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Gabapentin and pregabalin (gabapentinoids) are medications that are commonly prescribed for neuropathic pain, and off label for chronic pain, fibromyalgia, general anxiety disorder, migraine and other chronic conditions1; their use globally rose significantly between 2008 and 2018.2 In 2017, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) issued an alert warning of a risk of severe respiratory depression in people using gabapentin with pre-existing poor respiratory function or neurological disease, renal impairment or concomitant use of central nervous system depressants. In 2019, both pregabalin and gabapentin were recategorised as controlled drugs because of their potential for abuse and risk of fatality, with a 300 mg gabapentin tablet worth approximately £1 on the street.3 A similar MHRA alert highlighting respiratory risks regarding pregabalin followed in 2021,4 and in 2020, the US Food and Drug Administration (FDA) issued an alert regarding the serious risk of breathing problems in patients receiving gabapentinoids based on data showing that patients with respiratory disease, including chronic obstructive pulmonary disease (COPD) or risk factors such as the use of other respiratory sedatives (including opioid pain medications), had a higher risk of respiratory depression and an increased risk of death with the use of gabapentin/pregabalin. Data were collated from both animal and human studies, two randomised controlled trials, numerous small studies and case reports.5