Characteristics of fatal gabapentinoid-related poisoning in Australia, 2000-2020

Clin Toxicol (Phila). 2022 Mar;60(3):304-310. doi: 10.1080/15563650.2021.1965159. Epub 2021 Aug 17.

Abstract

Introduction: Gabapentinoids are centrally active GABA agonists whose use has increased substantially in the past decade. The current study aimed to provide a comprehensive clinical profile of a national case series of fatal poisonings related to gabapentinoids.

Methods: Retrospective study of all deaths due to drug toxicity in Australia in which gabapentinoids were a contributory mechanism, retrieved from the National Coronial Information System (2000-2020). Information was collected on case characteristics, toxicology and major organ pathology.

Results: A total of 887 cases were identified, with a mean age of 45.7 years and 55.2% being male. Death was due to accidental toxicity in 81.3% of cases and intentional in 18.7%. Pre-existing disease was co-contributory to drug toxicity in 19.5%. Pregabalin was present in 92.9% of cases, with a median blood concentration of 7.6 mg/L (range 0.1-850.0 mg/L). Gabapentin was present in 7.2%, with a median blood concentration of 9.5 mg/L (range 0.5-1940.0 mg/L). Both pregabalin and gabapentin were present in five cases. No other gabapentinoids were detected. Drugs other than gabapentinoids were present in 99.8%, most frequently opioids (90.1%), hypnosedatives (76.9%) and antidepressants (60.5%). A body mass index in the obese range was seen in 45.4%. Clinically significant pre-existing disease was common, notably cardiomegaly (24.9%), emphysema (20.2%), nephrosclerosis (18.7%) and severe hepatic steatosis (11.7%).

Conclusions: The concomitant use of other drugs was close to universal, with CNS depressants predominating. Mental health problems, chronic pain and substance misuse were prominent.

Keywords: Pregabalin; circumstances; gabapentin; mortality; toxicity; toxicology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Drug Overdose* / drug therapy
  • Drug Overdose* / epidemiology
  • Female
  • Gabapentin
  • Humans
  • Male
  • Middle Aged
  • Pregabalin
  • Retrospective Studies

Substances

  • Analgesics, Opioid
  • Pregabalin
  • Gabapentin