（3）癫痫加重：加巴喷丁治疗中可能突现癫痫加重的情况，特别是全身性发作患者。
Gabapentin
Gabapentin, sold under the brand name Neurontin among others, is an anticonvulsant medication used to treat partial seizures, neuropathic pain, hot flashes, and restless legs syndrome.[4][5] It is recommended as one of a number of first-line medications for the treatment of neuropathic pain caused by diabetic neuropathy, postherpetic neuralgia, and central neuropathic pain.[6] About 15% of those given gabapentin for diabetic neuropathy or postherpetic neuralgia have a measurable benefit.[7] Gabapentin is taken by mouth.[4]
Common side effects include sleepiness and dizziness.[4] Serious side effects include an increased risk of suicide, aggressive behavior, and drug reactions.[4] It is unclear if it is safe during pregnancy or breastfeeding.[8] Lower doses are recommended in those with kidney disease associated with a low kidney function.[4] Gabapentin is a gabapentinoid.[9] It has a molecular structure similar to that of the neurotransmitter γ-aminobutyric acid (GABA) and acts by inhibiting certain calcium channels.[10][9][11]
Gabapentin was first approved for use in 1993.[12] It has been available as a generic medication in the United States since 2004.[4] The wholesale price in the developing worldas of 2015 was about US$10.80 per month;[13] in the United States, it was US$100 to US$200.[14] In 2016, it was the 11th most prescribed medication in the United States, with more than 44 million prescriptions.[15] During the 1990s, Parke-Davis, a subsidiary of Pfizer, began using a number of illegal techniques to encourage physicians in the United States to use gabapentin for unapproved uses.[16] They have paid out millions of dollars to settle lawsuits regarding these activities.[17]
Medical uses
Gabapentin is FDA approved to treat seizures and neuropathic pain.[18][19][20] It is primarily administered by mouth, with a study showing that "rectal administration is not satisfactory".[21] It is also commonly prescribed for many off-label uses, such as treatment of anxiety disorders,[22][23] insomnia, and bipolar disorder.[22] About 90% of usage is for off-label conditions.[20] There are, however, concerns regarding the quality of the trials conducted and evidence for some such uses, especially in the case of its use as a mood stabilizer in bipolar disorder.[24]
Seizures
Gabapentin is approved for treatment of focal seizures[25] and mixed seizures. There is insufficient evidence for its use in generalized epilepsy.[26]
Neuropathic pain
A 2018 review found that gabapentin was of no benefit in sciatica nor low back pain.[27]
A 2010 European Federation of Neurological Societies task force clinical guidelinerecommended gabapentin as a first-line treatment for diabetic neuropathy, postherpetic neuralgia, or central pain. It found good evidence that a combination of gabapentin and morphine or oxycodone or nortriptyline worked better than either drug alone; the combination of gabapentin and venlafaxine may be better than gabapentin alone.[6]
A 2017 Cochrane review found evidence of moderate quality showing a reduction in pain by 50% in about 15% of people with postherpetic neuralgia and diabetic neuropathy.[7]Evidence finds little benefit and significant risk in those with chronic low back pain.[28] It is not known if gabapentin can be used to treat other pain conditions, and no difference among various formulations or doses of gabapentin was found.[7]
A 2010 review found that it may be helpful in neuropathic pain due to cancer.[29] It is not effective in HIV-associated sensory neuropathy[30] and does not appear to provide benefit for complex regional pain syndrome.[31]
A 2009 review found gabapentin may reduce opioid use following surgery, but does not help with post-surgery chronic pain.[32] A 2016 review found it does not help with pain following a knee replacement.[33]
It appears to be as effective as pregabalin for neuropathic pain and costs less.[34] All doses appear to result in similar pain relief.[35]
Migraine
The American Headache Society (AHS) and American Academy of Neurology (AAN) guidelines classify gabapentin as a drug with "insufficient data to support or refute use for migraine prophylaxis".[36] A 2013 Cochrane review concluded that gabapentin was not useful for the prevention of episodic migraine in adults.[37]
Anxiety disorders
Gabapentin has been used off-label for the treatment of anxiety disorders. However, there is dispute over whether evidence is sufficient to support it being routinely prescribed for this purpose.[22][23][38][39] While pregabalin may have efficacy in the treatment of refractory anxiety in people with chronic pain, it is unclear if gabapentin is equally effective.[40]
Other uses
Gabapentin may be useful in the treatment of comorbid anxiety in bipolar patients; however, it is not effective as a mood-stabilizing treatment for manic or depressive episodes themselves.[24][41][42][22] Other psychiatric conditions, such as borderline personality disorder, have also been treated off-label with gabapentin.[20] There is insufficient evidence to support its use in obsessive–compulsive disorder and treatment-resistant depression.[43]
Gabapentin may be effective in acquired pendular nystagmus and infantile nystagmus (but not periodic alternating nystagmus).[44][45] It is effective for treating hot flashes.[46][47][48] It may be effective in reducing pain and spasticity in multiple sclerosis.[49]
Gabapentin may reduce symptoms of alcohol withdrawal (but it does not prevent the associated seizures), alcohol dependence and craving.[50][43] There is some evidence for its role in the treatment of alcohol use disorder; the 2015 VA/DoD guideline on substance use disorders lists gabapentin as a "weak for" and is recommended as a second-line agent.[51]Use for smoking cessation has had mixed results.[52][53] There is insufficient evidence for its use in cannabis dependence.[54]
Gabapentin is effective in alleviating itching in kidney failure (uremic pruritus)[55] and itching of other causes.[56] It is an established treatment of restless legs syndrome.[57] Gabapentin may help sleeping problems in people with restless legs syndrome and partial seizures due to its increase in slow-wave sleep and augmentation of sleep efficiency.[58][59][60] Gabapentin may be an option in essential or orthostatic tremor.[61][62][63] Gabapentin does not appear effective for the treatment of tinnitus.[64]
Overdose
Through excessive ingestion, accidental or otherwise, persons may experience overdose symptoms including drowsiness, sedation, blurred vision, slurred speech, somnolence, uncontrollable jerking motions, anxiety and possibly death, if a very high amount was taken, particularly if combined with alcohol. For overdose considerations, serum gabapentin concentrations may be measured for confirmation.[79]
