The Medical Letter on Drugs and Therapeutics
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1599
In Brief: Respiratory Depression with Gabapentinoids
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 Select a term to see related articles  COPD   Drug Safety   Gabapentin   Lyrica   Neurontin   Opioids   Pregabalin 

The FDA has required new warnings in the labels of gabapentin (Neurontin, and others) and pregabalin (Lyrica, Lyrica CR, and generics) about the risk of life-threatening or fatal respiratory depression in patients with respiratory risk factors.1 Respiratory risk factors include chronic obstructive pulmonary disease (COPD) and concurrent use of opioids or other CNS depressants. Elderly patients are also at increased risk.

Gabapentin and pregabalin are FDA-approved to treat a variety of neurologic and neuropathic disorders and are frequently used off-label to treat non-neuropathic pain, anxiety, and insomnia, and hot flashes in women with breast cancer.2-5 Often prescribed with opioids and other CNS depressants, gabapentinoid misuse and abuse has been increasing. Gabapentin and pregabalin have a lower potential for abuse than opioids, but physical and psychological dependence can occur.

Gabapentinoids alone can cause respiratory depression. Coadministration with an opioid can increase the risk of opioid-related death.6 Possible mechanisms include reversal of opioid-induced tolerance and additive respiratory depression.7

Starting gabapentinoids at a low dose and titrating carefully is recommended to reduce the risk of respiratory depression in patients with respiratory risk factors and in the elderly. Reductions in the dosage of gabapentin and pregabalin are necessary in patients with renal impairment.

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