Prescribing Pregabalin and Gabapentin

Prescribing pregabalin and gabapentin Pregabalin is a gabapentinoid medicine (in the same group as gabapentin) that is recommended for neuropathic pain conditions. It has been available in NZ for several years as an unfunded medicine and become funded without restriction on 1 May 2018. Gabapentin also became funded without restriction from June 2018. Over prescribing of gabapentinoids is a major problem in other countries.

It is important to remember: - Whilst both pregabalin and gabapentin are recommended for neuropathic pain, there is no evidence that they are better than tricyclic antidepressants or each other for this indication - There is no rationale for co-prescribing pregabalin and gabapentin - Emerging information indicates both pregabalin and gabapentin have potential for misuse and diversion due to their euphoric effects, beware of potential drug-seeking behavior - Both pregabalin and gabapentin may cause adverse effects, dizziness and sedation are the most commonly reported adverse effects affecting 1 in 3 patients - Despite widespread use of pregabalin and gabapentin off-label to manage non-specific chronic low back pain, the evidence from RCTS does not support this indication o A recent meta-analysis on the use of pregabalin and gabapentin in chronic low back pain found an increased risk of adverse effects with only minimal benefit for gabapentin compared with placebo, and no evidence for benefit with pregabalin compared with other analgesics o A recent Australian study of sciatica found no benefit of pregabalin over placebo For further information and reading, please see: https://bpac.org.nz/2018/gabapentinoids.aspx http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002369 https://www.nejm.org/doi/full/10.1056/NEJMoa1614292 HQSC 6 June 2018. With thanks to the Pegasus Clinical Quality and Education team, and Dr. Matt Doogue, Clinical Pharmacologist, University of Otago and Christchurch & Canterbury District Health Board.