[Benefits and risks of gabapentinoids in geriatric psychiatry].

Abstract

Background: Gabapentinoids (gabapentin, pregabalin) are increasingly being prescribed and frequently in off-label indications. This applies also to older people.

Objective: This article provides a current overview regarding the pharmacology, safety and tolerability and efficacy of gabapentinoids in psychogeriatric indications, particularly behavioral and psychological symptoms of dementia (BPSD).

Material and methods: A selective literature search was carried out in the databases PubMed and ScienceDirect using the search terms "gabapentin", "pregabalin", "dementia" and "elderly".

Results: The precise mechanism of action of the gabapentinoids is unclear but is based on inhibition of the α2δ subunits of presynaptic voltage-gated calcium channels. Rapid onset of action, principally good tolerability, negligible hepatic metabolization, low interaction potential and efficacy in relevant comorbid disorders such as epilepsy, neuropathic pain syndrome and anxiety disorders can be beneficial in gerontopsychiatric patients; however, in older patients there is an increased risk of falls and fractures, respiratory depression and pneumonia, cognitive and functional impairments and possibly atrial fibrillation. Regarding BPSD only one randomized controlled trial (RCT, pregabalin), systematic reviews and case series/case reports are available, predominantly reporting good efficacy and tolerability of gabapentinoids. In addition, a positive RCT (pregabalin) concerning generalized anxiety disorder (GAD) in older patients exists.

Conclusion: Currently, sufficient evidence for a recommendation on gabapentinoids for the treatment of BPSD (or other off-label indications in geriatric psychiatry) or GAD in older patients is not available. In the case of insufficient efficacy of nonpharmacological interventions and substances with better evidence, gabapentinoids can be considered for the treatment of BPSD and GAD in older patients, particularly when the specific characteristics of gabapentinoids can be beneficial in a particular case; however, the specific risks should be considered.