A class of drugs commonly used to treat nerve and muscle pain has been linked to an increased risk of suicidal behavior, unintentional overdoses, injuries and car accidents, according to a new study published in the journal BMJ. And the risk is even greater for teenagers and young adults.

The drug class, known as gabapentinoids, include medications like Lyrica (pregabalin) and is approved by the Food and Drug Administration (FDA) to treat a variety of pain as well as preventing epileptic seizures. Off-label uses for conditions like anxiety have caused prescriptions to skyrocket in recent years. But researcher Dr. Seena Fazel of the University of Oxford said doctors and patients should be cautious.

Fazel and colleagues used Swedish registry data involving more than 191,000 patients age 15 and older who were prescribed pregabalin or the older gabapentinoid gabapentin during 2006 and 2013. They found that 5.2% were treated for suicidal behavior or had committed suicide, 8.9% had unintentional overdose, 6.3% were involved in serious car accidents requiring emergency hospitalization or death, or were arrested or convicted of a traffic offense, 36.7% had head or body injuries, and 4.1% were arrested for violent crimes.

When compared to people who didn’t take gabapentinoids, those who did were 26% more likely to have suicidal behavior or commit suicide, 24% more likely to have an accidental overdose, 22% more likely to have a head or body injury, and 13% more likely to be involved in a serious car accident or traffic offense. Both drugs showed similar results though the behaviors were more often seen with patients taking Lyrica, researchers noted.

“These medications clearly have a role if they’re used in people who have clear indications for their use,” Fazel told Reuters Health. “(But) we need to be more careful about how these medications are prescribed and I think at the very least we should review guidelines about their use just to make sure these guidelines are up to date with the latest evidence.”

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