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New patterns emerge, especially for young people.
Gabapentinoid prescriptions were associated with an increased risk of suicidal behavior and unintentional overdose, a population cohort study in Sweden showed.
The risks were strongest for people who were prescribed pregabalin (Lyrica) over gabapentin (Neurontin), especially among young people, reported Seena Fazel, MD, of the University of Oxford in England, and colleagues in The BMJ.
“Our results also suggest an increased risk of head and body injuries, road traffic accidents, and criminal offenses,” co-author Yasmina Molero, PhD, of the Karolinska Institute in Stockholm, told MedPage Today. “Importantly, when we broke down the findings by 10-year age bands, increased associations were consistently found in younger people, particularly those age 15 to 24.”
Gabapentin and pregabalin, two main drugs in the gabapentinoid drug class, are approved for epilepsy and post-herpetic neuralgia in the U.S., but both frequently are used off-label. Pregabalin also is approved for fibromyalgia and neuropathic pain in the U.S. and for treating generalized anxiety disorder in Europe.
Evidence has emerged that gabapentinoids are being used “clinically (but ineffectively) as an opioid substitute and diverted to recreational use, and detection at post mortem has increased, along with direct attribution as cause of death,” noted Derek Tracey, a consultant psychiatrist at Queen Mary’s Hospital in London, in an accompanying editorial. “These concerns have led to legislative changes to restrict or control prescribing in several countries, including the United Kingdom.”
In the U.S., gabapentin and pregabalin have tripled in use from 2002 to 2015