GABAPENTINOIDS may increase asthma exacerbation risk in adults treated for chronic or neuropathic pain, according to a nationwide retrospective cohort study.
Gabapentinoids and Asthma Exacerbations
Gabapentinoids were associated with a higher risk of asthma exacerbations in adults with asthma and comorbid neuropathic or chronic pain, compared with tricyclic antidepressants and serotonin norepinephrine reuptake inhibitors. The findings add population-based evidence to existing concerns about respiratory adverse events linked to this drug class.
The study used Japan’s National Database of Health Insurance Claims and Specific Health Check ups from January 2015 through December 2022. Investigators constructed two active comparator, new user cohorts of patients with asthma and neuropathic or chronic pain who initiated gabapentinoids or comparator drugs. Tricyclic antidepressants and serotonin norepinephrine reuptake inhibitors were selected because they are also used as first line options for neuropathic or chronic pain.
Higher Risk Seen Across Comparator Cohorts
In the tricyclic antidepressant cohort, 171,393 patients initiated gabapentinoids and 5,916 initiated tricyclic antidepressants. Gabapentinoids were linked to a higher incidence of asthma exacerbations requiring systemic corticosteroids, at 59.4 versus 33.7 events per 100 person years, with a hazard ratio of 1.46. Hospitalizations for asthma were also higher among gabapentinoid users, at 0.91 versus 0.42 events per 100 person years, with a hazard ratio of 2.02.
In the serotonin norepinephrine reuptake inhibitor cohort, 189,055 patients initiated gabapentinoids and 19,800 initiated comparator therapy. Gabapentinoid use was again associated with more asthma exacerbations requiring systemic corticosteroids, at 63.5 versus 42.8 events per 100 person years, with a hazard ratio of 1.24. The difference in hospitalization for asthma did not reach statistical significance.
Prescribing Caution in Patients With Asthma
Subgroup findings showed that pregabalin and mirogabalin were each associated with elevated asthma exacerbation risk in both comparator cohorts, while gabapentin was not. Although the study was observational, the consistency of findings across active comparator cohorts supports caution when initiating gabapentinoids in patients with asthma.
For clinicians managing chronic or neuropathic pain, the results highlight the importance of weighing respiratory risk alongside analgesic benefit. Physicians and patients with asthma should remain vigilant for worsening respiratory symptoms when gabapentinoids are started.
Reference
Kimura Y et al. Gabapentinoids and risk for asthma exacerbations: a nationwide retrospective cohort study. Thorax. 2026;81(2):121.
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