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已发表论文
加巴喷丁类药物所致横纹肌溶解症/肌病：临床特征、管理、结局及关键安全警示
Received 17 June 2025
Accepted for publication 26 November 2025
Published 4 December 2025 Volume 2025:18 Pages 6491—6503
DOI https://doi.org/10.2147/JPR.S547736
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor King Hei Stanley Lam
Miao Liu,1 Minghui Long,1 Xingchen Zhou2
1Department of Pharmacy, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People’s Republic of China; 2Department of Pharmacy, XiangYa Hospital, Central South University, Changsha, Hunan, People’s Republic of China
Correspondence: Xingchen Zhou, Department of Pharmacy, XiangYa Hospital, Central South University, No. 87 XiangYa Road, Changsha, Hunan, 410008, People’s Republic of China, Email 1010421885@qq.com Minghui Long, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, 410011, People’s Republic of China, Email 569841351@qq.com
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, thereby significantly increasing the risk of rhabdomyolysis.
Conclusion: This study provides the first evidence-based framework for gabapentinoid myotoxicity monitoring, emphasizing renal function-guided dosing, early CPK surveillance, and drug interaction vigilance. Clinicians should consider gabapentinoid cessation in unexplained myalgia with CK > 3×ULN, particularly in high-risk populations.
Keywords: gabapentin, rhabdomyolysis/myopathy, characteristics, treatments, abuse
1Department of Pharmacy, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People’s Republic of China; 2Department of Pharmacy, XiangYa Hospital, Central South University, Changsha, Hunan, People’s Republic of China
Correspondence: Xingchen Zhou, Department of Pharmacy, XiangYa Hospital, Central South University, No. 87 XiangYa Road, Changsha, Hunan, 410008, People’s Republic of China, Email 1010421885@qq.com Minghui Long, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, 410011, People’s Republic of China, Email 569841351@qq.com
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, thereby significantly increasing the risk of rhabdomyolysis.
Conclusion: This study provides the first evidence-based framework for gabapentinoid myotoxicity monitoring, emphasizing renal function-guided dosing, early CPK surveillance, and drug interaction vigilance. Clinicians should consider gabapentinoid cessation in unexplained myalgia with CK > 3×ULN, particularly in high-risk populations.
Keywords: gabapentin, rhabdomyolysis/myopathy, characteristics, treatments, abuse