Home > Safety of gabapentin prescribed for any indication in a large clinical cohort of 571,718 US Veterans with and without alcohol use disorder.

Rentsch, Christopher T and Morford, Kenneth L and Fiellin, David A and Bryant, Kendall J and Justice, Amy C and Tate, Janet P (2020) Safety of gabapentin prescribed for any indication in a large clinical cohort of 571,718 US Veterans with and without alcohol use disorder. Alcoholism, Clinical and Experimental Research, 44, (9), pp. 1807-1815. https://doi.org/10.1111/acer.14408.

External website: https://onlinelibrary.wiley.com/doi/full/10.1111/a...

BACKGROUND - Gabapentin is prescribed for seizures and pain and has efficacy for treating alcohol use disorder (AUD) starting at doses of 900 milligrams per day (mg/d). Recent evidence suggests safety concerns associated with gabapentin including adverse neurologic effects. Individuals with hepatitis C (HCV), HIV, or AUD may be at increased risk due to comorbidities and potential medication interactions.

METHODS - We identified patients prescribed gabapentin for ≥ 60 days for any indication between 2002 and 2015. We propensity-score matched each gabapentin-exposed patient with up to 5 gabapentin-unexposed patients. We followed patients for 2 years or until diagnosed with (i) falls or fractures, or (ii) altered mental status using validated ICD-9 diagnostic codes. We used Poisson regression to estimate incidence rates and relative risk (RR) of these adverse events in association with gabapentin exposure overall and stratified by age, race/ethnicity, sex, HCV, HIV, AUD, and dose.

RESULTS - Incidence of falls or fractures was 1.81 per 100 person-years (PY) among 140,310 gabapentin-exposed and 1.34/100 PY among 431,408 gabapentin-unexposed patients (RR 1.35, 95% confidence interval [CI] 1.28 to 1.44). Incidence of altered mental status was 1.08/100 PY among exposed and 0.97/100 PY among unexposed patients, RR of 1.12 (95% CI 1.04 to 1.20). Excess risk of falls or fractures associated with gabapentin exposure was observed in all subgroups except patients with HCV, HIV, or AUD; however, these groups had elevated incidence regardless of exposure. There was a clear dose-response relationship for falls or fractures with highest risk observed among those prescribed ≥ 2,400 mg/d (RR 1.90, 95% CI 1.50 to 2.40). Patients were at increased risk for altered mental status at doses 600 to 2,399 mg/d; however, low number of events in the highest dose category limited power to detect a statistically significant association ≥ 2,400 mg/d.

CONCLUSIONS - Gabapentin is associated with falls or fractures and altered mental status. Clinicians should be monitoring gabapentin safety, especially at doses ≥ 600 mg/d, in patients with and without AUD.

Item Type
Publication Type
International, Open Access, Article
Drug Type
Alcohol, New psychoactive substance
Intervention Type
Drug therapy, Treatment method
6 July 2020
Identification #
Page Range
pp. 1807-1815

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