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Steroid-induced mania — SCE Geriatric Medicine MCQ

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HardOld age psychiatrySteroid-induced maniaSCE Geriatric Medicine

An 85-year-old with COPD, eGFR 24 mL/min and neuropathic pain becomes somnolent with shallow breathing after gabapentin escalation. She takes no opioid or benzodiazepine. Which interpretation is most accurate?

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Correct answer: E — Treat gabapentin-associated respiratory depression urgently and reduce the renally cleared dose

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · A = shown as D · B = shown as E

B is correct: MHRA warns that gabapentin can rarely cause severe respiratory depression even without an opioid. Older age, respiratory disease, neurological disease, renal impairment and other CNS depressants increase risk, and dose adjustment may be required. Her renal and pulmonary reserve make the recent escalation a strong causal signal. Continuing the dose is unsafe. Pregabalin shares respiratory-depression risk and is also renally cleared, so an unadjusted switch does not solve the mechanism.

Reference: MHRA: Gabapentin risk of severe respiratory depression: https://www.gov.uk/drug-safety-update/gabapentin-neurontin-risk-of-severe-respiratory-depression