Gabapentinoids linked to new risks, including suicidal behaviour

Medical training might start with “first, do no harm,” but in truth the prescribing of drugs is a balance of risks. All drugs can cause harm, although the extent of this varies among different people, drugs, dosages, and durations of use.

Gabapentinoids (primarily gabapentin and pregabalin) are indicated for epilepsy and neuropathic pain. Pregabalin is also used for anxiety disorders. Off-label use has included restless leg syndrome, migraine, menopausal flushes, and alcohol dependency.1 Acute, well documented side effects of gabapentinoids include motor incoordination, dizziness, cognitive impairment, and suicidal ideation.2 Few data exist on how these might translate into longer term harm over months and years, and existing evidence is patchy and inconsistent.

Molero and colleagues (doi:10.1136/bmj.l2147) help to fill this evidence gap3 by exploring a range of harms among adolescents and adults (>15 years) prescribed gabapentinoids, including suicidal behaviour, unintentional overdose, injuries, road traffic incidents, and violent crime. Their study is timely. Prescribing rates have risen sharply in recent years4; evidence has emerged that these agents are being used clinically (but ineffectively) …