National assessment of anti-epileptic drug exposures among pre-teens and adolescents, 2000-2020

Gabapentin and pregabalin exposures reported to United States poison centers, 2012-2022

BACKGROUND

Gabapentin and pregabalin were originally introduced as anticonvulsant medications but are now also prescribed on- and off-label for multiple medical disorders, especially for pain management. The national opioid crisis has led to increased use of non-opioid pain medications, including gabapentinoids, which has been associated with changing patterns of adverse events associated with these medications. This study investigated the characteristics and trends of gabapentin and pregabalin exposures reported to US poison centers from 2012 to 2022.

METHODS

National Poison Data System data involving gabapentin and pregabalin exposures for 2012 to 2022 were analyzed.

RESULTS

There were 124,161 exposures involving gabapentin and pregabalin as the primary substance reported to US poison centers during the study period. Most exposures involved gabapentin (85.9%), females (59.4%), single-substance exposures (62.9%), or occurred at a residence (97.2%). Suspected suicides accounted for 45.2% of exposures. Most exposures were associated with a minor effect (27.4%) or no effect (34.0%), while 22.1% experienced a serious medical outcome, including 96 fatalities. The rate of gabapentin and pregabalin exposures per one million US population increased by 236.1% from 22.7 in 2012 to 76.5 in 2019 (P < 0.001), followed by a non-significant decrease to 68.5 in 2022 (P = 0.068).

CONCLUSIONS

The rate of gabapentin and pregabalin exposures reported to US poison centers increased by more than 230% from 2012 to 2019 before plateauing from 2019 to 2022. The observed rate trend was driven primarily by gabapentin exposures and by cases associated with suspected suicide. Although most exposures were associated with a minor or no effect, 22% of individuals experienced a serious medical outcome, including 96 fatalities. These findings contribute to the discussion of rescheduling gabapentin as a federally controlled substance, which is the current status of pregabalin. Prevention of suicide associated with gabapentin and pregabalin merits special attention.

Significant Increase in Deliberate Self-Poisonings Among Adolescents During the Second Year of the COVID-19 Pandemic

PURPOSE

The COVID-19 pandemic has been associated with a decline in mental health of adolescents. The aim of this study was to analyze the rate of deliberate self-poisonings (DSPs) among adolescents reported to the Dutch Poisons Information Center before and during the COVID-19 pandemic.

METHODS

A retrospective study from 2016 until 2021 was performed to characterize DSPs among adolescents, and to analyze trends in the number of DSPs. All DSPs among adolescents with the age of 13 up to and including 17 years were included. DSP characteristics included: age, gender, bodyweight, used substance, dose, and treatment advice. Trends in the number of DSPs were analyzed using time series decomposition and Seasonal Autoregressive Integrated Moving Average models.

RESULTS

Six thousand nine hundred fifteen DSPs in adolescents were recorded from January first 2016 until December 31st 2021. Females were involved in 84% of adolescent DSPs. A strong increase in the number of DSPs was observed in 2021 (45% increase compared to 2020), which deviated from the predicted trend based on previous years. This increase was most prominent in 13-, 14-, and 15-year-old female adolescents. Commonly involved drugs were paracetamol, ibuprofen, methylphenidate, fluoxetine, and quetiapine. The contribution of paracetamol rose from 33% in 2019 to 40% in 2021.

DISCUSSION

The strong increase in the number of DSPs during the second year of the COVID-19 pandemic suggests that long-term containment measures such as quarantines, lockdowns, and school closures may enhance self-harm behavior among adolescents, especially among younger females (13-15 years of age), with a preference for paracetamol as DSP substance.

Suicidality and antiepileptic drugs in people with epilepsy: an update

INTRODUCTION

Almost 15 years after the Food and Drug Administration (FDA) issued an alert about an increased suicidality risk with antiseizure medications (ASMs), there is still considerable debate on this subject.

AREAS COVERED

This is a review of the role of ASMs in the context of suicide in epilepsy.

EXPERT OPINION

After an explosion of research shortly after the FDA warning was released, only a limited number of studies were published in more recent years and they did not overcome the limitations of previous studies. Overall, available literature does not support an obvious causal relationship between ASMs and suicide. On the contrary, studies are highlighting the complex relationship between suicide and epilepsy, strengthening the bidirectional relationship and the multifactorial origin.

A pharmacovigilance approach for assessing the occurrence of suicide-related events induced by antiepileptic drugs using the Japanese adverse drug event report database

Increased suicidality after antiepileptic drug (AED) treatment remains controversial. This study aimed to investigate the occurrence of suicide-related events (SREs) in Japan. SREs signals with AEDs used orally were evaluated by calculating reporting odds ratios (RORs) and information components (ICs) using the Japanese Adverse Drug Event Report (JADER) database from April 2004 to December 2021. Additionally, factors affecting the occurrence of SREs and time-to-onset from the initial AED treatment were analyzed. Of 22 AEDs, 12 (perampanel hydrate, nitrazepam, levetiracetam, clonazepam, clobazam, sodium valproate, phenobarbital, lamotrigine, lacosamide, gabapentin, zonisamide, and carbamazepine) showed signals of SREs. Patients in their 20 and 30 s, female sex, and concomitant use of multiple AEDs affected the occurrence of SREs. In six AEDs, the median time-to-onset of SREs in patients taking all AEDs was <100 days. The pharmacovigilance approach revealed that several AEDs displayed suicidality signals. Female patients, those in their 20 and 30 s, undergoing combination therapy with ≥2 AEDs, and patients early (<100 days from the initial treatment) in the course of AED therapy should be cautioned about SREs.