Gabapentin not linked to falls in older adults with neuropathy, fibromyalgia

Compared with duloxetine, gabapentin was not associated with increased fall-related visits and hospitalizations within six months of initiation, a study found.

To compare the risk for fall-related visits from gabapentin versus duloxetine, researchers studied data from 57,086 adults ages 65 years or older with diabetic neuropathy, postherpetic neuralgia, or fibromyalgia who were newly prescribed either drug between January 2014 and December 2021. Patients with cancer, epilepsy/seizure disorders, or depression/anxiety were excluded. The primary outcome was any fall-related visit to an inpatient or outpatient facility. The study was published Jan. 7 by Annals of Internal Medicine.

There were 52,152 patients in the gabapentin group and 4,934 in the duloxetine group. Overall median follow-up was 30 days. Weighted cumulative incidence of a fall-related visit per 1,000 person-years at 30, 90, and 180 days was 103.60, 90.44, and 84.44 for gabapentin users and 203.43, 177.73, and 158.21 for duloxetine users, respectively. At six months of follow-up, gabapentin users had fewer falls (hazard ratio, 0.52; 95% CI, 0.43 to 0.64). There was no difference in the hazard of severe falls.

According to the authors, patients with pain often report feeling undertreated, which makes accurate risk/benefit estimates for pain medications especially important.

“One bioplausible explanation for our results is that gabapentin is a highly titratable medication and many in our cohort started on low doses,” the authors wrote. “Alternatively, duloxetine is usually titrated only once or twice. Thus, although it may be that gabapentin is simply safer than duloxetine from a falls perspective, it may also be likely that we are measuring specific clinical scenarios, the peri-initiation and titration period, in which gabapentin may be less likely to cause falls than duloxetine.”