Gabapentin and Pregabalin and Risk of Atrial Fibrillation in the Elderly: A Population-Based Cohort Study in an Electronic Prescription Database

Leticia Ortiz de Landaluce, Pere Carbonell, Carmen Asensio, Núria Escoda, Pilar López and Joan-Ramon Laporte ()
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Leticia Ortiz de Landaluce: Servei Català de la Salut
Pere Carbonell: Servei Català de la Salut
Carmen Asensio: Fundació Institut Català de Farmacologia (FICF), HU Vall d’Hebron, Universitat Autònoma de Barcelona, WHO Collaborating Centre for Research and Training in Pharmacoepidemiology
Núria Escoda: Servei Català de la Salut
Pilar López: Servei Català de la Salut
Joan-Ramon Laporte: Fundació Institut Català de Farmacologia (FICF), HU Vall d’Hebron, Universitat Autònoma de Barcelona, WHO Collaborating Centre for Research and Training in Pharmacoepidemiology

Drug Safety, 2018, vol. 41, issue 12, No 7, 1325-1331

Abstract: Abstract Introduction 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. Objective The aim of this study was to assess the association between exposure to gabapentin or pregabalin and AF in the elderly. Methods 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. Results 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. Conclusion 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.

Date: 2018
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DOI: 10.1007/s40264-018-0695-6

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