Gabapentin (Neurontin): Risk of developing respiratory depression without concomitant use of opioids

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Gabapentin (Neurontin) is an anti-epileptic drug indicated for partial seizures with and without secondary generalisation and peripheral neuropathic pain such as painful diabetic neuropathy and post-herpetic neuralgia in adults.

In the UK, there have been 50 Yellow Card reports of respiratory depression or dyspnoea associated with gabapentin of these cases, 17 report opioids as co-suspect or concomitant medications. 

A European review of gabapentin was triggered by reports of patients developing respiratory depression without concomitant use of opioids. This reaction has already been recognised with concomitant use of gabapentin with opioids . Considering the available evidence from worldwide spontaneous reports and in the literature, the review recommended that the product information for gabapentin should be amended to include warnings for severe respiratory depression (frequency rare; may affect up to 1 in 1,000 patients post-marketing).

Dose adjustments might be required in patients at increased risk of experiencing this severe adverse reaction, including those:

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