Ann Am Thorac Soc

Gabapentinoids may raise risk of severe COPD exacerbations

September 29, 2025

Gabapentinoids confer a modest but clinically significant increase in COPD exacerbation risk relative to other CNS-active agents used for pain. Prescribers should limit gabapentinoid use in COPD to cases with clear benefit, and consider alternative agents when feasible.

Study details: This retrospective cohort study utilized a nationwide administrative claims database (2015–2022) to evaluate whether gabapentinoid initiation in patients with COPD and neuropathic or chronic pain increases the risk of exacerbations requiring systemic corticosteroids. An active comparator new-user design was employed, with tricyclic antidepressants (TCAs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) as comparators. Propensity score weighting balanced baseline characteristics.

Results: Gabapentinoid use was associated with a higher incidence of COPD exacerbations compared with both TCAs (67.8 vs. 46.7 per 100 person-years; hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03–1.42) and SNRIs (68.8 vs. 51.4 per 100 person-years; HR, 1.18; 95% CI, 1.10–1.28). The increased risk was consistent across both comparator cohorts.

Source:

Kimura Y, et al. (2025, July 16). Ann Am Thorac Soc. Gabapentinoids and Risk for Exacerbation of Chronic Obstructive Pulmonary Disease. https://pubmed.ncbi.nlm.nih.gov/40668951/