Gabapentin and Pregabalin: Do the Benefits Outweigh the Harms?

Abstract

Gabapentin and pregabalin prescribing in Scotland has increased substantially over recent years. Evidence suggests that prescribers may be advocating the use of these medicines off-label to avoid prescribing opioid analgesics. The evidence to support gabapentin and pregabalin use in non-neuropathic pain disorders indicates they are less effective than several other licensed non-opioid analgesics. Notably, patients may not bene t from gabapentin and pregabalin but remain at risk of adverse drug reactions. Furthermore, greater availability has resulted in increased diversion of gabapentin and pregabalin; creating problems within the opioid misuse population and prison service. As a consequence, both gabapentin and pregabalin may soon be controlled under the Misuse of Drugs Act 1971. Prescribers should be aware of the very limited clinical evidence for use of gabapentin and pregabalin outside their licensed indications, as well as their capacity to do harm.

Patterns of gabapentin and pregabalin use and misuse: Results of a population‐based cohort study in France

“…First of all, this high dose use could be an indicator of lack of effectiveness, as suggested elsewhere, explaining the higher frequency observed with pregabalin. For duloxetine, the use of high dose could be related to a lack of effectiveness for neuropathic pain or depression, or the need for high doses regarding the intensity of depressive symptoms.…”

“…Gabapentin has been suggested as a treatment option for alcohol and substance abuse, but it should be monitored because of potential deleterious consequences . A history of alcohol or substance abuse appears to be a significant part of a patient's medical history when evaluating the risk for gabapentin addiction and dependence . In the US, gabapentin is not nationally scheduled, but several states have chosen to schedule it (e.g., Kentucky, Tennessee, West Virginia).…”

Automated symptom and treatment side effect monitoring for improved quality of life among adults with diabetic peripheral neuropathy in primary care: a pragmatic, cluster, randomized, controlled trial

“…This may be especially important given the challenges we observed with physician recall of participant-reported data within the context of EHR data overload and alert fatigue. However, high rates of side effects and recent reports of the potential for abuse of gabapentinoids suggest such interventions in diabetic peripheral neuropathy would need to first identify which individuals are most likely to benefit from and not be harmed by these treatments [38].…”

Gabapentin for alcohol use disorder: A good option, or cause for concern?

“…44 Clinicians should prescribe gabapentin only when it is likely to be helpful and should carefully document its effi cacy. 2,45 At each visit, an open and honest assessment of the benefi ts and risks serves to promote shared decision-making regarding initiating, continuing, or discontinuing gabapentin.…”