Opioid-gabapentinoid therapy for GI diseases increases risk of depression

The key findings of the study were:

1. Mortality was observed in 10 non-RCTs, while adverse events were documented in 26 RCTs and 7 non-RCTs.

2. Dizziness, cognitive dysfunction, and respiratory depression in combination therapy considerably increased when compared to opioid therapy in non-RCTs, and a comparable trend for these side effects was also found in the RCT analysis, while the difference was not statistically significant.

3. In a subgroup analysis, combination medication for cancer pain was linked to the highest risk of sedation.

4. Constipation, vomiting, and other GI side effects were all greatly reduced by combination therapy.

5. Compared to opioid medication, the mortality risk linked with combo therapy was greater.

In conclusion, these findings imply that combination therapy, particularly in cancer patients, necessitates careful monitoring of CNS depression. Due to the lack of a risk difference in respiratory depression in the RCT-only analysis and the lack of RCT or prospective studies looking at mortality, caution should be used when interpreting the clinical findings.

Reference:

Hahn, J., Jo, Y., Yoo, S. H., Shin, J., Yu, Y. M., & Ah, Y.-M. (2022). Risk of major adverse events associated with gabapentinoid and opioid combination therapy: A systematic review and meta-analysis. In Frontiers in Pharmacology (Vol. 13). Frontiers Media SA. https://doi.org/10.3389/fphar.2022.1009950