Risk of respiratory depression with opioids and concomitant gabapentinoids

Abstract

Introduction

The combination of opioids and central nervous system depressants such as benzodiazepines and barbiturates has an additive effect on the frequency of oversedation and respiratory depression requiring naloxone use in hospitalized patients. Gabapentinoids (gabapentin and pregabalin) are frequently prescribed with opioids for their opioid-sparing and adjuvant analgesic effects. There is limited literature on the risk of respiratory depression due to the combination of opioids and gabapentinoids requiring naloxone administration.

Methods

This retrospective study evaluated patients who were prescribed opioids and at least one dose of naloxone between March 1, 2014 and September 30, 2016. The primary objective of this study was to compare the frequency of respiratory depression among patients who received naloxone and opioids (non-gabapentinoid group) with those who received naloxone, opioids, and gabapentinoids (gabapentinoid group). Secondary objectives included comparing the association of oversedation, using the Pasero Opioid-induced Sedation Scale, and various risk factors with those in the gabapentinoid group.

Results

A total of 153 patient episodes of naloxone administration (102 in the non-gabapentinoid and 51 in the gabapentinoid groups) in 125 unique patients were included in the study. For the primary objective, there were 33 episodes of respiratory depression associated with the non-gabapentinoid group (33/102=32.4%) versus 17 episodes of respiratory depression with the gabapentinoid group (17/51=33.3%) (p=0.128). Secondary objectives showed a significant association between respiratory depression and surgery in the previous 24 hours (p=0.036) as well as respiratory depression and age >65 years (p=0.031) for patients in the non-gabapentinoid group compared to the gabapentinoid group.

Conclusion

There was no significant association of respiratory depression in the gabapentinoid group versus the non-gabapentinoid group. There was an increased risk of respiratory depression in the gabapentinoid group, specifically in patients who had surgery within the previous 24 hours.

Keywords:

• naloxone
• opioid analgesics
• respiratory depression
• gabapentin
• pregabalin
• POSS

View correction statement:

Risk of respiratory depression with opioids and concomitant gabapentinoids [Corrigendum]

Supplementary material

Figure S1 UCSDH equianalgesic opioid dosing guidelines.

Notes: Text shown in bold, red, or all-capitals is for emphasis. **Indicates the text is a note. ----Indicates not applicable.

Abbreviations: CURES, Controlled Substance Utilization Review and Evaluation System; IV, intravenous; min, minute; PCA, patient-controlled analgesia; PO, per oral; PRN, as needed; q, every; Ref, reference; UCSD, UC San Diego; UCSDH, UC San Diego Health.

Acknowledgments

Special thanks to and Shobha Khan, Grace Kuo, Felix Yam, Philip Anderson, Justin Bouw, and the UCSDH Pain Committee for their support and guidance in this project.

Disclosure

The authors report no conflicts of interest in this work.