A Decade of Gabapentinoid Misuse: An Analysis of the European Medicines Agency's 'Suspected Adverse Drug Reactions' Database.
The gabapentinoids pregabalin and gabapentin are being increasingly prescribed for a range of clinical conditions. Recently, although gabapentinoids at therapeutic dosages may present with low addictive liability levels, cases of misuse and rising numbers of related fatalities have been reported.



The aim of the study was to identify and assess cases of gabapentinoid misuse or dependence as reported to the European Medicines Agency's EudraVigilance database, to identify the magnitude of this problem and the characteristics of these reactions.



All spontaneous reports of both gabapentin- (2004-2015) and pregabalin- (2006-2015) related misuse/abuse/dependence were retrieved. A descriptive analysis by source, sex, age, and type of report was performed.



From the EudraVigilance database 7639 (6.6 % of a total of 115,616) and 4301 (4.8 % of 90,166) adverse drug reaction reports of misuse/abuse/dependence were, respectively, associated with pregabalin and gabapentin, with an overall reporting frequency increasing over time. For both molecules, subjects typically involved were female adults. A total of 27 and 86 fatalities, respectively, associated with pregabalin and gabapentin, and mostly in combination with opioids, were identified. Analysis of proportional reporting ratios for drug abuse/dependence/intentional product misuse values seem to indicate that these adverse drug reactions were more frequently reported for pregabalin (1.25, 1.39, and 1.58, respectively) compared with gabapentin.



Despite data collection/methodological approach limitations, the present data seem to suggest that gabapentinoid misuse may be a cause for concern, especially in patients with a history of substance misuse. Hence, healthcare professionals should be vigilant when prescribing these molecules.
Department of Psychiatry, Catholic University School of Medicine, Largo Agostino Gemelli 8, Rome, 00168, Italy. stefaniachiappini9@gmail.com.
Stefania
S
Chiappini
School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK.
Fabrizio
F
Schifano
D000328:Adult; D000588:Amines / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016739:Behavior, Addictive / Q000188:drug therapy / Q000517:prevention & control*; D003509:Cyclohexanecarboxylic Acids / Q000009:adverse effects*; D016208:Databases, Factual; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069583:Pregabalin / Q000627:therapeutic use; D063487:Prescription Drug Misuse; D019966:Substance-Related Disorders / Q000188:drug therapy*; D005680:gamma-Aminobutyric Acid / Q000009:adverse effects*
D000588:Amines; D000701:Analgesics, Opioid; D003509:Cyclohexanecarboxylic Acids; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin