Analgesics: Morphine and Other Natural Cogeners
361
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
361
Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
430
Respiratory symptoms, such as congestion and cough, commonly accompany respiratory tract conditions. Various medications, such as antitussives, expectorants, and mucolytics, play crucial roles in providing relief.
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by...
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by...
430
Analgesia and Pain Management
788
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
788
Drug Abuse and Addiction: Pharmacological Phenomena
655
Drug dependence, abuse, and addiction are complex phenomena that can precipitate various abnormal states. Physical dependence refers to a state of pharmacological adaptation to a drug. This adaptation often results in tolerance—a reduced response to the drug after repeated administrations. When the drug use is abruptly stopped, withdrawal symptoms occur due to the body's need to readjust from the pharmacologically induced imbalance. However, tolerance and withdrawal symptoms do not...
655
Drug Dependence
1.2K
Medications are typically administered to achieve therapeutic effects. Some drugs can modify an individual's mood and perception, frequently resulting in various enjoyable experiences. However, this can result in drug dependency, a condition marked by continuous drug use despite potential negative consequences. Drug dependency primarily falls into two categories: psychological and physical dependence. Psychological dependence occurs when the pleasurable feelings induced by the drug...
1.2K


