A Decade of Gabapentinoid Misuse: An Analysis of the European Medicines Agency’s ‘Suspected Adverse Drug Reactions’ Database

Abstract

Despite data collection/methodological approach limitations, the present data seem to suggest that gabapentinoid misuse may be a cause for concern, especially in patients with a history of substance misuse. Hence, healthcare professionals should be vigilant when prescribing these molecules.

Nasal pregabalin overdose and myclonus: a new way of misuse

“…Pregabalin may have a higher addiction potential due to its rapid absorption with peak plasma concentration achieved within one hour. There are case reports of its misuse, particularly in cocaine users and prisoners [10].…”

Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis

“…8 Such an increase could be justified if these drugs relieve symptoms and the benefits outweigh harms. The latter is important, as recent reports point to an increased risk of suicidality 9 and the potential for misuse 10,11 of some anticonvulsants. The analgesic action of anticonvulsant medicines is thought to be a result of limiting neuronal excitation and enhancing inhibition.…”

Gabapentin and Pregabalin: Do the Benefits Outweigh the Harms?

“…8,22 Notably, in the majority of reports promoting the benefi ts of off-label use, gabapentin is not the optimal treatment. 23 Existing evidence for the use of gabapentinoids in chronic lower back pain demonstrates the risk of adverse effects without any clear benefi t.…”

“…36 Current estimates suggest 1% of the general population misuse gabapentin, as do 15-22% of people who misuse opioids, and 40-65% of people with gabapentinoid prescriptions. 37 Reports of misuse normalised to prescription number would suggest that drug dependence issues are more frequently reported with pregabalin than gabapentin 22 and cases of pregabalin misuse are increasing. 38 Pregabalin may have a higher misuse potential than gabapentin due to its rapid absorption and faster onset of action.…”

“…Unsurprisingly, known substance misuse is associated with misuse of pregabalin. 22,40,41 Opioid users report that pregabalin reinforces the effects of opioids and reduces the undesirable effects of withdrawal symptoms, EE Morrison, EA Sandilands, DJ Webb making it widely sought after for misuse. 35,42 Opioid treatment programmes have reported approximately 10% of patients test positive for pregabalin, the majority of whom were not prescribed this medication.…”