Author Information

An event is serious (FDA MedWatch definition) when the patient outcome is:

  • * death

  • * life-threatening

  • * hospitalisation

  • * disability

  • * congenital anomaly

  • * requires intervention to prevent permanent impairment or damage

Drug overdose

A 47-year-old woman developed acute pneumonia and respiratory depression due to gabapentin toxicity following administration of gabapentin at overdose. Subsequently, she died.

The woman was found unresponsive, not breathing and cold to the touch the morning following an overnight shift. During the night, loud breathing and gurgling noises were heard from the room where she was attending to her charge. On the evening of her death she experienced wheezing, coughing and shortness of breath and that every time she sat down she fell asleep. Emergency medical services confirmed the death without any intervention. She had ingested 26 tablets of gabapentin 600mg from a prescription bottle belonging to her daughter.

An autopsy revealed atherosclerotic calcification of proximal ascending aorta along with dilated and enlarged heart, consistent with hypertension. The lungs had evidence of early acute pneumonia, which had resulted during respiratory depression prior to the death, due to the toxic effects of gabapentin. The alkaline drug screen confirmed the detection of gabapentin. Postmortem concentrations of gabapentin in peripheral blood was 37 mg/L, in central blood was 32 mg/L, in liver was 26 mg/kg, in vitreous was 32 mg/L and in gastric contents was 6mg. Eventually, the cause of death was considered as gabapentin toxicity leading to an accidental death.

Author comment: "The pneumonia likely resulted during a period of respiratory depression (decreased ventilation) prior to death due to the toxic effect of gabapentin." "The cause of death was determined to be [gabapentin] toxicity in an individual with obesity and pre-existing cardiovascular disease, and the manner of death was determined to be accidental."