Same Song, Different Lyrica – Pregabalin and Risk of Opiate Overdose

September 20, 2018

Written by Clay Smith

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Use of pregabalin in addition to opioids vs opioids alone was associated with an increased risk of death by opioid overdose.

Why does this matter?
Use of concomitant gabapentin and opiates is associated with an increased risk of death from overdose.  Prescription of opioids with gabapentinoids is a common practice.  Does the same increased risk of overdose hold true for the newer drug pregabalin?

Same song, different Lyrica
This was a nested case-control study of 1,417 patients who died of opioid overdose matched to 5,097 controls who had received recent opioid prescriptions.  Cases (deaths) were matched to controls on the basis of age, sex, index year, history of chronic kidney disease, and comorbidity index score.  Exposure to pregabalin plus opioids was associated with a 68% increase in the odds of death by opioid overdose compared to those with exposure to opioids alone [4.9% (69/1,417) vs 3.0% (153/5,097) = adjusted odds ratio 1.68 (1.19−2.36)].  The authors concluded this was, “compelling evidence for a potentially life-threatening drug–drug interaction involving pregabalin and opioids similar to that previously observed with gabapentin and opioids.”

Source
Pregabalin and the Risk for Opioid-Related Death: A Nested Case-Control Study.  Ann Intern Med. 2018 Aug 21. doi: 10.7326/M18-1136. [Epub ahead of print]
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Reviewed by Thomas Davis