Gabapentinoids and COPD Exacerbation

Explore the connection between Gabapentinoids and severe COPD exacerbation

A population-based cohort study of almost 10,000 people who used gabapentinoids discovered that they raised the risk of chronic obstructive pulmonary disease (COPD) exacerbation. This study backs existing regulatory agency warnings and emphasizes the need of taking this potential risk into account when administering gabapentin and pregabalin to COPD patients. The study was published in the Annals of Internal Medicine.

Gabapentinoid medicines are anticonvulsant medications used to treat epilepsy and neuropathic pain. Despite restricted indications, its prescription has increased in North America and Europe, which may be due to excessive off-label prescriptions. However, animal and human investigations have shown that these medicines produce central nervous system depression, resulting in sedation and respiratory depression. This safety problem may be of particular concern for those suffering from respiratory disorders such as COPD.

McGill University and Lady Davis Institute for Medical Research researchers analyzed insurance data for 356 gabapentin users with epilepsy, 9,411 with neuropathic pain, and 3,737 with other chronic pain.

Gabapentin users were matched 1:1 with nonusers based on COPD duration, gabapentin indication, age, gender, calendar year, and time-conditional propensity score. The authors discovered that gabapentinoid use, when compared to nonuse, was associated with an increased risk of severe COPD exacerbation among users taking these drugs for epilepsy, neuropathic pain, and chronic pain, with the peak increase occurring after about six months of continuous use.

The risk was detected in patients with neuropathic pain and other chronic pain regardless of age, gender, number of previous COPD exacerbations, past use of inhaled corticosteroids (ICS), number of respiratory medicines taken, or opiate or benzodiazepine usage. The authors recommend that physicians evaluate these potential concerns before giving gabapentin and pregabalin to COPD patients.

For more information: Gabapentinoids and Risk for Severe Exacerbation in Chronic Obstructive Pulmonary Disease

DOI: https://doi.org/10.7326/M23-0849