Pregabalin is increasingly prescribed for neuropathic pain, generalised anxiety disorder and epilepsy but many patients discontinue treatment

Wettermark, Björn; Brandt, Lena; Kieler, Helle; Bodén, Robert

doi:10.1111/ijcp.12182

Cited by 51 publications

(49 citation statements)

References 24 publications

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“…Since the registration in 2004, the clinical utilisation has increased substantially, with neuropathic pain being the major indication (195)(196) and today, pregabalin is one of the most commonly prescribed drugs in the world (197). The mode of action of pregabalin involves binding to calcium channels in the CNS, leading to properties analogous to the ones of γ-aminobutyric acid (GABA) (198).…”

Section: Pregabalinmentioning

confidence: 99%

“…Daily doses exceeding the clinical recommendation measured by means of prescription fills, further suggest misuse in a proportion of patients (112,114,211). Notably, sub-therapeutic effects of pregabalin are among the most commonly reported ADRs (212), potentially an important cause of treatment discontinuations (195).…”

Section: Pregabalinmentioning

confidence: 99%

“…A binary outcome variable measuring use above the maximum recommended dose of pregabalin or not, was created. Finally, as pregabalin is primarily used as a second-line treatment some patients may require regular prescriptions of higher-than-approved doses (6,195). To reduce the sensitivity of our measure for occasional early refills or dispensing of large volumes, we therefore allowed one treatment period of use above the MAD.…”

Section: Defining Psychoactive Prescription Drug Use Disorder Misusementioning

confidence: 99%

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Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Tjäderborn

2016

Linköping University Medical Dissertations

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Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognised and emerging public health concerns. Aim:The aim of this thesis is to estimate the occurrence and prevalence of psychoactive prescription drug use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods:A study using register data from forensic cause of death investigations analysed and described cases of fatal unintentional intoxications with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were scrutinized and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming intake of tramadol, diazepam, flunitrazepam, zolpidem and zopiclone, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a national cohort of patients initiating prescribed treatment with pregabalin, identified using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use above the maximum approved daily dose (MAD) of the drug, and factors associated with the utilisation patterns (Study IV).Results: In the first study, 17 cases of unintentional intoxications were identified, in which tramadol was judged to have caused or contributed to the death. Of the deceased, more were men, the median age was 44 years and the majority used multiple psychoactive substances (prescription drugs, alcohol and/or illicit drugs). In the second study, 104 spontaneously vi reported cases of possible or probable tramadol dependence were identified, of which more concerned women. The median age in these cases was 45 years and in about a third of cases the person had a history of substance abuse and in 40% of cases there was documented history of psychoactive medication use. Severe addiction was reported. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription.Non prescribed use was most frequent in users of benzodiazepines and of tramadol compared to users of zolpidem or zopiclone, and was more likely in younger individuals and in multiplesubstance users and less likely in individuals with a recent prescription for another psychoactive medication. In the last paper, five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of use of doses above the maximum approved daily dose. The highest risk of use of daily doses above the MAD over time was associated with male sex, younger age, non-urban residency, and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions

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Section: Pregabalinmentioning

confidence: 99%

Section: Pregabalinmentioning

confidence: 99%

Section: Defining Psychoactive Prescription Drug Use Disorder Misusementioning

confidence: 99%

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Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Tjäderborn

2016

Linköping University Medical Dissertations

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“…[51] All patients who filled at least one prescription of pregabalin between July 2005 and December 2009 were included, with a number of users in 2006 of 3400 and in 2009 of 11083. Patients were mainly women (63.1%), with a mean age of 54.8 years, the prevalence of treated patients being estimated at 5.6 subjects for 1 000 inhabitants in 2009.…”

Section: Surveys In General Population: Prescription Databases or Othmentioning

confidence: 99%

“…The most recently published study was performed in Sweden, using the same data source than previously cited, [51] with the aim of determining the characteristics of patients dispensed pregabalin that exceeds the maximum approved dose. [53] Among the 48 550 patients who were dispensed pregabalin at least three times during the study period, 8.5% had an estimated daily dosage that exceeded the maximum approved dose (i.e.…”

Section: Surveys In General Population: Prescription Databases or Othmentioning

confidence: 99%

Drug Abuse Monitoring: Which Pharmacoepidemiological Resources at the European Level?

Lapeyre‐Mestre

Dupui

2015

Therapies

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-Monitoring the potential for abuse and dependence of psychoactive substances falls within the scope of international conventions on narcotic drugs. At the European level, this monitoring is based on activities controlled by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) for substance abuse in general and by the European Medicines Agency (EMA) for marketed drugs, in the context of pharmacovigilance. If France has set up in the early 1990s an original system to assess potential for abuse of psychoactive substances, with specific tools combining both the evaluation of the use of these substances (illicit substances or diverted drugs), and the consequences of that use in terms of morbidity and mortality, there is no equivalent in other European countries. Indeed, unlike the USA, who, for several decades, organized this type of surveillance, with a multisource approach (sentinel systems, databases, medical and administrative data, databases for seeking care in relation abuse), we have not found in other European countries integrated system for identifying a signal of drug abuse, or to assess the impact of measures for minimizing the risk of abuse. However, some recent examples show a growing concern about drug addiction, based on a pharmacoepidemiological approach using pharmacovigilance databases or medical administrative data. These examples illustrate the interest of these approaches in the field of drug of abuse.Abbreviations: see end of article.

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Safe Deprescribing of Gabapentinoids

2024

The Maudsley Deprescribing Guidelines – Antidepressants, Benzodiazepines, Gabapentinoids and Z‐drugs

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Gabapentinoids are widely used off‐label for conditions for which the balance of harms and benefits is uncertain or unfavourable. Long‐term use of gabapentinoids in mental health conditions is affected by issues such as physical dependence, addiction, tolerance and withdrawal effects. Harms include numerous cognitive, physical and emotional effects, and spiking rates of accidental overdoses (especially when used with opioids). Withdrawal effects arise due to adaptation to chronic use of gabapentinoids – often termed physical dependence, distinct from addiction. Addiction is an issue for a minority of gabapentinoid users whilst withdrawal effects and physical dependence affect a larger group of patients taking medication as prescribed. Withdrawal effects can manifest as either physical or psychological symptoms and can be mistaken for a return of an underlying condition or onset of a new physical or mental health condition. The most severe withdrawal effects are suicidality, akathisia and protracted withdrawal syndromes which can last for months or years and can sometimes be debilitating. Careful tapering can minimise these effects. After long‐term use tapering should be gradual (months or years), and adjusted to a rate that the individual can tolerate. Dose reduction should be conducted in a hyperbolic pattern (so that decrements become smaller and smaller as the total dose gets lower) to reflect the hyperbolic relationship between dose and receptor occupancy (and clinical effects), as dictated by the law of mass action. In order to facilitate gradual hyperbolic tapering sometimes formulations other than widely available tablets or capsules will be required.

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Pregabalin is increasingly prescribed for neuropathic pain, generalised anxiety disorder and epilepsy but many patients discontinue treatment

Cited by 51 publications

References 24 publications

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Drug Abuse Monitoring: Which Pharmacoepidemiological Resources at the European Level?

Safe Deprescribing of Gabapentinoids

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