Gabapentinoids and unexplained death in general practice: Case series and feasibility study arising from a critical incident
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Prescribing epidemiology in general practice shows gabapentinoid drugs to be independently associated with unexpected, drug-related death. There is an increasing trend of gabapentinoid deaths throughout Europe and North America.Objectives The overall aim of this study was to assess how patient, practice and health system factors might be associated with gabapentinoid prescribing in primary care.Methods Case series following a critical incident of an unexpected death in a patient prescribed a gabapentinoid drug in a single general practice. Unexpected and expected deaths in patients prescribed a gabapentinoid drug deaths over an 11-year period in a single general practice. We examined patient, prescriber and health system factors. Toxicology and post-mortem data were provided by the Coroner.Results There were 36 deaths (four unexpected and 32 expected deaths) during the study period. Of the four patients who suffered an unexpected death, one of these patients’ cause of death could be attributed to drug and alcohol toxicity. Over half of gabapentinoid prescribing (n = 19,53%) was hospital initiated, often ‘off-label’ (n = 6, 17%) and commonly co-prescribed with opiates (n = 15, 42%) and benzodiazepines (n = 11, 31%) to patients with high multi-morbidity.Conclusions Gabapentinoids are often initiated in the outpatient setting in clinically complex patients, often for ‘off label’ indications, with high polypharmacy. Patient, practice and health-system related factors need to be addressed in relation to gabapentinoid associated deaths and reflected in clinical practice guidelines. There is critical value in using toxicology reports from Coroner’s offices in cases of unexplained gabapentinoid death in general practice.
Authors: Augustin Gabriel, Tom Fahey
Institution: Royal College of Surgeons in Ireland
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,563
OpenAlex ID: W7140083664