Rise of Pregabalin Poisoning and Abuse Cases in Serbia: A Ten-Year Retrospective Study

Marko Antunovic,1,2 Slavica Vucinic,1,2 Jelena Kotur-Stevuljevic,3 Kristijan Krstic,4 Jasmina Jovic-Stosic,1,2 Vesna Kilibarda,1,2 Natasa Perkovic-Vukcevic,1,2 Snezana Djordjevic1,2 1Medical Faculty Military Medical Academy, University of Defense, Belgrade, Serbia; 2National Poison Control Center, Military Medical Academy, Belgrade, Serbia; 3Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia; 4Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, SerbiaCorrespondence: Marko Antunovic, National Poison Control Center, Military Medical Academy, Crnotravska 17, Belgrade, 11040, Serbia, Tel +381 11 3608 264, Fax +381 11 367 21 87 264, Email antunovic.marko87@gmail.comPurpose: The aim of this study was to analyze data on gabapentinoid-related attendances to the National Poison Control Center of Serbia (NPCC), particularly abuse cases; to estimate its changes and to compare it with trends in national consumption rates of these drugs. We also aimed to analyze the main characteristics of the study population and to investigate the major clinical effects in poisoned patients.Patients and Methods: This is a retrospective study of patients admitted to the NPCC for acute poisoning involving gabapentinoids from 1 May 2012 to 1 October 2022.Results: There were 357 (95.5%) pregabalin-related and 17 (4.5%) gabapentin-related poisoning cases in 302 patients. Abuse of pregabalin was detected in 27.8% (84/302), while gabapentin abuse occurred in 0.7% (2/302) of all patients. A steady increase in rates of pregabalin poisoning and abuse cases strongly correlated with the increase in overall consumption of this drug, while there were no significant changes in rates of gabapentin consumption, poisoning and abuse rate during the study period. Most patients who abused pregabalin pregabalin were males (84.5%) and the median age was 26 years (range: 15– 45 years). Almost 60% of patients who abused pregabalin (48/84) belonged to the migrant population. Co-ingestions occurred in 89.4% of pregabalin-related cases (319/357), resulting in more severe poisoning. The most often co-ingested drugs were benzodiazepines and among them clonazepam was detected in the largest number of cases.Conclusion: The poisoning and abuse cases involving pregabalin are on the rise in Serbia, which coincided with an increase in its overall consumption during the study period. Isolated pregabalin ingestions resulted in mild poisoning, although severe symptoms such as coma and bradycardia were recorded. When prescribing pregabalin to patients at risk of abuse caution is needed. Strengthening the measures for dispensing of pregabalin may reduce the risks associated with its abuse.Keywords: gabapentinoids, overdose, misuse, drug consumption, psychoactive substances