Pregabalin prescriptions in the United Kingdom: a drug utilisation study of The Health Improvement Network (THIN) primary care database

Asomaning, Kofi; Abramsky, Staci; Liu, Q.; Zhou, Xiaofeng; Sobel, Rachel E.; Watt, Steve

doi:10.1111/ijcp.12791

Cited by 34 publications

(46 citation statements)

References 32 publications

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“…The absolute figure may be an overestimation, however, the primary aim was to assess variations over time. Comparable studies have not been conducted, but the findings are consistent with previous findings of high treatment discontinuation rates (195) and low average doses (195,211), corresponding to our low risk trajectory. The development of tolerance and subsequently, gradually increasing doses in some subjects, is further supported by our identified trajectories.…”

Section: Specific Drug Classes N (%)supporting

confidence: 90%

“…In one other study, considerably lower estimates of 1.0% were reported, as individual-level patterns of drug dispenses were not taken into account (211). Considering our longer observation period, a higher estimate was expected, but differences in the definition of the outcome variables may further explain discrepancies.…”

Section: Specific Drug Classes N (%)mentioning

confidence: 61%

“…Increases in the daily dose during prescribed treatment are also reported (203). 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%

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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: Specific Drug Classes N (%)supporting

confidence: 90%

Section: Specific Drug Classes N (%)mentioning

confidence: 61%

Section: Pregabalinmentioning

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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“…A UK study in primary care noted that almost two-thirds of pregabalin prescriptions did not have a diagnostic code corresponding to an approved indication. 17 Healthcare professionals should be aware of their greater responsibilities when prescribing off-label medicines, in comparison to a licensed drug. 18 Prescribers must be satisfi ed that such use would better serve the patient's needs than an appropriately licensed alternative, including confi dence in the balance between the potential benefi t and the risk of harms.…”

Section: What Are the Indications For Gabapentinoids?mentioning

confidence: 99%

Gabapentin and Pregabalin: Do the Benefits Outweigh the Harms?

Morrison

Sandilands

Webb

2017

Journal of the Royal College of Physicians of Edinburgh

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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.

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“…A Cochrane review including 10 randomised trials (n=426) found antidepressant medicines did not relieve pain or depressive symptoms more than placebo in people with chronic non-specific low back pain 17. While anticonvulsants are increasing in popularity to manage non-specific low back pain,18 there are no trials in this patient group. A recent trial in patients with acute and chronic sciatica suggests a lack of efficacy of pregabalin on back and radicular pain outcomes, and almost twice the risk of adverse events, compared with placebo 19.…”

Section: The Evidence For Changementioning

confidence: 99%

Avoid routinely prescribing medicines for non-specific low back pain

et al. 2018

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Pregabalin prescriptions in the United Kingdom: a drug utilisation study of The Health Improvement Network (THIN) primary care database

Abstract: Data from this DUS indicated that the majority of pregabalin prescribing in the UK was consistent with product labelling. The proportion of patients with prescribed ADD > 600 mg/day was small and with a similar proportion with a history of substance abuse as in the full population.

Cited by 34 publications

References 32 publications

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

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

Gabapentin and Pregabalin: Do the Benefits Outweigh the Harms?

Avoid routinely prescribing medicines for non-specific low back pain

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