Dangerous Combination: Pregabalin Plus an Opioid

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Pregabalin, gabapentin and opioids are commonly used for pain management. While the product labeling for gabapentin contains a warning about serious side effects when it is combined with opioids, the labeling for pregabalin does not. As the use of pregabalin for chronic pain increases, a new warning may be forthcoming from the FDA.

In a recent study, patients who took the combination of pregabalin and an opioid had a higher likelihood of opioid-related death compared with patients who took opioids alone.

Tecovirimat (600 mg) is taken orally twice daily for 14 days. It will be available initially only through the US government’s Strategic National Stockpile. Two million treatments have been stockpiled to date.

Using Canadian prescription records, researchers matched 1,417 patients who died from opioidrelated causes to patients who were prescribed opioids but did not die. Those who died from opioid-related causes were about 70% more likely to have been prescribed pregabalin in the prior 120 days. The risk of dying increased with higher pregabalin doses.

Advise prescribers to use caution when prescribing gabapentin or pregabalin with opioids, particularly with high doses of either class.

• Gomes T, et al. [published online August 21, 2018]. Ann Intern Med. doi:10.7326/M18-1136.

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