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Signs and Symptoms of Gabapentin Overdose. A gabapentin overdose can be dangerous or even deadly. Some factors can increase the risk of a fatal overdose, such as taking several substances at once. Gabapentin overdose symptoms can include: Drowsiness; Movement difficulties; Dizziness; Nausea or vomiting; Rapid heartbeat; Low blood pressure Specific issues relating to the management of common drug overdoses are discussed separately (see appropriate topic reviews). Topics devoted to the management of the critically ill adult and the child with an unknown overdose are found separately. (See "Initial management of the critically ill adult with an unknown overdose".) 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. If you or someone you know is experiencing an overdose or toxic reaction to gabapentin, seek immediate medical attention. Don’t administer any medications or drinks unless instructed by qualified medical professionals. Gabapentin enacarbil available under the trade name Horizant is the only gabapentin product approved for treatment of Restless Legs Syndrome (RLS). A daily dose of 1200 mg provided no additional benefit compared with the 600 mg dose, but caused an increase in adverse reactions. Gabapentin Overdose Symptoms. It isn’t as easy to overdose on gabapentin as it is to overdose on more potent drugs like heroin, fentanyl, or oxycodone. However, an overdose is possible if someone takes far too many pills or combines the drug with another intoxicating substance.[2] Symptoms of gabapentin overdose include:[1] The diagnosis of opioid overdose is often confirmed using naloxone or nalmefene in adequate doses that reverse the toxidrome. 37 These mu receptor antagonists reliably reverse coma and respiratory depression if used shortly after an opioid overdose. Depending on the clinical scenario, lack of response is essentially diagnostic of another The newer anticonvulsant agents include: Gabapentin, Lamotrigine, Levetiracetam, Oxcarbazepine, Pregabalin, Tiagabine, Topiramate and Vigabatrin. These are generally less toxic in overdose causing sedation and non-specific neurological symptoms and patients do well with supportive care. 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. Common symptoms of gabapentin overdose are drowsiness, fast heartbeat, dizziness, low blood pressure, nausea, vomiting, and impaired coordination. In severe cases, lethargy, coma, and death may occur. If someone takes too much gabapentin or takes gabapentin by accident, get guidance from Poison Control immediately. Status epilepticus and wide-complex tachycardia secondary to diphenhydramine overdose. Clin Toxicol (Phila). 2010 Nov;48(9):945-8. doi: 10.3109/15563650.2010.527850 [ PubMed ] 24943229 Walker A, Delle Donne A, Douglas E, Spicer K, Pluim T. Novel use of dexmedetomidine for the treatment of anticholinergic toxidrome. Table 2 includes a number of toxidromes, the syndrome of signs and symptoms caused by certain classes of substances, usually in overdose. Toxidromes are useful if the poisoning involves one drug, however, if multiple drugs have been ingested a constellation of symptoms may be present which makes diagnosis more complex. Table 1. Gabapentin is generally safe and non-toxic, although there have been several published case reports of adverse effects with gabapentin including severe myopathy, severe myoclonus, neutropenia, hypoglycaemia episodes and altered consciousness. 3 The recommended dose of gabapentin in patients with creatinine clearance >60 ml/min is 1200 mg/day The critical care physician is often called to care for poisoned patients. This article reviews the general approach to the poisoned patient, specifically focusing on the utility of the toxidrome. A toxidrome is a constellation of findings, either from the physical examination or from ancillary testing, which may result from any poison. There are numerous toxidromes defined in the medical Misusing gabapentin can lead to a fatal overdose, though the risk is much less if you take it as prescribed. However, unlike opioids, there is no antidote to reverse the overdose like naloxone. A gabapentin overdose is a medical emergency. - Lone Pregabalin or Gabapentin exposures are usually well - Supportive care is the mainstay of management tolerated - Coma with loss of airway reflexes is rare and may require intubation - Clinical effects are dose dependent Decontamination: 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. Chiew AL, Buckley NA. The serotonin toxidrome: shortfalls of current diagnostic criteria for related syndromes. Clin Toxicol (Phila) 2022; 60:143. Cooper J, Duffull SB, Isbister GK. Predicting serotonin toxicity in serotonin reuptake inhibitor overdose. Clin Toxicol (Phila) 2023; 61:22. Mills KC. Serotonin syndrome. A clinical update. A recent report from the US Centers for Disease Control and Prevention (CDC) found that between 2019 and 2020, coroners and medical examiners detected gabapentin in 5687, or almost 10%, of the 58 362 overdose deaths in 23 states and the District of Columbia that had available toxicology results. Officials ruled that gabapentin was a cause of Constellations of findings (toxidromes) aren't completely reliable, but it can help focus the differential diagnosis. In complex polysubstance intoxications, toxidromes can become jumbled together. among patients who are comatose or obtunded: Additionally, perform a coma neurological examination (figure below; more on this here).
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