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It’s become trendy in recent years for U.S. hospitals to use gabapentin (Neurontin) as a “safer” alternative to opioids for post-operative pain. But a large new study has found that gabapentin increases the risk of delirium and other adverse health effects in older patients recovering from surgery. Gabapentin (Neurontin) is approved by the US Food and Drug Administration for treatment of epilepsy and post-herpetic neuralgia. Despite lack of strong evidence, gabapentin is also often prescribed off-label for psychiatric conditions. The case described here involved a 38-year-old male physician wi Abstract. Background and Objectives: Gabapentin has shown promise as a potential agent for the treatment of alcohol withdrawal syndrome. We aimed to evaluate the effectiveness of gabapentin as a benzodiazepine-sparing agent in patients undergoing alcohol withdrawal treatment in all the hospitals of a large tertiary healthcare system. syndrome (AWS), establishing a treatment and monitoring plan, and providing medications and resources to support delirium tremens, and death. ing gabapentin (Neurontin) after 3 days of We retrospectively assessed the efficacy and safety of gabapentin (GBP) as an alternative and adjunct medication for delirium. Methods: We retrospectively investigated the records of patients with delirium treated with GBP (71 patients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. Current recommendations for pharmacologic treatment of delirium, based on recent reviews of the evidence, recommend reserving use of antipsychotics and other sedating medications for treatment of severe agitation that poses risk to patient or staff safety or threatens interruption of essential medical therapies. We retrospectively assessed the efficacy and safety of gabapentin (GBP) as an alternative and adjunct medication for delirium. Methods: We retrospectively investigated the records of patients with delirium treated with GBP (71 patients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. We examined The anticonvulsant drug gabapentin is used off-label to treat alcohol-related withdrawal, cravings, anxiety, and insomnia. Although it is well tolerated and has demonstrated efficacy for mild alcohol withdrawal and early abstinence, there is concern about its potential for abuse. Gabapentin should be prescribed only as a second-line alternative to standard therapies, and only after screening Although these recommendations are made for the routine treatment of delirium, patients who are experiencing distress secondary to symptoms of delirium such as anxiety, fearfulness, hallucinations, and delusions or those who may be agitated and causing physical harm to themselves or others may benefit from short-term use of antipsychotics. 2 Of It was hypothesized that gabapentin may prevent delirium by improving pain control and reducing opioid dose, whereas gabapentin-related adverse effects may increase delirium. 40 To date, several studies investigated whether gabapentin could reduce perioperative delirium. However, gabapentin is frequently prescribed off-label as treatment for a variety of neuropathic pain syndromes . The prevalence of gabapentin usage is unknown, but one U.S. study identified gabapentin in in 7,013 (12.2%) of urine specimens from 57,542 patients with chronic pain ( 2 ). Delirium Definition & diagnosis Delirium mimics Causes Diagnostic approach Treatment Antipsychotic use in acute care Antipsychotics – overview Butyrophenones (haloperidol & droperidol) Olanzapine Quetiapine Chlorpromazine Risperidone Lurasidone definition Delirium is acute, generalized brain dysfunction (“cerebral insufficiency”). Key features: Acute (e.g. not dementia). Causes Treatment goals include reducing withdrawal symptoms, preventing seizures, and preventing progression to delirium tremens, which has a 5% to 10% mortality rate. 8 – 10 In appropriate patients In the current clinical practice, anticonvulsants (such as sodium valproate and gabapentin) are often used to treat delirium, but there are limited data on their use. 27, 28 Previous researchers believe that gabapentin may prevent delirium by improving pain control and reducing opioid dose. 29 To date, several studies investigated whether Prevention and therapy of delirium are based on the following principles: Avoiding factors known to cause or aggravate delirium, such as multiple medications, dehydration, immobilization, sensory impairment, and disruption of the sleep-wake cycle. Identifying and treating the underlying acute illness. In detail, gabapentin is a structural analogue of GABA, and it has been approved for adjunctive treatment of patients (12 years or older) with partial seizures and mixed seizure disorders and refractory partial seizures especially in children. GBP may improve delirium with fewer adverse effects and may be a safe alternative or adjunct treatment for delirium. Dosage adjustment may be necessary to prevent sleepiness. Cholinesterase inhibitors in the treatment of dementia; Clinical features and diagnosis of dementia with Lewy bodies; Delirium and acute confusional states: Prevention, treatment, and prognosis; Diagnosis and management of late-life depression; Diagnosis of delirium and confusional states; Drug prescribing for older adults We retrospectively assessed the efficacy and safety of gabapentin (GBP) as an alternative and adjunct medication for delirium. Methods: We retrospectively investigated the records of patients with delirium treated with GBP (71 pa-tients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. The treatment of delirium is, fundamentally, the treatment of its underlying causes. 5 Pediatric ICU delirium treatment algorithms have been evolving over the past decade. They provide systematic approaches for management including: recognizing underlying disease and iatrogenic factors, environmental modifications, and occasionally
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