Methadone and Buprenorphine for the Management of Opioid Dependence in Pregnancy
Methadone and Buprenorphine for the Management of Opioid Dependence in Pregnancy
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DOI：
10.2165/11632820-000000000-00000
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发表时间：
2012-01-01
期刊：
影响因子：
11.5
通讯作者：
Kaltenbach, Karol
中科院分区：
文献类型：
--
作者：
Jones, Hendree E.;Finnegan, Loretta P.;Kaltenbach, Karol
本文概述并讨论了对怀孕期间维持美沙酮或丁丙诺啡的妇女进行的集体孕产妇、胎儿和新生儿结局研究。其重点是评估美沙酮和丁丙诺啡药物治疗的比较有效性，特别关注文献中的最新发现。概述了临床实践的建议，并提出了未来研究的方向。美沙酮和丁丙诺啡的比较研究结果强调了这两种药物在治疗阿片类药物依赖妊娠患者中预防非法阿片类药物复发的功效，以及美沙酮诱导的简单性和患者在接受此类治疗时保留的效果。胎儿监测表明，丁丙诺啡对胎儿心脏和运动的抑制作用比美沙酮要小。这些发现的临床意义需要未来的探索。对于新生儿，使用各种设计的研究证据，包括回顾性图表审查、前瞻性观察研究和随机临床试验，显示出一致的结果，与美沙酮相比，产前接触丁丙诺啡导致新生儿戒断综合症较轻。任何给予孕妇的药物都应在考虑母婴二元的风险：效益比后才开具。怀孕期间每位阿片类药物依赖患者的药物选择需要根据患者情况进行选择，同时考虑患者的阿片类药物依赖史、既往和当前的治疗经历、医疗情况和治疗偏好。此外，为了在产后和整个生命周期内持续全面缓解阿片类药物成瘾，治疗提供者不能仅仅依靠药物来治疗患者，还应该利用针对女性的综合治疗模式，解决患者生活中潜在的多方面复杂性。
This article provides an overview and discussion of the collective maternal, fetal and neonatal outcome research on women maintained on methadone or buprenorphine during pregnancy. Its focus is on an assessment of the comparative effectiveness of methadone and buprenorphine pharmacotherapy, with particular attention given to recent findings from the literature. Recommendations for clinical practice are outlined, and directions for future research are presented.Findings from comparative studies of methadone and buprenorphine underscore the efficacy of both medications in preventing relapse to illicit opioid use in the treatment of opioid-dependent pregnant patients, as well as the simplicity of induction onto methadone and patient retention while receiving such therapy. Fetal monitoring suggests that buprenorphine results in less fetal cardiac and movement suppression than does methadone. The clinical implications of these findings need future exploration. For the neonate, evidence from studies using a wide range of designs, including retrospective chart reviews, prospective observational studies, and randomized clinical trials, show consistent results, with prenatal exposure to buprenorphine resulting in less severe neonatal abstinence syndrome relative to methadone.Any medication given to pregnant women should be prescribed only after considering the risk : benefit ratio for the maternal-fetal dyad. Medication choices for each opioid-dependent patient during pregnancy need to be made on a patient-by-patient basis, taking into consideration the patient's opioid dependence history, previous and current treatment experiences, medical circumstances and treatment preferences. Moreover, for a full remission of opioid addiction to be sustainable, both post-partum and across the lifespan, treatment providers must not rely solely on medication to treat their patients but should also utilize women-specific comprehensive treatment models that address the underlying multifaceted complexities of their patient's lives.