NALTREKSON İMPLANTA BAĞLI GELİŞMİŞ LOKAL KOMPLİKASYONLARA MULTİDİSİPLİNER YAKLAŞIM: OLGU SUNUMU

Year 2020, , 28 - 34, 07.04.2020

Mustafa Akan Sibel Altunışık Toplu Hatice Birgül Cumurcu

https://doi.org/10.5455/car.105-1581010511

Abstract

Madde bağımlılığı; tedavisi güç, hastanın kendisi ve yakın çevresine yıkıcı etkileri olan önemli bir halk sağlığı sorunudur. Tedavideki zorlukların ana kaynağı uyumu zayıf olan hastanın oral medikal tedavisini sonlandırması ve artan madde isteği ile birlikte yeniden madde kullanımına başlamasıdır. Bağımlılıkla mücadele için oral tedaviye alternatif yeni ajanlar geliştirilmiştir. Alkol ve opioid bağımlılıkları tedavisinde yeni tedavi seçenekleri arasında naltrekson cilt altı implant yer almaktadır. Ağrı, kusma, dehidratasyon, yara yerinde enfeksiyon ve hematom, kaşıntı, lokal doku reaksiyonu naltrekson implant kullanımında bildirilen sık yan etkilerdir. Bu çalışmada naltrekson implant uygulaması sonrasında yumuşak doku enfeksiyonu gelişmiş iki vaka tartışılacaktır. Çalışmamızın implanta bağlı gelişebilecek komplikasyonların yönetimi hususunda literatüre katkı sağlayacağını düşünmekteyiz

Keywords

bağımlılık, naltrekson implantı, komplikasyon, yumuşak doku enfeksiyonu, doku nekrozu

References

• 1. WHO. Global Health Risks: Mortality and burden of disease attributable to selected major risks. Bulletin of the World Health Organization. 2009.
• 2. Tiffany ST, Wray JM. The clinical significance of drug craving. Ann N Y Acad Sci. 2012;1248(1):1–17.
• 3. Skinner MD, Aubin HJ. Craving’s place in addiction theory: Contributions of the major models. Neurosci Biobehav Rev. 2010;34(4):606–23.
• 4. Trigo JM, Martin-García E, Berrendero F, Robledo P, Maldonado R. The endogenous opioid system: A common substrate in drug addiction. Drug Alcohol Depend. 2010;108(3):183–94.
• 5. Di Chiara G, Bassareo V, Fenu S, De Luca MA, Spina L, Cadoni C, et al. Dopamine and drug addiction: The nucleus accumbens shell connection. Neuropharmacology. 2004;47:227–41.
• 6. Beveridge TJR, Smith HR, Nader MA, Porrino LJ. Abstinence from chronic cocaine self-administration alters striatal dopamine systems in rhesus monkeys. Neuropsychopharmacology. 2009;34:1162–71.
• 7. George FK, Michel Le M. Drug addiction, dysregulation of reward and allostasis. Neuropsychopharmacology. 2001;24(2):97–129.
• 8. Mansour A, Fox CA, Akil H, Watson SJ. Opioid-receptor mRNA expression in the rat CNS: Anatomical and functional implications. Trends Neurosci. 1995;18(1):22–9.
• 9. Delfs JM, Kong H, Mestek A, Chen Y, Yu L, Reisine T, et al. Expression of Mu opioid receptor mRNA in rat brain: An in situ hybridization study at the single cell level. J Comp Neurol. 1994;345(1):46–68.
• 10. Hirose N, Murakawa K, Takada K, Oi Y, Suzuki T, Nagase H, et al. Interactions among mu- and delta-opioid receptors, especially putative delta1- and delta2 -opioid receptors, promote dopamine release in the nucleus accumbens. Neuroscience. 2005;135(1):213–25.
• 11. F.Koob G, Moal M Le. Addiction and the brain antireward system. Annu Rev Psychol. 2008;59:29–53.
• 12. Robinson TE, Berridge KC. The incentive sensitization theory of addiction: Some current issues. Philos Trans R Soc B Biol Sci. 2008;363:3137–46.
• 13. Martin WR, Gorodetzky CW, McClane TK. An experimental study in the treatment of narcotic addicts with cyclazocine. Clin Pharmacol Ther. 1966;7(4):455–65.
• 14. O’brien CP, Greenstein RA, Mintz J, Woody GE. Clinical experience with naltrexone. Am J Drug Alcohol Abuse. 1975;2:365–77.
• 15. Greenstein RA, al et. Naltrexone: A clinical perspective. J Clin Psychiatry. 1984;45:25–8.
• 16. Gonzalez JP, Brogden RN. Naltrexone: A review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in the management of opioid dependence. Drugs. 1988;35:192–213.
• 17. Volpicelli JR, Alterman AI, Hayashida M, O’brien CP. Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry. 1992;49(11):876–80.
• 18. Kirchmayer U, Davoli M, Verster A. Naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst Rev. 2003;2:1-19.
• 19. Comer SD, Sullivan MA, Hulse GK. Sustained-release naltrexone: Novel treatment for opioid dependence. Expert Opin Investig Drugs. 2007;16(8):1285–94.
• 20. Lobmaier PP, Kunøe N, Gossop M, Waal H. Naltrexone depot formulations for opioid and alcohol dependence: A systematic review. CNS Neurosci Ther. 2011;17(6):629–36.
• 21. Krupitsky EM, Blokhina EA. Long-acting depot formulations of naltrexone for heroin dependence: A review. Curr Opin Psychiatry. 2010;23(3):210–4.
• 22. Kunøe N, Lobmaier P, Vederhus JK, Hjerkinn B, Hegstad S, Gossop M, et al. Retention in naltrexone implant treatment for opioid dependence. Drug Alcohol Depend. 2010;111(1–2):166–9.
• 23. Hartung DM, McCarty D, Fu R, Wiest K, Chalk M, Gastfriend DR. Extended-release naltrexone for alcohol and opioid dependence: A meta-analysis of healthcare utilization studies. J Subst Abuse Treat. 2014;47(2):113–21.
• 24. Tiihonen J, Krupitsky E, Verbitskaya E, Blokhina E, Mamontova O, Föhr J, et al. Naltrexone implant for the treatment of polydrug dependence: A randomized controlled trial. Am J Psychiatry. 2012;169(5):531–6.
• 25. Reece AS. Comparative treatment and mortality correlates and adverse event profile of implant naltrexone and sublingual buprenorphine. J Subst Abuse Treat. 2009;37(3):256–65.
• 26. Lintzeris N, Lee S, Scopelliti L, Mabbutt J, Haber PS. Unplanned admissions to two Sydney public hospitals after naltrexone implants. Med J Aust. 2008;188(8):441–4.
• 27. Ak S, Gurel SC. Drug eruption after sustained-release Naltrexone pellet implantation. Turkish J Psychiatry. 2020;31(2):146–7.
• 28. Hulse GK, Morris N, Arnold-Reed D, Tait RJ. Improving clinical outcomes in treating heroin dependence: Randomized, controlled trial of oral or implant naltrexone. Arch Gen Psychiatry. 2009;66 (10):1108–15.
• 29. Kranzler HR, Modesto-Lowe V, Nuwayser ES. Sustained-release Naltrexone for alcoholism treatment: A preliminary study. Alcohol Clin Exp Res. 1998;22(5):1074–9.