Gabapentinoids-Induced Rhabdomyolysis/Myopathy: Clinical Characteristics, Management, Outcomes, and Critical Safety Alerts
Abstract
Background: Gabapentinoids, increasingly prescribed for neuropathic pain, demonstrate undercharacterized muscular toxicity risks despite perceived safety advantages over opioids, this includes the potential to induce rhabdomyolysis-a critical condition characterized by rapid release of intracellular contents into the systemic circulation due to muscle cell injury, ultimately leading to systemic complications.
Methods: A systematic global review (inception-2024) identified 19 gabapentinoid-induced rhabdomyolysis cases across 15 databases, analyzed via standardized protocols for clinical patterns, management, and outcomes.
Results: Cases (median age 63; 52.6% male) manifested rapid symptom onset (≤7 days in 52.9%), severe creatine phosphokinase(CPK) elevation (median 3,095 U/L), and renal impairment (78.9%). All patients discontinued gabapentinoids, with 57.9% receiving hydration/alkalinization and 31.6% requiring dialysis. Biochemical resolution occurred in 78.9% (median 14 days), though one mortality resulted from comorbid complications. Naranjo assessments confirmed probable causality in 84.2% of cases. Of note, a significant majority of patients (89.5%) presented with multiple comorbidities (such as hypertension, diabetes, and hyperlipidemia) and received polypharmacy. Particularly when co-administered with statins (as observed in 7 cases where symptom onset occurred following combination therapy), drug-drug interactions may lead to accumulation of medicinal products,…
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