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Researchers call for review of treatment guidelines
Adrian O & # 39; Dowd
Thursday, June 13, 2019
People treated with gabapentinoids – a group of medications used for epilepsy, nerve pain, and anxiety disorders – may be at higher risk for suicidal behavior, unintentional overdose, injury, and accidents. of the road, suggests a study * published in Sweden today by The bmj.
The number of prescriptions for these drugs by doctors has increased significantly in recent years and gabapentinoids are one of the 15 best-selling drugs in the world.
Previous studies have linked gabapentinoids to suicidal behavior and overdose-related deaths, but results have been inconsistent and longer-term injury data are lacking.
Concerns have also been expressed about the use of these drugs as a substitute for opioids and recreational purposes, which has led to prescribing restrictions in several countries, including the United Kingdom.
To learn more, an international research team examined the badociations between gabapentinoids and various injuries, including suicidal behavior, unintentional overdoses, injuries, traffic accidents and violent crime.
Using national registers of prescriptions, patients, deaths and crimes, they identified 191,973 people aged 15 and over who were prescribed pregabalin or gabapentin in Sweden between 2006 and 2013. Overall, 59% of participants were women and most were 45 years of age and older. .
The researchers then compared the risk of injury during treatment periods with baseline risk during periods without treatment.
After taking into account potentially influential factors, they found that during treatment periods, participants were:
- 26% increased risk of suicidal behavior or death by suicide
- 24% increased risk of unintentional overdose
- 22% increased risk of injury to the head or body
- Increase of 13% of the risk of incidents or infractions of the road.
There was no statistically significant badociation between gabapentinoid treatment and violent crime.
When drugs were examined separately, only pregabalin, not gabapentin, was badociated with an increased risk of adverse effects.
When researchers badyzed the results by age, the risks were higher among those aged 15 to 24, which could be due to impulsivity and risk-taking, alcohol and illicit drug use alongside gabapentinoids.
It was an observational study. It was therefore not possible to establish the cause and the researchers were unable to report adherence to treatment or any interaction between alcohol and illicit drug use.
Nevertheless, it was a large study examining a wide range of results and designed to minimize the effects of confounding factors.
The researchers concluded, "Overall, gabapentinoids appear to be safe for a range of outcomes in the elderly. However, the increased risks in adolescents and young adults (aged 15 to 24) who have been prescribed gabapentinoids, particularly in cases of suicidal behavior and unintentional overdoses, warrant further research.
"If our results are triangulated with other forms of evidence, clinical guidelines may require a review of prescriptions for youth and those with substance use disorders."
* Molero Y, et al. Associations between gabapentinoids and suicidal behavior, unintentional overdoses, injuries, traffic accidents and violent crime: population-based cohort study in Sweden. BMJ 2019; 365: 12147.
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