Gabapentinoid Prescribing: Primary Care Update
Background
- Prescribing teams in NHSGGC have been reviewing patients prescribed gabapentinoids (gabapentin and pregabalin) over the past year with an aim of reducing prescribing where it is safe and appropriate to do so
- This initiative was undertaken in response to increasing concerns and evidence that many analgesics including gabapentinoids have the potential for harm and abuse
- Evidence also highlights that over recent years, there has been a significant increase in the number of drug related deaths where both gabapentinoids have been involved
- Following concerns about abuse, both gabapentinoids were reclassified as Schedule 3 Controlled Drugs in April 2019.
Key Messages
- Discuss realistic expectations of therapy with patients who experience chronic pain – a realistic goal of treatment would be a 30% improvement in pain and/or a significant improvement in functional ability
- Review patients prescribed gabapentinoids as appropriate with a view to dose reduction/treatment cessation where appropriate
- Continue to review prescribing practice to ensure adherence to the NHSGGC Chronic Non-Malignant Neuropathic Pain Guidelines
- Prescribe gabapentinoids with caution in the elderly
NHSGGC Prescribing Indicator
This prescribing indicator aimed to reduce gabapentinoid prescribing in patients where this is safe and appropriate to do so.
The prescribing reviews have focused on:
- Ensuring prescribing of gabapentinoids is in accordance with NHSGGC Formulary and NHSGGC Chronic Non-Malignant Neuropathic Pain Guidelines
- Considering if the gabapentinoid can be reduced, gradually withdrawn or optimised without compromising patient safety or care
- Considering a trial of another step 1 treatment (amitriptyline) if the patient has not already tried this treatment
Outcome
Prescribing of gabapentinoids increased slightly in NHSGGC between April 2019 and March 2020, but remains below the Scottish average.
Further information
Link to MHRA advice HERE
Published 04/08/2021. Links updated 09/03/2022 and again 01/05/24.
Medicines Update blogs are correct at the time of publication.