A study using UK data suggests that gabapentinoid prescribing has tripled since 2007, with more than half the use off-label.

The rate of new scripts for gabapentin rose 2.95 fold from 230 per 100,000 patients per year in 2007 to 679 per 100,000 in 2017. Scripts for pregabalin rose by a similar amount (rate ratio [RR] 2.96) from 128 to 379 per 100,000 patients per year over the same time.

The proportion of patients who received a co-prescription for benzodiazepines, opioids or both also rose about three-fold between 2007 and 2017, from 56.4 to 148.1 per 100,000 patients per year for gabapentin (RR 2.62) and from 28.7 to 91.2 for pregabalin (RR 3.18). During 2017, 21.8 and 24.1 per cent of patients newly treated with gabapentin and pregabalin respectively received a concomitant prescription, usually for opioids.

The rate of off-label prescriptions rose from 58.7 per 100,000 patients per year in 2007 to 216.0 per 100,000 in 2017 for gabapentin (RR 3.68) and from 34.7 to 117.8 for pregabalin (RR 3.40). During 2017, 52.0 and 54.8 per cent of prescriptions for gabapentin and pregabalin respectively with an identified indication were off-label. Of these, 80.4 and 58.3 per cent respectively were for non-neuropathic pain.

“Given the safety concerns of gabapentinoids and the lack of robust evidence supporting their efficacy in cases of non-neuropathic pain, caution is necessary when prescribing gabapentinoids, especially among patients also prescribed opioids,” the authors concluded.