From the Guidelines
Gabapentin is not recommended as a primary treatment for Chronic Obstructive Pulmonary Disease (COPD) management, but it may be considered as an adjunctive therapy for specific symptoms such as neuropathic pain or refractory chronic cough, as evidenced by recent clinical guidelines 1, 2.
Role of Gabapentin in COPD
The primary goal in managing COPD is to alleviate symptoms, improve health status, prevent exacerbations, and reduce mortality. The 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD emphasizes the importance of inhaled maintenance therapy with LABD (long-acting bronchodilators) and LAMA/LABA (long-acting muscarinic antagonist/long-acting beta-agonist) dual therapy for individuals with moderate to severe dyspnea and reduced health status 1.
Adjunctive Use of Gabapentin
While gabapentin is not a first-line treatment for COPD, it may be used as an adjunctive therapy for specific symptoms. For chronic cough, typical dosing starts at 300mg daily and can be titrated up to 300-600mg three times daily as needed and tolerated. Gabapentin works by modulating calcium channels and inhibiting the release of excitatory neurotransmitters, which may help reduce cough sensitivity in some patients.
Considerations for Use
However, gabapentin should be used cautiously, especially in elderly patients or those with renal impairment, as it can cause side effects including dizziness, somnolence, and peripheral edema. Dose adjustment is necessary for patients with reduced kidney function. Before initiating gabapentin, clinicians should ensure that standard COPD therapies (bronchodilators, inhaled corticosteroids, pulmonary rehabilitation) have been optimized, and that the target symptom (such as cough) is not better addressed by treating other common causes like GERD or post-nasal drip.
Key Points
- Gabapentin is not a primary treatment for COPD
- May be considered as an adjunctive therapy for specific symptoms such as neuropathic pain or refractory chronic cough
- Use cautiously, especially in elderly patients or those with renal impairment
- Dose adjustment necessary for patients with reduced kidney function
- Ensure standard COPD therapies have been optimized before initiating gabapentin, as supported by the 2023 Canadian Thoracic Society guideline 1, 2.
From the Research
Role of Gabapentin in COPD
- Gabapentinoids, including gabapentin, have been associated with an increased risk of severe exacerbation in patients with Chronic Obstructive Pulmonary Disease (COPD) 3.
- The use of gabapentinoids in patients with COPD may lead to severe breathing problems, as warned by North American and European health agencies 3.
- A study found that gabapentin use was associated with increased risk for severe COPD exacerbation across different indications, including epilepsy, neuropathic pain, and other chronic pain 3.
Gabapentin for Refractory Chronic Cough
- Gabapentin has been shown to be effective in treating refractory chronic cough, with significant improvements in cough-specific quality of life compared to placebo 4.
- A randomized, double-blind, placebo-controlled trial found that gabapentin improved cough symptoms and quality of life in patients with refractory chronic cough 4.
- Another study is investigating the efficacy of gabapentin for the treatment of refractory cough associated with interstitial lung disease, with preliminary results expected to provide data on efficacy, safety, and quality of life 5.
Alternative Treatments for COPD
- Antibiotic prophylaxis has been shown to prevent COPD exacerbations and hospitalizations, particularly in patients with severe or very severe COPD with frequent or severe exacerbations 6.
- Pharmacotherapeutic options for chronic refractory cough include centrally-acting drugs like gabapentin, as well as novel drugs that target cough reflex pathways, such as P2X3 antagonists 7.
- The choice of treatment for COPD and refractory chronic cough depends on various factors, including the severity of symptoms, underlying conditions, and potential risks and benefits of each treatment option 6, 7.