FDA Warns of Deadly Risks Tied to Gabapentin for Vulnerable Patients

Gabapentin is a medication that some people take to treat epilepsy, restless legs syndrome, or nerve pain from shingles. It also goes by the brand names Neurontin, Gralise, and Horizant.

Gabapentin belongs to a group of drugs called anticonvulsants. They work by altering the transmission of chemicals in your nervous system. Doctors also commonly prescribe it off-label to treat:

• neuropathic pain
• bipolar disorder
• attention deficit hyperactivity disorder (ADHD)
• hot flashes in menopause

Some doctors also prescribe gabapentin and pregabalin (a similar drug) to treat many kinds of pain. According to a 2017 editorial, the motivation for this is to offer an alternative to opioids. In 2019, there were gabapentin prescriptions in the United States, making it the seventh-most prescribed medication.

Despite its common use, there are risks linked to gabapentin. People with lung conditions such as chronic obstructive pulmonary disease (COPD) who take the drug can experience serious breathing problems. It can even lead to respiratory depression, which is potentially fatal.

If you have COPD, this article will review your risks of taking gabapentin. We'll also look at alternatives you might use.

What is COPD?

COPD is a group of conditions that cause breathing problems and blockages in the flow of air in and out of your lungs.

There are two common types. Chronic bronchitis is swelling and mucus in the airways of your lungs. Emphysema is where air is trapped inside your lungs, so you feel short of breath.

According to the American Lung Association, more than 16.4 million people in the United States have COPD.

What are the risks of taking gabapentin if you have COPD?

In late 2019, the issued a warning about the use of gabapentin or pregabalin (Lyrica) by people with respiratory risk factors. The warning identifies the following groups as most at risk:

• the elderly
• those with COPD
• those who use medications that depress the central nervous system (CNS), such as opioids

The warning came after a of reports that people submitted to the FDA Adverse Event Reporting System. The review linked gabapentin or pregabalin to 49 cases of respiratory depression from 2012 to 2017. In 92% of those cases, the person had a respiratory risk factor, and 12 of the 49 people died.

The FDA also looked at before issuing the warnings. These included published case reports, observational studies, animal studies, and human trials.

When to seek medical help

Caregivers of those who may experience respiratory issues while taking gabapentin should be to the following symptoms. If any are present, they should contact a doctor immediately:

• confusion
• disorientation
• dizziness
• lightheadedness
• extreme sleepiness
• lethargy
• slow or shallow breathing
• difficulty breathing
• unresponsiveness, or inability to rouse from sleep
• bluish skin, especially fingers, lips, or toes

Who else should not take gabapentin?

The about gabapentin was not only addressed to people with respiratory risk factors such as COPD. It also included people who use medications that depress the CNS, such as opioids.

Other such medications include:

• benzodiazepines, such as Valium and Xanax
• non-benzodiazepine sedative hypnotics, such as Ambien and Lunesta
• barbiturates, such as Mebaral and Luminal

A from the Centers for Disease Control and Prevention (CDC) examined the role of gabapentin in drug overdose deaths across the United States from 2019 to 2020. The report found that 90% of drug overdoses that involved gabapentin also included an opioid.

Are there alternatives to gabapentin?

A doctor can help you find a different drug if you're not comfortable taking gabapentin. The right alternative for you will depend on the reason you use the medication. A doctor can help you find an alternative that's safe for people with COPD.

Epilepsy

The FDA has approved for epilepsy. Some treat focal epilepsy, and others treat generalized epilepsy.

To help you find an alternative, a doctor will take into account the nature of your epilepsy. They'll also consider your age and medical history.

Neuropathic pain

Gabapentin is to treat postherpetic neuralgia, a type of pain in your skin caused by shingles. It can also treat other kinds of neuropathic pain.

If you take gabapentin for neuropathic pain, you may be able to take amitriptyline (Amitid or Elavil). Another possible substitute is duloxetine (Cymbalta or Drizalma Sprinkle). Both are antidepressants that regulate the levels of certain chemicals in your brain.

Restless legs syndrome

There are other FDA-approved medications for restless legs syndrome:

• ropinirole (Requip)
• pramipexole (Mirapex)
• rotigotine (Neupro)

Hot flashes

Some people may use gabapentin off-label to help with hot flashes. A possible alternative for hot flashes is paroxetine (Paxil or Seroxat), an antidepressant.

What other medications should people with COPD avoid?

The FDA warning about gabapentin also cautions against the use of pregabalin in people with COPD. Like gabapentin, pregabalin is an anticonvulsant. Doctors prescribe this medication to treat:

• neuropathic pain
• fibromyalgia
• seizures

The use of beta-blockers in people with COPD is controversial. Beta-blockers can improve outcomes in those with cardiovascular disease. However, it may also lower lung function in people with COPD.

A found beta-blockers are generally positive for people with COPD. But one beta-blocker - propranolol - contributed to a decline in lung function.

Can gabapentin be fatal to people with COPD?

Gabapentin can lead to respiratory depression in people with reduced lung function due to COPD. That's when your breathing is too slow and ineffective.

When this is the case, your lungs aren't able to remove enough carbon dioxide (hypercarbia) or take in enough oxygen (hypoxia). Both can ultimately lead to death.

Takeaway

Gabapentin is a widely prescribed medication people use to manage seizures and control pain. Some people with certain risk factors have reported respiratory problems after taking gabapentin or similar medications, such as pregabalin. Those risk factors include having COPD and using CNS depressants.

The FDA has warned against the use of gabapentin for people with COPD. If you rely on gabapentin to manage conditions, talk with a doctor about what alternative treatments you can take.