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Tratamento da ansiedade com fármacos não indicados: uma revisão sistemática
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O presente relatório de estágio foi elaborado no contexto da unidade curricular “Estágio”,
inserida no plano curricular do 2.º semestre do 5.º ano do Mestrado Integrado em
Ciências Farmacêuticas. O documento está organizado em três secções distintas: um
trabalho de investigação intitulado “Tratamento da ansiedade com fármacos não
indicados: uma revisão sistemática”, o relatório de estágio em farmácia comunitária e,
por último, o relatório de estágio em farmácia hospitalar.
O primeiro capítulo, correspondente ao trabalho de investigação “Tratamento da
ansiedade com fármacos não indicados: uma revisão sistemática”, teve como objetivo
realizar uma revisão sistemática com vista a explorar a tendência crescente da utilização
de medicamentos off-label no tratamento da ansiedade, avaliando as evidências
disponíveis e as respetivas implicações clínicas. A pesquisa bibliográfica foi conduzida
nas bases de dados PubMed, Web of Science e Scopus. O risco de viés dos ensaios clínicos
randomizados foi avaliado com recurso à ferramenta RoB 2 da Cochrane, enquanto o
risco de viés dos estudos não randomizados e dos relatos de caso foi avaliado com recurso
à ferramenta ROBINS-I, também da Cochrane. A avaliação da confiança nos resultados
da síntese seguiu as diretrizes Grading of Recommendations, Assessment, Development
and Evaluations (GRADE).
No que respeita aos resultados, foram incluídos 12 estudos: três ensaios clínicos
randomizados, sete estudos não randomizados e dois relatos de casos. Todos os trabalhos
relacionaram o uso off-label de gabapentina, pregabalina ou metilfenidato com a
melhoria dos sintomas de ansiedade, tendo sido observada redução dos sintomas com a
administração destes medicamentos. A análise do risco de viés dos ensaios clínicos
randomizados indicou que 66,7% foram classificados como apresentando alto risco e
33,3% como apresentando algumas preocupações. Já a avaliação dos estudos não
randomizados e relatos de caso revelou que 55,6% apresentavam risco moderado e 44,4%
risco sério. Assim, concluiu-se que o uso off-label de estimulantes (metilfenidato) e
anticonvulsivantes (gabapentina e pregabalina) no tratamento de sintomas ou
perturbações de ansiedade poderá representar uma alternativa terapêutica em situações
em que a terapêutica convencional se mostra ineficaz ou limitada pelas opções
farmacológicas disponíveis. O segundo capítulo corresponde às competências adquiridas no estágio curricular
efetuado na Farmácia Tanara Castelo Branco, no período abrangido entre 3 de fevereiro
de 2025 e 25 de abril de 2025, sob orientação da diretora técnica, Dra. Andreia Esteves.
O terceiro capítulo aborda as atividades executadas no decurso do estágio em farmácia
hospitalar, concretizado nos Serviços Farmacêuticos da Unidade Local de Saúde de
Castelo Branco, entre 28 de abril e 20 de junho de 2025, sob orientação da diretora
técnica, Dra. Sandra Queimado.
Estes relatórios têm como propósito apresentar de forma detalhada as atividades
realizadas e as competências desenvolvidas no decurso dos estágios em contexto
comunitário e hospitalar.
This internship report was written as part of the "Internship" curriculum unit, which was included in the second semester of the fifth year Integrated Master of Pharmaceutical Sciences. The document is organized into three distinct sections: a research paper entitled “Treatment of Anxiety with Non-Indicated Drugs: A Systematic Review”; a community pharmacy internship report; and, finally, a hospital pharmacy internship report. The first chapter, the research paper “Treatment of Anxiety with Non-Indicated Drugs: A Systematic Review”, aimed to conduct a systematic review to explore the growing trend in the off-label use of drugs for anxiety, assessing the available evidence and its clinical implications. The literature search was conducted in the PubMed, Web of Science, and Scopus databases. The risk of bias of randomized controlled trials was assessed using Cochrane’s RoB 2 tool, while the risk of bias of non-randomized studies and case reports was assessed using Cochrane’s ROBINS-I tool. The overall certainty of evidence was evaluated according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines. In total, 12 studies were included: three randomized clinical trials, seven nonrandomized studies, and two case reports. All studies associated the off-label use of gabapentin, pregabalin, or methylphenidate with an improvement in anxiety symptoms, with symptom reduction being observed following administration of these drugs. The risk of bias assessment for randomized clinical trials indicated that 66.7% of the studies were classified as high risk and 33.3% as some concern. In turn, the risk of bias assessment of non-randomized studies and case reports indicated that 55,6% presented a moderate risk and 44,4% a serious risk. Based on these findings, it was concluded that the off-label use of stimulants (methylphenidate) and anticonvulsants (gabapentin and pregabalin) in the management of anxiety symptoms or anxiety disorders may represent a therapeutic alternative in cases where conventional therapy proves ineffective or when pharmacological options are limited. The second chapter corresponds to the competences acquired during the community pharmacy internship report, carried out at Farmácia Tanara Castelo Branco, between 3 February 2025 and 25 April 2025, under the supervision of the technical director, Dr. Andreia Esteves. The third chapter covers the activities performed during the hospital pharmacy internship, conducted at the Pharmaceutical Services of the Unidade Local de Saúde de Castelo Branco, between 28 April and 20 June 2025, under the supervision of the technical director, Dr. Sandra Queimado. The main goal of these reports is to give a thorough account of the tasks carried out and the skills gained during both internship placements.
This internship report was written as part of the "Internship" curriculum unit, which was included in the second semester of the fifth year Integrated Master of Pharmaceutical Sciences. The document is organized into three distinct sections: a research paper entitled “Treatment of Anxiety with Non-Indicated Drugs: A Systematic Review”; a community pharmacy internship report; and, finally, a hospital pharmacy internship report. The first chapter, the research paper “Treatment of Anxiety with Non-Indicated Drugs: A Systematic Review”, aimed to conduct a systematic review to explore the growing trend in the off-label use of drugs for anxiety, assessing the available evidence and its clinical implications. The literature search was conducted in the PubMed, Web of Science, and Scopus databases. The risk of bias of randomized controlled trials was assessed using Cochrane’s RoB 2 tool, while the risk of bias of non-randomized studies and case reports was assessed using Cochrane’s ROBINS-I tool. The overall certainty of evidence was evaluated according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines. In total, 12 studies were included: three randomized clinical trials, seven nonrandomized studies, and two case reports. All studies associated the off-label use of gabapentin, pregabalin, or methylphenidate with an improvement in anxiety symptoms, with symptom reduction being observed following administration of these drugs. The risk of bias assessment for randomized clinical trials indicated that 66.7% of the studies were classified as high risk and 33.3% as some concern. In turn, the risk of bias assessment of non-randomized studies and case reports indicated that 55,6% presented a moderate risk and 44,4% a serious risk. Based on these findings, it was concluded that the off-label use of stimulants (methylphenidate) and anticonvulsants (gabapentin and pregabalin) in the management of anxiety symptoms or anxiety disorders may represent a therapeutic alternative in cases where conventional therapy proves ineffective or when pharmacological options are limited. The second chapter corresponds to the competences acquired during the community pharmacy internship report, carried out at Farmácia Tanara Castelo Branco, between 3 February 2025 and 25 April 2025, under the supervision of the technical director, Dr. Andreia Esteves. The third chapter covers the activities performed during the hospital pharmacy internship, conducted at the Pharmaceutical Services of the Unidade Local de Saúde de Castelo Branco, between 28 April and 20 June 2025, under the supervision of the technical director, Dr. Sandra Queimado. The main goal of these reports is to give a thorough account of the tasks carried out and the skills gained during both internship placements.
Descrição
Palavras-chave
Ansiedade Anticonvulsivantes Estimulantes Farmácia Comunitária Farmácia Hospitalar Transtornos de Ansiedade Uso Off-Label