Gabapentinoids, Used for Epilepsy and Pain Relief, Associated with Exacerbation of Pulmonary Disease Interview with:
Christel Renoux,  MD, PhD
Associate Professor
Dept. of Neurology & Neurosurgery
McGill University
Centre For Clinical Epidemiology H-416.1
Jewish General Hospital – Lady Davis Research Institute
Montreal Canada and
Alvi Rahman MSc
Pharmacoepidemiologist | HEOR Consulting
McGill University
Montreal, Quebec, Canada What is the background for this study?

Response: . Gabapentinoids are anticonvulsant drugs that include the two drugs, gabapentin and pregabalin. They are indicated for the treatment of epilepsy and neuropathic pain, with minor variations between countries (pregabalin is also indicated for generalized anxiety disorders in some countries). However, they are often prescribed off-label for any type of pain, sometimes with the perception that they may be a safer alternative to opioids. Yet, gabapentinoids also may have serious adverse effects owing to the depressant effect they have on the central nervous system, which can lead to sedation or respiratory depression.

Several public health agencies have warned of breathing problems related to gabapentinoids, including the U.S. Food and Drug Administration (FDA), Health Canada, and the European Medicines Agency. Specifically, the FDA suggested that patients with respiratory risk factors, including those with chronic obstructive pulmonary disease (COPD) may be at higher risk. These warnings were based mainly on case reports, and there was a lack of large population-based studies on this topic, which led us to conduct this study assessing the association between gabapentinoid use and severe exacerbation of COPD (hospitalization). What are the main findings?

Response: Out of 156,803 patients with COPD, our study cohort included 13,504 gabapentinoid users matched to an equal number of nonusers on age, sex, duration of COPD, indication for gabapentinoids, calendar year, and time-conditional propensity score.

Overall, we found that gabapentinoid use was associated with an increased risk of severe exacerbation of COPD compared with non-use. We reported that this risk was increased in all patients regardless of age, sex, or different markers of COPD severity. What should readers take away from your report?

Response: The key takeaway from the study for physicians would be to consider the potential increased risk of severe exacerbation when prescribing gabapentin and pregabalin to patients with COPD. Close monitoring of patients can help avoid harmful adverse effects and subsequent deterioration of health. What recommendations do you have for future research as a result of this study?

Response: Future research may assess whether the dosing of gabapentinoids is associated with the risk of severe COPD exacerbation. The possible identification of a safer range of dose may help avoid harm in patients. In addition, the exploration of possible alternatives to gabapentinoids for pain may provide safer treatment options for patients with COPD at highest risk of exacerbation.

 Any disclosures? No disclosures. Thank you very much for your interest in our study!


Gabapentinoids and Risk for Severe Exacerbation in Chronic Obstructive Pulmonary Disease
Alvi A. Rahman, Sophie Dell’Aniello, Erica E.M. Moodie, et al. Gabapentinoids and Risk for Severe Exacerbation in Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study. Ann Intern Med. [Epub 16 January 2024]. doi:10.7326/M23-0849

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Last Updated on January 18, 2024 by