Minor
Probable
Descripción
Hydrochlorothiazide-induced sodium and fluid loss can increase the risk of dizziness and orthostatic hypotension when combined with gabapentin, which also causes dizziness and impairs balance.
Mecanismo
Gabapentin causes dose-dependent dizziness and gait instability via its alpha-2-delta mechanism; volume depletion from thiazide diuretics predisposes to orthostatic hypotension, compounding fall risk.
Relevancia clínica
Gabapentin-diuretic combinations are associated with increased fall and fracture risk in elderly patients in retrospective cohort studies.
Manejo clínico
Monitor blood pressure (standing and supine) in elderly patients; ensure adequate hydration; start gabapentin at the lowest dose and titrate slowly.