Several widely used anticonvulsants, including Pfizer's Neurontin, may increase the risk of suicide, attempted suicide and violent death in patients taking them for the first time, according toa study in the Journal of the American Medical Association.
Compared with Johnson & Johnson's Topamax (known generically as topiramate), the study found increased suicide risks for new patients using Neurontin (sold generically as gabapentin); GlaxoSmithKline's Lamictal; Novartis' Trileptal, or Cephalon's Gabitril. Researchers also found an increased risk with Abbott Labs' Depakine and Epilim, which is sold by Sanofi-Aventis.
The findings come two years after the FDA required anticonvulsants to carry a warning they double the risk of suicidal thoughts and behaviors, based on a meta-analysis of nearly 200 clinical trials. But the analysis wasn't large enough to show which drugs in the class were risky (background here). And while largely used to treat epilepsy, the drugs are also sometimes aggressively promoted for unapproved uses, such as bipolar disorder, pain and migraines. You may recall that last month, a federal court jurly found Pfizer violated federal racketeering law by improperly promoting Neurontin and was ordered to pay $47 million in damages (see here).
The researchers analyzed prescription and clinical data for nearly 300,000 patients 15 years of age and older who were given an anticonvulsant for the first time between July 2001 and December 2006. They found 827 suicidal acts, including 801 attempted suicides and 26 completed suicides, and 41 violent deaths. "We found increased risk for suicidal acts beginning within the first 14 days after treatment initiation, opening the possibility that anticonvulsant medications could induce behavioral effects prior to the achievement of their full therapeutic effectiveness," the researchers wrote.