Gabapentin utilization among older adults with different cognitive statuses enrolled in the National Alzheimer's Coordinating Center (2006–2019)

Oh, GYeon; Moga, Daniela C.; Abner, Erin L.

doi:10.1111/bcp.15532

Cited by 7 publications

(8 citation statements)

References 30 publications

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“…In addition to the neurocognitive outcomes under study, we also found that the gabapentin initiators had higher prevalence of opioid use, as well as antidepressants, antipsychotics, benzodiazepines, and anxiolytics, sedatives, and hypnotics compared to nonusers. This result is consistent to our previous study that examined the concurrent use of gabapentin with CNSdepressant medications (Oh et al, 2022). As the FDA and the Beers 2019 criteria warn about using gabapentin concurrently with some medications due to risk of respiratory depression (U.S. Food and Drug Administration, 2019; By the 2019 American Geriatrics Society Beers Criteria ® Update Expert Panel, 2019), further studies are needed to examine the risk of concurrently using gabapentin with other CNS depressants in older adults.…”

Section: Discussionsupporting

confidence: 93%

The association of gabapentin initiation and neurocognitive changes in older adults with normal cognition

Moga

Fardo

et al. 2022

Front. Pharmacol.

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Background: Gabapentin is increasingly prescribed to older adults, which raises concerns about its potential to cause neurocognitive changes. Therefore, we aimed to examine the association of gabapentin use with neurocognitive changes (i.e., cognitive decline, functional status decline, and motor function change) in older adults.Methods: We conducted a retrospective cohort study using the National Alzheimer’s Coordinating Center Uniform Data Set (UDS; September 2005-March 2021 data freeze). From the eligible sample (≥age 65 years), we identified cognitively normal new-users of gabapentin and the visit they initiated gabapentin (i.e., index visit). Initiators were matched to randomly selected nonusers on year of UDS enrollment and visit number from enrollment to index. Cognitive decline was defined as any increase in the Clinical Dementia Rating global score (CDRGLOB) and as a 1-point increase in CDR sum of boxes (CDR-SB). Functional status decline was defined as a 3-point increase in the sum of the Functional Activities Questionnaire (FAQ) and as 0.3-point increase in mean FAQ. Decline in motor function was defined as new clinician reports of gait disorder, falls, and slowness. To mitigate confounding and selection bias, we used joint stabilized inverse probability of treatment weights and stabilized inverse probability of censoring weights. All analyses were conducted comparing index to index+1 and index+2 visits.Results: From the eligible UDS participants (N = 23,059), we included 480 initiators (mean age [SD]: 78.7 [6.9]; male 34.4%); 4,320 nonusers (78.3 [7.0]; 34.4%). Gabapentin initiation was significantly associated with cognitive/functional status decline: worsening CDRGLOB at index+1 visit (odds ratio [95% confidence interval]: 1.55 [1.07, 2.25]); CDR-SB at index+1 visit (1.94 [1.22, 3.09]); and mean of FAQ at index+2 visit (1.78 [1.12, 2.83]). After excluding initiators with extant motor dysfunction (n = 21), we identified 459 initiators (78.7 [6.9]; 34.0%) and 4,131 nonusers (78.2 [6.9]; 34.7%); in this sample, gabapentin initiation was associated with increased falls at the index+2 visit (2.51 [1.19, 5.31]).Conclusion: Gabapentin initiation was significantly associated with deleterious neurocognitive changes among older adults with initially normal cognition. Further studies are needed to examine the risk/benefit of prescribing gabapentin in older adults.

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Section: Discussionsupporting

confidence: 93%

The association of gabapentin initiation and neurocognitive changes in older adults with normal cognition

Moga

Fardo

et al. 2022

Front. Pharmacol.

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“…benzodiazepines) and opioid analgesics significantly increases adverse events, such as respiratory depression and mortality 6,21 . Moreover, gabapentinoid use has also been associated with increased risks of suicidal ideation and behaviour, particularly among adolescents and young adults (15–24 years) and women 22–24 . Furthermore, physical dependence, tolerance and withdrawal from gabapentinoids have been well documented at both recommended dosages and supratherapeutic dosages 6,22,25,26 …”

Section: Introductionmentioning

confidence: 99%

“…6,21 Moreover, gabapentinoid use has also been associated with increased risks of suicidal ideation and behaviour, particularly among adolescents and young adults (15-24 years) and women. [22][23][24] Furthermore, physical dependence, tolerance and withdrawal from gabapentinoids have been well documented at both recommended dosages and supratherapeutic dosages. 6,22,25,26 In cases where a drug is no longer needed or is associated with more harm than benefits, the medicine should cease (or reduce in dose).…”

Section: Introductionmentioning

confidence: 99%

“…[22][23][24] Furthermore, physical dependence, tolerance and withdrawal from gabapentinoids have been well documented at both recommended dosages and supratherapeutic dosages. 6,22,25,26 In cases where a drug is no longer needed or is associated with more harm than benefits, the medicine should cease (or reduce in dose). Deprescribing is the complex process of tapering or ceasing unnecessary medication, aimed at improving patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Deprescribing interventions for gabapentinoids in adults: A scoping review

Anderson

McLachlan

Shaheed

et al. 2023

Brit J Clinical Pharma

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The emerging issue of rising gabapentinoid misuse is being recognized alongside the lack of current evidence supporting the safe and effective deprescribing of gabapentinoids. This scoping review aimed to assess the extent and nature of gabapentinoid deprescribing interventions in adults, either in reducing dosages, or prescribing of, gabapentinoids. Electronic databases were searched on 23 February 2022 without restrictions. Eligible studies included randomized, non‐randomized and observational studies that assessed an intervention aimed at reducing/ceasing the prescription/use of a gabapentinoid in adults for any indication in a clinical setting. The research outcomes investigated the type of intervention, prescribing rates, cessations, patient outcomes and adverse events. Extracted outcome data were categorized as either short (≤3 months), intermediate (>3 but <12 months) or long (≥12 months) term. A narrative synthesis was conducted. The four included studies were conducted in primary and acute care settings. Interventions were of dose‐reducing protocols, education and/or pharmacological‐based approaches. In the randomized trials, gabapentinoid use could be ceased in at least one third of participants. In the two observational trials, gabapentinoid prescribing rates decreased by 9%. Serious adverse events and adverse events specifically related to gabapentinoids were reported in one trial. No study included patient‐focused psychological interventions in the deprescribing process, nor provided any long‐term follow‐up. This review highlights the lack of existing evidence in this area. Due to limited available data, our review was unable to make any firm judgements on the most effective gabapentinoid deprescribing interventions in adults, highlighting the need for more research in this area.

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“…(14-16) Furthermore, physical dependence, tolerance and withdrawal from gabapentinoids have been well documented at both recommended dosages and supratherapeutic dosages. (2,14,17,18) In cases where a drug is no longer needed or is associated with more harms than benefits, the medicine should cease (or reduce in dose). Deprescribing is the complex process of tapering or ceasing unnecessary medication, aimed at improving patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Deprescribing interventions for gabapentinoids in adults: a scoping review

Anderson¹,

McLachlan

Shaheed

et al. 2022

Preprint

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The emerging issue of rising gabapentinoid misuse is being recognised alongside the lack of current evidence supporting the safe and effective deprescribing of gabapentinoids. This scoping review aimed to assess the extent and nature of gabapentinoid deprescribing interventions in adults, either in reducing dosages, or prescribing of, gabapentinoids. Electronic databases were searched on 23rd February 2022 without restrictions. Eligible studies included randomised, non-randomised and observational studies that assessed an intervention aimed at reducing/ceasing the prescription/use of a gabapentinoid in adults for any indication in a clinical setting. The research outcomes investigated type of intervention, prescribing rates, cessations, patient outcomes, and adverse events. Extracted outcome data was categorised as either short (≤ 3 months), intermediate (>3 but <12 months) or long (≥ 12 months) term. A narrative synthesis was conducted. The four included studies were conducted in primary and acute care settings. Intervention were of dose reducing protocols, education and/or pharmacological-based approaches. In the randomised trials, gabapentinoid use could be ceased in at least one-third of participants. In the two observational trials, gabapentinoid prescribing rates decreased by 9%. Serious adverse events and adverse events specifically related to gabapentinoids were reported in one trial. No study included patient-focussed psychological interventions in the deprescribing process, nor provided any long-term follow-up. This review highlights the lack of existing evidence in this area. Due to limited available data, our review was unable to make any firm judgements on the most effective gabapentinoid deprescribing interventions in adults, highlighting the need for more research in this area.

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Gabapentin utilization among older adults with different cognitive statuses enrolled in the National Alzheimer's Coordinating Center (2006–2019)

Cited by 7 publications

References 30 publications

The association of gabapentin initiation and neurocognitive changes in older adults with normal cognition

The association of gabapentin initiation and neurocognitive changes in older adults with normal cognition

Deprescribing interventions for gabapentinoids in adults: A scoping review

Deprescribing interventions for gabapentinoids in adults: a scoping review

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