Pregabalin may increase the risk of death when coprescribed with opioids

1. Patients coprescribed opioids and pregabalin had significantly increased odds of opioid-related death compared to opioid prescription alone.

2. More than half of Ontario residents who take pregabalin are already prescribed opioids.

Evidence Rating Level: 2 (Good)

Study Rundown: Pregabalin is an anticonvulsant that is increasingly prescribed as an adjunct for chronic pain, often of a neuropathic nature. Many patients taking pregabalin for pain management are also prescribed opioids. This situation raises concerns, as both medications can result in CNS depression. The authors of this study published a brief research report to examine the relationship between pregabalin and opioids, considering that these medications are often prescribed concurrently. Specifically, they found an association between pregabalin and an increased risk for opioid-related death when coprescribed. One limitation of this study was that it only included patients from Ontario and may therefore not be applicable to other patient populations. However, the results are significant and applicable due to the large cohort. Overall, the results of the study highlighted the importance of considering revision to the pregabalin product monograph, which does not currently warn about the risk for serious adverse events when coprescribed with opioids.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Risk of respiratory depression with opioids and concomitant gabapentinoids

In-Depth [case-control]: The authors conducted a nested case-control study to evaluate the risk of opioid-related death in patients that are co-prescribed opioids and pregabalin. A cohort of patients aged 15 to 105 years who received publicly funded opioids prescriptions were identified for inclusion in the study (ranging from 1997 to 2016). The case patients consisted of those who died of an opioid-related cause and was matched to up to 4 control participants. A total of 1417 case patients were ultimately matched to 5097 control participants. Exposure to pregabalin in the preceding 120 days was found to have significantly increased odds of opioid-related death (adjusted odds ratio [aOR], 1.68 [95% CI, 1.19 to 2.36]) compared to exposure to opioids alone within the 120 days. Further, the authors examined dose-response and found the higher dose of pregabalin to be associated with greater risk for opioid-related death.

Image: PD

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