Gabapentinoids and suicide, and other more subtle issues

There continues to be grave safety concerns involving adverse effects of gabapentinoid medications (especially gabapentin and pregabalin), and in this context Swedish researchers have conducted a major pharmacoepidemiological study of 191 973 people from the Swedish Prescribed Drug Register who collected prescriptions for these drugs from 2006 – 2013. Outcomes examined included suicidal behaviour, unintentional overdoses, head/body injuries, road traffic incidents and offences, and arrests for violent crime. Stratified Cox proportional hazards regression was conducted comparing treatment periods with non-treatment periods within an individual. In all, 10 026 people (5.2%) received treatment for suicidal behaviour or died from suicide, 17 144 (8.9%) experienced an unintentional overdose, 12 070 (6.3%) had a road traffic incident or offence, 70 522 (36.7%) presented with head/body injuries, and 7984 (4.1%) were arrested for a violent crime. Gabapentinoid treatment was associated with increased hazard rations for suicidal behaviour and deaths from suicide, unintentional overdoses, head/body injuries (1.22, 1.19 to 1.25), and road traffic incidents and offences Examined separately, pregabalin was associated with increased hazards of all outcomes, but gabapentin was associated with decreased or no statistically significant hazards. Risk appeared to be greatest for young people aged 15 to 24 years.