Publication date: Aug 09, 2026
Gabapentin and duloxetine are common treatments for neuropathic pain in adults over 65, but data on their gastrointestinal (GI) bleeding risk are limited. We compared GI bleeding risk after starting gabapentin or duloxetine in this population. We used the TriNetX US Collaborative Network to conduct an active-comparator cohort study using target trial emulation. Patients aged 65 years and above with neuropathic pain diagnosed between January 2020 and December 2024 were included, excluding those with prior GI bleeding, major depressive disorder, or thrombocytopenia. Propensity score matching balanced key covariates. The main outcome was GI bleeding within 24 months, analyzed with Cox regression; secondary analyses included upper/lower GI bleeding, mortality, and hospitalization. Negative controls assessed confounding. The study analyzed 62,926 patients (55,236 gabapentin; 7,690 duloxetine) and matched 7,599 pairs. GI bleeding was less common with gabapentin initiators (1. 22%) than duloxetine initiators (2. 49%), showing an absolute risk reduction of 1. 27% (HR 0. 86, 95% CI 0. 84-0. 89, p
| Concepts | Keywords |
|---|---|
| 24months | Duloxetine |
| Adults | Gabapentin |
| December | Gastrointestinal bleeding |
| Pharmacol | Neuropathic pain |
| Thrombocytopenia | Older adults |
Semantics
| Type | Source | Name |
|---|---|---|
| drug | DRUGBANK | Gabapentin |
| drug | DRUGBANK | Duloxetine |
| disease | MESH | neuropathic pain |
| disease | MESH | bleeding |
| disease | MESH | included |
| disease | MESH | major depressive disorder |
| disease | MESH | thrombocytopenia |