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All studies with novel data related to pregabalin and/or gabapentin abuse, misuse, or overdose conducted during the study period were included. Articles not written in English, review articles, and animal studies were excluded. Gabapentinoids are commonly ingested in self-harm attempts and often misused for their sedative and euphoric properties. These medications can cause lethargy or agitation in overdose, increase risk of death combined with opioids, and manifest a withdrawal syndrome. Context: Prescriptions for nonopioid pharmacological therapies such as gabapentin and baclofen have been increasing. While gabapentin and baclofen are less likely than opioids to result in fatal overdose, they are each associated with dependence, misuse and adverse effects. Objective: T Postmortem toxicology tests detected gabapentin in almost 1 in 10 US overdose deaths between 2019 and 2020. In about half of the cases, a medical examiner or coroner ruled the drug was a cause of the death, according to a report from the CDC’s Division of Overdose Prevention. In our series, we review 104 cases of decedents who tested positive for gabapentin in postmortem blood samples and an additional 53 nonfatal cases of motor vehicle drivers suspected of driving under the influence. In 47.1% of the fatality cases, gabapentin was directly involved in death. Gabapentin is an antiepileptic drug that is prescribed for both FDA-approved and multiple off-label conditions, and has a relatively safe side-effect profile. Rare cases of overdose-related adverse effects have been reported in the literature. Described herein are the circumstances and autopsy findi Gabapentin Increasingly Implicated in Overdose Deaths Gabapentin is an anticonvulsive medication that received approval from the US Food and Drug Administration (FDA) in 1993 and has been available in generic form in the USA since 2004. Gabapentin was originally used as a muscle relaxant and an anti-spasmodic. However, it was later discovered that gabapentin has the potential of an anticonvulsive medication and can be used as an adjunct to more decedents remained largely similar. Most gabapentin-involved overdose deaths occurred among non-Hispanic White persons (83.2%) and persons aged 35–54 years (52.2%); gabapentin-involved overdose deaths occurred with approximately equal frequency among men (49.7%) and women (50.3%). During the second quarter of 2020, the number of deaths For this narrative literature review, PubMed was systematically searched for articles published through 31 December, 2019 utilizing the following search strategy: pregabalin OR gabapentin OR gabapentinoid AND one of the following qualifiers: abuse, misuse, overdose, or substance related disorders. Gabapentin was found at very high frequency in accidental mixed drug fatalities. Gabapentin concentrations were generally within the normal therapeutic range (2-20 μg/mL). It is unknown whether a synergistic effect with opioids may contribute to central respiratory depression. Gabapentin is an antiepileptic agent that is indicated for use as adjunctive therapy for partial seizures. It has a relatively benign side effect profile, but little data exists on massive overdoses with this agent. The authors present a case of a patient who received a massive overdose of this agen We report a rare case with gabapentin overdose that caused severe rhabdomyolysis and acute tubular necrosis which required renal replacement therapy. A better awareness of its adverse effect and a close follow-up of laboratory tests are recommended. Expert opinion: Loperamide, gabapentin, and modafinil are becoming drugs of abuse, and as such, should be on the radar of healthcare providers. Recognizing their unique toxicity profiles is imperative in providing optimal resuscitative care. Routine gabapentin postmortem testing and linking of death certificate, medical examiner, coroner, toxicology, and prescription history data will provide more reliable information on the extent of gabapentin misuse, diversion, and implications for clinical care. The purpose of this study is to document the clinical manifestations and outcomes of gabapentin exposures reported to poison centers. Methods: A multicenter prospective observational study of all gabapentin exposures reported to three poisoncenters was conducted between 4/1/98 and 4/1/2000. Databases were searched for peer-reviewed articles demonstrating gabapentin misuse, characterized by taking a larger dosage than prescribed or taking gabapentin without a prescription, and diversion. All types of studies were considered; grey literature was excluded. IMS Health data, Gabapentin dispensed prescriptions, in millions[]While it may be legal for medical practitioners to prescribe medications for off-label uses, in the United States it is illegal for manufacturers to market medications for off-label uses, which is one reason why Pfizer was fined $420 million after it was acquired from Warner-Lambert.[] Reports of gabapentin and pregabalin abuse, misuse, dependence, or overdose: An analysis of the Food And Drug Administration Adverse Events Reporting System (FAERS) Res Social Adm Pharm . 2019 Aug;15(8):953-958. doi: 10.1016/j.sapharm.2018.06.018. A recent police report indicates the increasing tendency to use gabapentin as a ‘cutting agent’ in street heroin (and to recover gabapentin on the street and in prisons), further adding to the abuse and danger potential. 5 Like opiates, gabapentin is fatal in overdose; unlike opiates, there is no antidote and the long half-life instils the
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