Gabapentinoids associated with severe exacerbation of COPD

A population-based cohort study of more than 10,000 persons using gabapentinoids found that their use was associated with an increased risk of chronic obstructive pulmonary disease (COPD) exacerbation. This study supports the warnings from regulatory agencies and highlights the importance of considering this potential risk when prescribing gabapentin and pregabalin to patients with COPD. The study is published in Annals of Internal Medicine.

Gabapentinoid drugs are anticonvulsant drugs indicated for the treatment of epilepsy and neuropathic pain. Despite limited indications, its prescription has surged across North America and Europe, which may partly stem from excessive off-label prescribing. However, these drugs have been reported to cause central nervous system depression, leading to sedation and respiratory depression in animal and human studies. This safety issue may be of particular concern in patients with respiratory diseases like COPD.

Researchers from McGill University and Lady Davis Institute for Medical Research studied insurance data for 356 gabapentinoid users with epilepsy, 9,411 with neuropathic pain, and 3,737 with other chronic pain.

The gabapentinoid users were matched 1:1 to nonusers on COPD duration, indication for gabapentinoids, age, sex, calendar year, and time-conditional propensity score. The authors found that compared with nonuse, gabapentinoid use was associated with an increased risk for severe COPD exacerbation among users taking these drugs for epilepsy, neuropathic pain, and chronic pain, and peak increase in risk for severe COPD exacerbation occurred after approximately six months of continuous use.

Among patients with neuropathic pain and other chronic pain, the risk was observed regardless of age, sex, number of prior COPD exacerbations, prior use of inhaled corticosteroids (ICS), number of respiratory medications used, or opioid or benzodiazepine use. According to the authors, physicians should consider these potential risks before prescribing gabapentin and pregabalin to patients with COPD.