Gabapentin dose and the 30-day risk of altered mental status in older adults: A retrospective population-based study

Abstract

Gabapentin is an effective treatment for chronic neuropathic pain but may cause dizziness, drowsiness, and confusion in some older adults. The goal of this study was to assess the association between gabapentin dosing and adverse outcomes by obtaining estimates of the 30-day risk of hospitalization with altered mental status and mortality in older adults (mean age 76 years) in Ontario, Canada initiated on high dose (>600 mg/day; n = 34,159) compared to low dose (≤600 mg/day; n = 76,025) oral gabapentin in routine outpatient care. A population-based, retrospective cohort study assessing new gabapentin use between 2002 to 2014 was conducted. The primary outcome was 30-day hospitalization with an urgent head computed tomography (CT) scan in the absence of evidence of stroke (a proxy for altered mental status). The secondary outcome was 30-day all-cause mortality. The baseline characteristics measured in the two dose groups were similar. Initiation of a high versus low dose of gabapentin was associated with a higher risk of hospitalization with head CT scan (1.27% vs. 1.06%, absolute risk difference 0.21%, adjusted relative risk 1.29 [95% CI 1.14 to 1.46], number needed to treat 477) but not a statistically significant higher risk of mortality (1.25% vs. 1.16%, absolute risk difference of 0.09%, adjusted relative risk of 1.01 [95% CI 0.89 to 1.14]). Overall, the risk of being hospitalized with altered mental status after initiating gabapentin remains low, but may be reduced through the judicious use of gabapentin, use of the lowest dose to control pain, and vigilance for early signs of altered mental status.

The Efficacy of Clonidine in the Pharmacological Management of Alcohol Withdrawal Syndrome: Preliminary Results

“…An increased dose of gabapentin could contribute to altering the mental state, especially in vulnerable patients. This result is also supported by another research [30]. Finally, in our study, clonidine was the only medication from the therapeutic schema that was associated with a significantly lower CIWA-Ar mean score after 5 days.…”

Patterns of Psychoactive Medication Use in Community-Dwelling Older Adults in the US in 2016: A Descriptive Cross-Sectional Study

“…Although use of gabapentin for pain management has increased extensively, clinical trials have shown mixed results with regards to its effectiveness in reducing pain (Derry et al, 2016; Mathieson et al, 2017). In the older adult population, there is evidence linking gabapentin use to atrial fibrillation (Ortiz de Landaluce et al, 2018), altered mental status (Yeddi et al, 2019), and hospitalization (Fleet et al, 2018). Given the uncertainty in the effectiveness and safety of gabapentin, especially in older adults, its widespread use is concerning and efforts to promote prudent use should be emphasized.…”

Multimodal Pain Management for Major Joint Replacement Surgery

“…This is more likely to occur in older patients. It appears that dose plays a large role in the development of these side effects, and using the lowest effective dose, specific to individual patients, decreases that risk (Fleet et al, 2018).…”