Side effects of gabapentin in the elderly
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Side Effects of Gabapentin in the Elderly
Common Adverse Effects of Gabapentin
Gabapentin, an anticonvulsant often used to treat neuropathic pain, is generally well-tolerated but can cause several side effects, particularly in elderly patients. Common adverse effects include somnolence, dizziness, ataxia, and peripheral edema 15. These side effects can be particularly problematic in older adults due to their increased susceptibility to drug-induced complications.
Increased Risk of Delirium and Pneumonia
A significant concern with gabapentin use in the elderly is the increased risk of delirium. A study examining perioperative gabapentin use found that older patients had a higher incidence of delirium, new antipsychotic use, and pneumonia compared to non-users . Specifically, the risk of delirium was 1.28 times higher, and the risk of pneumonia was 1.11 times higher in gabapentin users . These findings suggest that gabapentin should be prescribed with caution in elderly patients, especially those with a high comorbidity burden or chronic kidney disease.
Respiratory Complications
Gabapentin has also been shown to acutely worsen sleep breathing in older men. A study found that gabapentin increased the apnea-hypopnea index and oxygen desaturation index, indicating a higher risk of sleep-related breathing disorders . This effect was particularly pronounced during non-rapid eye movement sleep and in the supine position .
Sexual Dysfunction
Anorgasmia, or the inability to achieve orgasm, is another side effect that may be more common in older patients taking gabapentin. A case report described four older patients who experienced dose-dependent anorgasmia, which resolved upon reducing or discontinuing the medication . This suggests that sexual dysfunction may be underreported in older adults on gabapentin.
Cardiovascular Risks
Gabapentin has been associated with an increased risk of atrial fibrillation (AF) in elderly patients. A population-based cohort study found that new exposure to gabapentin was linked to a higher incidence of initiating treatment for AF compared to opiate analgesics and benzodiazepines . This highlights the need for careful cardiovascular monitoring in elderly patients starting gabapentin therapy.
Altered Mental Status
High doses of gabapentin have been linked to an increased risk of altered mental status in older adults. A retrospective study found that initiating gabapentin at doses higher than 600 mg/day was associated with a higher risk of hospitalization due to altered mental status, as indicated by urgent head CT scans . This underscores the importance of starting with the lowest effective dose and monitoring for signs of cognitive impairment.
Conclusion
While gabapentin is effective for managing neuropathic pain, its use in the elderly comes with several risks, including delirium, respiratory complications, sexual dysfunction, cardiovascular issues, and altered mental status. These side effects necessitate a careful risk-benefit assessment and vigilant monitoring when prescribing gabapentin to older adults.
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