Pregabalin plus opioids: a deadly combination

  • Ann Intern Med

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Concomitant use of pregabalin and opioids significantly increased the risk for opioid-related death vs opioids alone, even with low doses of pregabalin.

Why this matters

  • Pregabalin is an anticonvulsant that is increasingly being prescribed as an adjunct for chronic pain.

Study design

  • Population-based, nested case-control study of 1417 patients who received pregabalin and 5097 matched control participants between August 1, 1997 and December 31, 2016.
  • Opioid-related death among patients coprescribed with pregabalin and opioids was assessed.
  • Funding: Ontario Ministry of Health and Long-Term Care.

Key results

  • Use of pregabalin over 120 days was found to be associated with significantly increased risk for opioid-related death (aOR, 1.68; 95% CI, 1.19-2.36) vs exposure to opioids alone.
  • The risk for opioid-related death was significantly high among patients receiving both a high dose of pregabalin (aOR, 2.51; 95% CI, 1.24-5.06) and a low or moderate dose of pregabalin (aOR, 1.52; 95% CI, 1.04-2.22) vs no pregabalin exposure.
  • No association observed between concomitant use of NSAIDs with opioids and risk for opioid-related mortality (aOR, 1.04; 95% CI, 0.90-1.19).

Limitations

  • Observational study design.

Coauthored with Anand Ramanathan, PharmD

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