University College London (UCL) researchers announced on Apr. 17 that people prescribed gabapentinoids for chronic pain face a significantly higher risk of drug poisoning if they are also taking other medications, according to a new study published in PLOS Medicine.
The findings highlight concerns about the safety of combining gabapentinoids with other drugs, particularly benzodiazepines and opioids. The study found that adding benzodiazepines doubled the risk of hospitalisation for drug poisoning among people already taking gabapentinoids, while adding opioids increased the risk by 30%.
Researchers reviewed prescription data from the UK between 2010 and 2020, focusing on over 16,800 individuals who had at least one hospitalisation due to drug poisoning. They observed that patients were frequently prescribed gabapentinoids alongside other medications: nearly nine out of ten took them with opioids at some point during the study period, and more than half combined them with benzodiazepines.
The highest risk period for drug poisoning was identified in the three months before starting gabapentinoid treatment. The authors suggest this may reflect attempts by clinicians to address concerns about existing medication risks by prescribing alternatives such as gabapentinoids. However, even after starting these drugs, an elevated risk persisted for several months.
Dr Andrew Yuen from UCL School of Pharmacy said: "A clinician's decision to prescribe gabapentinoids may sometimes be an attempt to minimise the risk of drug poisoning linked to opioids or other medications. While the risk of poisoning did decrease somewhat after patients began gabapentinoid treatment, they still faced an elevated risk of drug poisoning, which suggests that clinicians need to remain vigilant to the risks." Dr Kenneth Man added: "Our findings do not suggest that gabapentinoids are unsafe or should not be prescribed, but clinicians should be cautious when prescribing them, particularly if a patient is taking other medications as well, and clinicians should closely monitor patients who are taking them."
The researchers noted their findings align with recent actions by the UK's Medicines and Healthcare products Regulatory Agency (MHRA), which strengthened warnings regarding addiction and dependence related to these drugs earlier this year.
While it remains unclear whether gabapentinoids directly cause drug poisonings or how such effects might occur physiologically, evidence suggests they can enhance sedative effects when used alongside certain other medications. The research team calls for ongoing caution among healthcare professionals when considering prescriptions involving multiple high-risk drugs.
