What is the relationship between Gabapentin and altered mental status?

From the Guidelines

Gabapentin can contribute to altered mental status, particularly when used in combination with other sedating medications.

Key Points

• The use of gabapentin in patients with altered mental status should be approached with caution due to its potential to exacerbate sedation 1.
• In patients with cirrhosis and altered mental status, it is recommended to avoid or minimize the use of opioids and other sedating medications, including gabapentin, to prevent delirium and other complications 1.
• The management of patients with altered mental status should prioritize the use of short-acting sedating medications, such as propofol or dexmedetomidine, which have a more favorable profile in terms of reducing ventilation duration and preserving cognitive function 1.
• Pain control is critical in these patients, and low doses of opioids with frequent readjustment and titration to mental status may be necessary to avoid hyperalgesia and prevent delirium resulting from opioid withdrawal 1.

From the FDA Drug Label

During the controlled epilepsy trials in patients older than 12 years of age receiving doses of gabapentin up to 1800 mg daily, somnolence, dizziness, and ataxia were reported at a greater rate in patients receiving gabapentin compared to placebo: Patients should be carefully observed for signs of central nervous system (CNS) depression, such as somnolence and sedation, when gabapentin is used with other drugs with sedative properties because of potential synergy

Altered Mental Status is related to Gabapentin through the adverse reactions of:

• Somnolence: reported at a greater rate in patients receiving gabapentin compared to placebo
• Sedation: patients should be carefully observed for signs of CNS depression when gabapentin is used with other drugs with sedative properties
• CNS depression: potential synergy when gabapentin is used with other drugs with sedative properties These adverse reactions can contribute to altered mental status in patients taking gabapentin 2

From the Research

Relationship Between Gabapentin and Altered Mental Status

• The relationship between gabapentin and altered mental status has been studied in various populations, including older adults and individuals with kidney disease 3, 4.
• A retrospective population-based study found that high-dose gabapentin (>600 mg/day) was associated with a higher risk of hospitalization with altered mental status compared to low-dose gabapentin (≤600 mg/day) in older adults 3.
• Another study found that coprescribing gabapentinoids and other psychoactive medications was associated with an increased risk of altered mental status and falls in adults receiving dialysis 4.
• The risk of altered mental status was also found to be increased in individuals who overused gabapentin, particularly when combined with opioids 5.
• A large clinical cohort study found that gabapentin was associated with an increased risk of altered mental status, particularly at doses ≥600 mg/d 6.
• A case report highlighted the potential for complex encephalopathy arising from the combination of opioids and gabapentin, emphasizing the importance of considering gabapentin withdrawal in patients who abruptly stop taking the medication 7.

Key Findings

• High-dose gabapentin is associated with a higher risk of altered mental status in older adults 3.
• Coprescribing gabapentinoids and other psychoactive medications increases the risk of altered mental status and falls in adults receiving dialysis 4.
• Overuse of gabapentin, particularly when combined with opioids, increases the risk of altered mental status 5.
• Gabapentin is associated with an increased risk of altered mental status, particularly at doses ≥600 mg/d 6.
• Gabapentin withdrawal should be considered in patients who abruptly stop taking the medication, particularly at high doses 7.

Population-Specific Findings

• Older adults: high-dose gabapentin is associated with a higher risk of altered mental status 3.
• Adults receiving dialysis: coprescribing gabapentinoids and other psychoactive medications increases the risk of altered mental status and falls 4.
• Individuals with kidney disease: gabapentin may increase the risk of altered mental status, particularly when combined with other psychoactive medications 4.