Risk of respiratory depression with opioids and concomitant gabapentinoids

Julie Savelloni, Heather Gunter, Kelly C Lee, Chih Hsu, Cassia Yi, Kyle P Edmonds, Timothy Furnish, Rabia S Atayee, Julie Savelloni, Heather Gunter, Kelly C Lee, Chih Hsu, Cassia Yi, Kyle P Edmonds, Timothy Furnish, Rabia S Atayee

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: POSS; gabapentin; naloxone; opioid analgesics; pregabalin; respiratory depression.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Indication of naloxone use based on the EMR. Notes: *Pearson χ2 statistical analysis (p=0.128; n=153 episodes of naloxone administration; 17/51 episodes in gabapentinoid group and 33/102 episodes in non-gabapentinoid group for respiratory depression as defined in our study. Abbreviation: EMR, electronic medical record.
Figure 2
Figure 2
Episodes of sedation characterized by POSS (n=153 episodes of naloxone administration). Abbreviation: POSS, Pasero Opioids-induced Sedation Scale.

References

    1. The Joint Commission Sentinel Event Alert. [Accessed August 29, 2016];Safe Use of Opioids in Hospitals. 2012 49:1–5. Available from: .
    1. Pawasauskas J, Stevens B, Youssef R, Kelley M. Predictors of naloxone use for respiratory depression and oversedation in hospitalized adults. Am J Health Syst Pharm. 2014;71(9):746–750.
    1. Yung L, Lee KC, Hsu C, Furnish T, Atayee RS. Patterns of naloxone use in hospitalized patients. Postgrad Med. 2017;129(1):40–45.
    1. Pasero C. Assessment of sedation during opioid administration for pain management. J Perianesth Nurs. 2009;24(3):186–190.
    1. Nisbet AT, Mooney-cotter F. Comparison of selected sedation scales for reporting opioid-induced sedation assessment. Pain Manag Nurs. 2009;10(3):154–164.
    1. Neurontin [package insert] New York, NY: Pfizer Inc; 2015.
    1. Lyrica [package insert] New York, NY: Pfizer Inc; 2016.
    1. Fukada C, Kohler JC, Boon H, Austin Z, Krahn M. Prescribing gabapentin off label: perspectives from psychiatry, pain and neurology specialists. Can Pharm J (Ott) 2012;145(6):280–284.e1.
    1. Mack A. Examination of the evidence for off-label use of gabapentin. J Manag Care Pharm. 2003;9(6):559–568.
    1. Nichols TA. Off-label use of gabapentin for management of alcohol use disorders. Menthal Health Clin. 2015;5(6):248–252.
    1. Zacny JP, Paice JA, Coalson DW. Subjective, psychomotor, and physiological effects of pregabalin alone and in combination with oxycodone in healthy volunteers. Pharmacol Biochem Behav. 2012;100(3):560–565.
    1. Millar J, Sadasivan S, Weatherup N, Lutton S. Lyrica nights-recreational pregabalin abuse in an Urban Emergency Department. Emerg Med J. 2013;30:874.
    1. Meisenberg B, Ness J, Rao S, Rhule J, Ley C. Implementation of solutions to reduce opioid-induced oversedation and respiratory depression. Am J Health Syst Pharm. 2017;74(3):162–169.
    1. Keskinbora K, Pekel AF, Aydinli I. Gabapentin and an opioid combination versus opioid alone for the management of neuropathic cancer pain: a randomized open trial. J Pain Symptom Manage. 2007;34(2):183–189.
    1. Peng PW, Wijeysundera DN, Li CC. Use of gabapentin for perioperative pain control – a meta-analysis. Pain Res Manag. 2007;12(2):85–92.
    1. Eipe N, Penning J. Postoperative respiratory depression with pregabalin: a case series and a preoperative decision algorithm. Pain Res Manag. 2011;16:353–356.
    1. Weingarten TN, Herasevich V, Mcglinch MC, et al. Predictors of delayed postoperative respiratory depression assessed from naloxone administration. Anesth Analg. 2015;121(2):422–429.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren