Résumés
Résumé
Le traitement de substitution, principalement avec la méthadone ou la buprénorphine, représente le traitement le plus efficace de la dépendance des opioïdes. Ces médicaments doivent, la plupart du temps, être pris pendant des périodes prolongées, soit plusieurs années ou toute la vie pour certains. Ces médicaments peuvent avoir des effets indésirables, ayant un impact sur la qualité de vie des patients, et nécessitent une attention de la part des professionnels de la santé impliqués dans le traitement. Seront révisés les effets indésirables suivants : hypogonadisme masculin, allongement du QT, sevrage néonatal, anomalies des fonctions respiratoires, hyperalgésie, risque d’intoxication, abus de la médication, interactions médicamenteuses. À ces effets pharmacologiques viennent s’ajouter des contraintes réglementaires, qui, si elles peuvent être pertinentes en début de traitement, s’avèrent lourdes et inadaptées pour les patients stables depuis plusieurs années. De l’écoute et une bonne gestion de ces effets indésirables sont indispensables pour améliorer l’acceptabilité du traitement et son attrait pour les usagers.
Mots-clés :
- méthadone,
- buprénorphine,
- dépendance aux opioïdes
Abstract
Substitution treatment, usually with methadone or buprenorphine, is the treatment of choice for opioid dependence. These medications have to be taken over extended periods of time, if not for life. They may have undesirable effects that can have an impact on the quality of life of some patients, requiring the involvement of health professionals in the treatment. This article will review the following undesirable effects: male hypogonadism, QT interval prolongation, neonatal withdrawal syndrome, lung function test anomalies, hyperalgesia, risk of intoxication, medication abuse, drug interactions. Substitution treatment is also associated with a number of regulatory constraints that, while they may be pertinent early in the treatment, may become a burden and inappropriate for patients who have been stable for several years. Being ready to listen and properly manage these undesirable effects is indispensable in making the treatment acceptable and attractive for users.
Keywords:
- methadone,
- buprenorphine,
- opioid dependence
Resumen
El tratamiento de sustitución, principalmente con la metadona o la buprenorfina, es el más eficaz para tratar la dependencia a los opioides. Estos medicamentos deben tomarse, la mayor parte de las veces, durante períodos prolongados, ya sea durante varios años o durante toda la vida en algunos casos. Pueden tener efectos secundarios indeseables que ejercen un impacto en la calidad de vida de los pacientes y requieren atención por parte de los profesionales de la salud implicados en el tratamiento. Se revisarán en el artículo los siguientes efectos secundarios: hipogonadismo masculino, alargamiento del QT, síndrome de abstinencia neonatal, anomalía de las funciones respiratorias, hiperalgesia, riesgo de intoxicación, abuso de la medicación, interacciones medicamentosas. A estos efectos farmacológicos se agregan las restricciones reglamentarias que, si bien pueden ser pertinentes al comienzo del tratamiento, devienen engorrosas e inadaptadas para los pacientes que están estables desde hace muchos años. La atención que se preste a estos efectos indeseables y una buena gestión de los mismos es indispensable para mejorar la aceptabilidad del tratamiento y su atracción para los usuarios.
Palabras clave:
- metadona,
- buprenorfina,
- dependencia a los opioides
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Bibliographie
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