|
Authors:
Multiple adverse behavioral and psychomotor associations are found with these drugs although the effects might be confined to pregabalin. Clinicians often prescribe gabapentin and pregabalin for pain, sleep, and anxiety symptoms, and some view these drugs as safe alternatives to benzodiazepines and opioids in, for example, patients with alcohol use, chronic insomnia, or chronic pain disorders. Thus, use of these medications has been increasing. Researchers in Sweden conducted a within-subjects epidemiological study of almost 200,000 people aged ≥15 with ≥2 prescriptions for gabapentin or pregabalin in 2006–2013. Periods of using gabapentinoids were associated with greater risks than nontreatment periods for suicidal behavior (hazard ratio, 1.26), unintentional overdose (HR, 1.24), head and bodily injuries (HR, 1.22), and traffic accidents (HR, 1.13). In subanalyses, the effects were mostly confined to pregabalin, appeared to be greatest in adolescents and young adults, and were absent in people aged ≥55. |
|
|
|
Leave a Reply Cancel reply
You must be logged in to post a comment.
COMMENT
The specific association of these adverse effects with pregabalin validates the U.S. placement of this drug in the same schedule as benzodiazepines, which also makes it harder to prescribe than gabapentin. However, the two medications are mechanistically similar. Recent data showing that gabapentin’s analgesic effects for fibromyalgia pain are less robust than previously thought (Cochrane Database Syst Rev 2017; 1:CD012188) suggest caution in prescribing it for nonneuropathic pain. In my practice (which is not focused on chronic pain), I do not prescribe pregabalin due to concerns about abuse and dependence, and I confine my prescription of gabapentin to patients with problematic insomnia (but only at low doses and only if the drug is clearly effective) and specific patients whose alcohol abuse is driven by anxiety not responsive to standard antidepressant treatments used for anxiety.