Humpert Shelby R, Reveles Kelly R, Bhakta Kajal, Torrez Sorina B, Evoy Kirk E
The University of Texas at Austin, Austin, TX, USA.
University of Texas Health San Antonio, San Antonio, TX, USA.
Hosp Pharm. 2024 Apr;59(2):188-197. doi: 10.1177/00185787231206522. Epub 2023 Oct 24.
Recent data suggest concomitant gabapentinoid use increases opioid-related overdose (ORO) risk; however, this association has not been well studied in the hospital setting. The primary objective of this study was to compare ORO risk, indicated by naloxone administration, in patients receiving opioids plus gabapentinoids versus opioids alone. In this retrospective case-control study of adults admitted to a large community hospital from 1/1/20 to 12/31/21, all cases (defined as patients who received naloxone more than 24 hours after admission) identified were matched 1:1 to randomly selected controls (defined as patients on opioids who did not receive naloxone). The primary outcome was the percentage of cases and controls with concomitant inpatient gabapentinoid use. Logistic regression was performed to determine the independent association between gabapentinoids and ORO (as evidenced by inpatient naloxone administration). Baseline characteristics were similar between the 144 cases and 144 controls. Gabapentinoid exposure was greater for cases than controls (34.0%vs 20.8%, = .0118). Median hospital length of stay (11vs 4 days, < .0001) and mortality (19%vs 5%; = .0018) were also higher for cases. In logistic regression analysis, ORO (adjusted OR 4.91; 95% CI 1.86-12.96) and serotonergic medication exposure (adjusted OR 4.31; 95% CI 1.50-12.38) were significantly associated with gabapentinoid use. Concomitant gabapentinoid use with opioids was associated with increased ORO risk in the inpatient setting. When considering prescribing gabapentinoids in conjunction with opioids in the hospital setting, potential benefits should be weighed against increased overdose risk.
近期数据表明，同时使用加巴喷丁类药物会增加阿片类药物相关过量用药（ORO）风险；然而，这种关联在医院环境中尚未得到充分研究。本研究的主要目的是比较接受阿片类药物加用加巴喷丁类药物的患者与仅接受阿片类药物的患者中，以纳洛酮使用为指标的ORO风险。在这项对2020年1月1日至2021年12月31日入住一家大型社区医院的成年人进行的回顾性病例对照研究中，所有确诊病例（定义为入院后24小时以上接受纳洛酮治疗的患者）与随机选择的对照（定义为使用阿片类药物但未接受纳洛酮治疗的患者）按1:1匹配。主要结局是住院期间同时使用加巴喷丁类药物的病例和对照的百分比。进行逻辑回归以确定加巴喷丁类药物与ORO之间的独立关联（以住院期间使用纳洛酮为证据）。144例病例和144例对照的基线特征相似。病例的加巴喷丁类药物暴露率高于对照（34.0%对20.8%，P = 0.0118）。病例的中位住院时间（11天对4天，P < 0.0001）和死亡率（19%对5%；P = 0.0018）也更高。在逻辑回归分析中，ORO（调整后的OR为4.91；95%置信区间为1.86 - 12.96）和血清素能药物暴露（调整后的OR为4.31；95%置信区间为1.50 - 12.38）与加巴喷丁类药物的使用显著相关。在住院环境中，同时使用加巴喷丁类药物与阿片类药物会增加ORO风险。在医院环境中考虑将加巴喷丁类药物与阿片类药物联合处方时，应权衡潜在益处与增加的过量用药风险。
