More bad news for users the popular drug gabapentin and other nerve drugs, which are widely prescribed to treat a variety of conditions, including neuropathy and fibromyalgia.  Recently, researchers had found gabapentin was linked to a number of attempted suicides, and according to the Food and Drug Administration (FDA), “All patients who are currently taking or starting on any antiepileptic drug for any indication should be monitored for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.”  Researchers linked the increase to an increasing number of prescriptions being issued for gabapentin rather than opioids, per the Centers for Disease Control and Prevention guidelines.  Now, there seems to be an even more significant link between gabapentin and the crisis.  Health regulators are warning that gabapentin can cause life-threatening breathing problems when combined with opioids.The FDA announced it will be adding warnings to the packaging for Neurontin, Lyrica and their generic versions (gabapentin and pregabalin).  The new labels are designed to warn practitioners against prescribing the drugs with other medications that can slow one’s breathing rate.

Photo by RAYMOND Wong on Unsplash

Poison control centers have reported an increased amount of calls involving the nerve drugs and these medications are commonly being abused in tandem with opioid drugs.  The FDA said it “received nearly 50 reports of breathing problems linked to gabapentin and pregabalin between 2012 and 2017, including 12 deaths” and now will “require drug makers to conduct new studies of the abuse risks of the drugs, especially in combination with opioids.”Previously, in a study published in the journal Clinical Toxicology, University of Pittsburgh researchers examined more than 90,000 calls involving medications to U.S. poison control centers and found that “calls about gabapentin and the muscle relaxant baclofen increased significantly just as opioid prescriptions began declining.”“Gabapentin and baclofen are two medications that have seen increased availability to patients as alternatives to opioids for the treatment of acute and chronic pain.  With greater accessibility, poison center exposures have demonstrated a marked increase in toxic exposures to these two medications,” wrote lead author Kimberly Reynolds of the University, adding, “As poison center data do not represent the totality of cases in the United States, the steep upward trends in reported exposures reflect a much larger problem than the raw numbers would suggest.”Researchers indicated, “Gabapentin has specifically been recognized for its misuse and diversion potential, synergistic effect with opioid use, and contribution to use disorders.  Baclofen misuse has not been as frequently described but is anecdotally observed and associated with severe toxicity, physical dependence, and complicated withdrawal.”Gabapentin ranked number ten on a list of the most widely prescribed drug in the U.S. in 2017, according to the FDA, and now researchers are recommending any patients being prescribed the drug should be pre-screened for substance use disorders.  Doing so may limit abuse or dangerous co-use with opioid drugs, which heightens the risk of breathing problems.Most at risk for overdoses or suicidal ideation were teenagers and young adults, according to the published studies.  Yet, doctors are still following the CDC’s guidelines and using nerve drugs as a “first line of defense” against opioid abuse.  There is still much progress to be made.

Sources:

Gabapentin is Being Substituted for Opioids, Attempted Suicides IncreaseGabapentin Linked to Growing Number of Suicide AttemptsFDA warns of breathing risks with popular nerve drugs