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Alcoholism and Drug Addiction/Alkoholizm i Narkomania
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3/2018
vol. 31
 
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Metadon czy buprenorfina? Wybór terapii substytucyjnej u kobiet w ciąży uzależnionych od opioidów

Jadwiga Zalewska-Kaszubska

Alcohol Drug Addict 2018; 31 (3): 213-224
Data publikacji online: 2019/01/16
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U kobiet w ciąży uzależnionych od opioidów istnieje zwiększone ryzyko powikłań zarówno w czasie jej trwania, jak i podczas porodu. Zastosowanie terapii substytucyjnej pozwala znacznie ograniczyć to ryzyko, ale niestety nie jest pozbawione działań niepożądanych. Często wiąże się z wystąpieniem zespołu abstynencyjnego u noworodków, zwykle wymagającego leczenia. W terapii substytucyjnej zastosowanie znalazły metadon i buprenorfina, których odpowiednie dawkowanie pozwala unikać skrajnych wahań stężenia opioidów we krwi, występujących podczas ich niekontrolowanego nadużywania. Stosowanie buprenorfiny wiąże się z niższym ryzykiem przedwczesnego porodu, łagodniejszymi objawami odstawienia oraz lepszym stanem zdrowia noworodków. Niestety, kobiety przyjmujące buprenorfinę częściej rezygnują z terapii. Dlatego metadon pozostaje preferowanym lekiem w terapii substytucyjnej, szczególnie u kobiet wymagających większych dawek opioidów w celu uzyskania homeostazy organizmu.

Pregnant opioid dependent women have an increased risk of complications both during pregnancy and delivery. Substitution therapy can considerably reduce this risk. Unfortunately, this treatment is not without its side effects, often associated with neonatal abstinence syndrome (NAS), which requires treatment. Methadone and buprenorphine used as substitution therapy, mitigate extreme fluctuations in the concentration of opioids in the blood, which may occur during uncontrolled opioids abuse. The use of buprenorphine is associated with a lower risk of premature delivery, milder withdrawal symptoms and better neonatal health. However, women receiving buprenorphine discontinued therapy more often. Therefore, methadone is preferred in substitution therapy, especially in women who require higher doses of opioids in order to achieve homeostasis.
słowa kluczowe:

ciąża, buprenorfina, metadon, terapia substytucyjna

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