Gabapentin and Pregabalin and Risk of Atrial Fibrillation in the Elderly : A Population-Based Cohort Study in an Electronic Prescription Database
Ortiz de Landaluce, Leticia (Servei Català de la Salut. Gerència de Prestacions Farmacèutiques i Accés al Medicament)
Carbonell, Pere (Servei Català de la Salut. Gerència de Prestacions Farmacèutiques i Accés al Medicament)
Asensio Ostos, Carmen (Fundació Institut Català de Farmacologia)
Escoda, Núria (Servei Català de la Salut. Gerència de Prestacions Farmacèutiques i Accés al Medicament)
López, Pilar (Servei Català de la Salut. Gerència de Prestacions Farmacèutiques i Accés al Medicament)
Laporte Rosselló, Joan-Ramón (Fundació Institut Català de Farmacologia)
Universitat Autònoma de Barcelona

Date:	2018
Abstract:	Gabapentin and pregabalin are widely prescribed to elderly people, but data on their pharmacokinetics, safety, and efficacy in this population are scarce. Neurological adverse effects are common. Atrial fibrillation (AF) associated with their use has been described in several case reports and case series, but the incidence is unknown. The aim of this study was to assess the association between exposure to gabapentin or pregabalin and AF in the elderly. Patients ≥ 65 years of age starting treatment with either gabapentin or pregabalin between January 1 and March 31, 2015, free of cardiovascular disease, and who did not receive the alternate study medications were studied. They were compared with patients who initiated treatment with an analgesic opiate or with alprazolam or diazepam. The two primary outcome variables were a first claim of an oral anticoagulant plus an antiarrhythmic drug (OAC + AA), or of an oral anticoagulant or an antiplatelet agent plus an antiarrhythmic drug (OAC/APA + AA), in the 3 months after treatment initiation. Compared with opiate analgesics, both gabapentin and pregabalin were associated with an increased risk of initiating OAC/APA + AA. The incidence was 6 of 668 (9. 0 per 1000 patients) with gabapentin, versus 12 of 3889 (3. 1 per 1000) with opiates, relative risk (RR) 2. 91 (95% confidence interval [CI] 1. 10-7. 73), and for pregabalin it was 6 of 698 (8. 6 per 1000) RR 2. 79 (95% CI 1. 05-7. 40). The comparison with alprazolam/diazepam gave similar results. The risks did not vary by age, sex, or co-treatment with NSAIDs, and they increased with dose. In elderly patients free of cardiovascular disease, an association between new exposure to gabapentin or pregabalin and initiating treatment for AF was found. These results should be confirmed in other studies. The online version of this article (10. 1007/s40264-018-0695-6) contains supplementary material, which is available to authorized users.
Note:	Altres ajuts: This work is part of a project on safety of electronic prescribing of the Catalan Health Service and Fundació Institut Català de Farmacologia.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Age factors ; Aged ; Adverse effects ; Analgesics ; Atrial fibrillation ; Cohort studies ; Diagnosis ; Electronic prescribing ; Epidemiology ; Gabapentin ; Humans ; Population Surveillance ; Pregabalin ; Retrospective studies ; Risk factors
Published in:	Drug Safety, Vol. 41 (june 2018) , p. 1325-1331, ISSN 1179-1942

DOI: 10.1007/s40264-018-0695-6
PMID: 29956217

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