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gabapentinoid; GABA analog

Contraindications: - perioperative gabapentinoids of minimal benefit for postoperative pain [3] Adverse effects: - respiratory depression in patients with COPD - perioperative gabapentinoids for hip replacement or knee replacement associated with excess pulmonary complications & do not spare opioid use [2] - prescription of gabapentinoids leads to a prescribing cascade resulting in unnecessary use of diuretics [4,5] Drug interactions: - increased risk of respiratory depression in combination with opiates Mechanism of action: 1) structurally related to GABA, but does not interact with GABA receptors 2) binds to alpha-2 delta subunit of voltage-gated Ca+2 channel 3) membrane stabilizer 4) may affect hypothalamic thermoregulatory centers

Interactions

drug interactions drug adverse effects of anticonvulsants monitor with anticonvulsants

Specific

gabapentin (Neurontin, Gralise) pregabalin (Lyrica,'son of gabapentin')

General

anticonvulsant

References

  1. FDA Drug Safety Communication. Dec 19, 2019 FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR). When used with CNS depressants or in patients with lung problems https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin - FDA Drug Safety Watch. Dec 19, 2019 Neurontin, Gralise, Horizant (gabapentin) and Lyrica, Lyrica CR (pregabalin): Drug Safety Communication - Serious Breathing Problems. https://www.fda.gov/safety/medical-product-safety-information/neurontin-gralise-horizant-gabapentin-and-lyrica-lyrica-cr-pregabalin-drug-safety-communication
  2. Ohnuma T, Raghunathan K, Moore S et al. Dose-dependent association of gabapentinoids with pulmonary complications after total hip and knee arthroplasties. J Bone Joint Surg Am 2020 Feb 5; 102:221 PMID: 31804238
  3. Verret M et al. Perioperative use of gabapentinoids for the management of postoperative acute pain: A systematic review and meta-analysis. Anesthesiology 2020 Aug; 133:265. PMID: 32667154 https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2766309 - Kharasch ED et al. Perioperative gabapentinoids: Deflating the bubble. Anesthesiology 2020 Aug; 133:251. PMID: 32667153 https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2766307
  4. Read SH, Giannakeas V, Pop P et al Evidence of a gabapentinoid and diuretic prescribing cascade among older adults with lower back pain. J Am Geriatr Soc 2021 Oct; 69:2842 PMID: 34118076 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17312
  5. Growdon ME, Jing B, Morris EJ et al. Which older adults are at highest risk of prescribing cascades? A national study of the gabapentinoid-oop diuretic cascade. J Am Geriatr Soc 2024 Jun; 72:1728-1740 PMID: 38547357 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18892