A snapshot on the usage pattern of gabapentinoids in Oman

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Pregabalin, Gabapentin, Abuse, Misuse, Off-label use


Background: Since their introduction as adjunct anticonvulsants, the use of gabapentinoids (gabapentin and pregabalin) has increased substantially worldwide to include a wide range of clinical conditions. Various reports have demonstrated that they possess addiction liability and can produce effects similar to traditional recreational drugs, such as significant euphoric effects, enhanced sociability, and relaxation. However, there is limited information on the use of these agents in the Middle East. Objectives: Here, we describe the usage pattern of gabapentinoids at Sultan Qaboos University Hospital, a tertiary care medical institution in Oman. Methods: Adult patients (≥18 years) who were prescribed gabapentinoids for six months (March–August 2019) were included in this retrospective cross-sectional study. Indications and dosing regimens were reviewed according to the Food and Drug Administration labeling. Controlled and restricted drugs were reviewed using Oman National Formulary. Institutional ethical approval was obtained before conducting the study. Results: We analyzed 291 prescriptions. The mean (standard deviation, SD) age was 60.5 years (SD = 13.0) with the age group of ≥60 years being the most common (190, 65.3%). Most of patients were females (178, 61.2%). The majority of prescriptions were for outpatients (85.8%). Drugs were prescribed as refill and follow-up in 116 (40.0%) and 97 (33.4%) of prescriptions, respectively. Diabetic peripheral neuropathy (50, 79.4%) was the most labeled indication for both. Off-label use was 128 (51.8%) and 31 (70.5%) for pregabalin and gabapentin, respectively, with lower back pain as being the most common indication for both drugs. A total of 54 (19.0%) patients were using at least one of the psychotropic drugs. Conclusions: Our findings indicate that gabapentinoids are frequently prescribed for off-label use. Awareness programs and the establishment of policy for the use of these drugs are required to ensure their rational use and prevent misuse and/or abuse.

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1. Goodman CW, Brett AS. Gabapentin and Pregabalin for Pain - Is Increased Prescribing a Cause for Concern? N Engl J Med.2017;377(5):411-414. https://doi.org/10.1056/NEJMp1704633
2. Johansen ME. Gabapentinoid Use in the United States 2002 Through 2015. JAMA Intern Med. 2018;178(2):292-294. https://doi.org/10.1001/jamainternmed.2017.7856
3. Spence D. Bad medicine: gabapentin and pregabalin. BMJ. 2013;347:f6747. https://doi.org/10.1136/bmj.f6747
4. Peckham AM, Evoy KE, Ochs L, et al. Gabapentin for Off-Label Use: Evidence-Based or Cause for Concern? Subst Abuse.2018;12:1178221818801311. https://doi.org/10.1177/1178221818801311
5. Zin CS, Chen LC, Knaggs RD. Changes in trends and pattern of strong opioid prescribing in primary care. Eur J Pain.2014;18(9):1343-1351. https://doi.org/10.1002/j.1532-2149.2014.496.x.
6. Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016;111(7):1160-1174.https://doi.org/10.1111/add.13324
7. McAnally H, Bonnet U, Kaye AD. Gabapentinoid Benefit and Risk Stratification: Mechanisms Over Myth. Pain Ther. 2020;9(2):441-452. https://doi.org/10.1007/s40122-020-00189-x 
8. Ghaly RF, Plesca A, Rana S, et al. Gabapentin-related suicide: Myth or fact? Surg Neurol Int. 2018;9:210. https://doi.org/10.4103/sni.sni_420_17
9. Driot D, Jouanjus E, Oustric S, et al. Patterns of gabapentin and pregabalin use and misuse: Results of a population-based cohort study in France. Br J Clin Pharmacol. 2019;85(6):1260-1269. https://doi.org/10.1111/bcp.13892
10. Chiappini S, Schifano F. A Decade of Gabapentinoid Misuse: An Analysis of the European Medicines Agency’s ‘Suspected Adverse Drug Reactions’ Database. CNS Drugs. 2016;30(7):647-654. https://doi.org/10.1007/s40263-016-0359-y
11. Nahar LK, Murphy KG, Paterson S. Misuse and Mortality Related to Gabapentin and Pregabalin are Being Under-Estimated: A Two-Year Post-Mortem Population Study. J Anal Toxicol. 2019;43(7):564-570. https://doi.org/10.1093/jat/bkz036
12. Torjesen I. Pregabalin and gabapentin: what impact will reclassification have on doctors and patients? BMJ. 019;364:l1107.https://doi.org/10.1136/bmj.l1107
13. Food and Drug Administration Highlights of Prescribing Information for Lyrica. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021446s035,022488s013lbl.pdf. Accessed on December 18, 2020.
14. Food and Drug Administration Highlights of Prescribing Information for Neurontin. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020235s064_020882s047_021129s046lbl.pdf. Accessed on December 18, 2020.
15. Martinotti G, Lupi M, Sarchione F, et al. The potential of pregabalin in neurology, psychiatry and addiction: a qualitative overview. Curr Pharm Des. 2013;19(35):6367-6374. https://doi.org/10.2174/13816128113199990425
16. Morrison EE, Sandilands EA, Webb DJ. Gabapentin and pregabalin: do the benefits outweigh the harms? J R Coll Physicians Edinb. 2017;47(4):310-313. https://doi.org/10.4997/JRCPE.2017.402
17. Schifano F, D’Offizi S, Piccione M, et al. Is there a recreational misuse potential for pregabalin? Analysis of anecdotal online reports in comparison with related gabapentin and clonazepam data. Psychother Psychosom. 2011;80(2):118-122. https://doi.org/10.1159/000321079
18. Schjerning O, Rosenzweig M, Pottegård A, et al. Abuse Potential of Pregabalin: A Systematic Review. CNS Drugs. 2016;30(1):9-25. https://doi.org/10.1007/s40263-015-0303-6
19. Soni A, Walters P. A study of the reasons for prescribing and misuse of gabapentinoids in prison including their co-prescriptionwi th opioids and antidepressants. Int J Prison Health. 2019;16(1):67-77. https://doi.org/10.1108/IJPH-01-2019-0004 20. Mazhar F, Shamim S, Malhi SM. Drug utilization evaluation of antiepileptics in three selected multidisciplinary teaching hospitals of Pakistan Int J Pharm Pharm Sci. 2014;6(5):59-66.
21. Landmark CJ, Beiske G, Baftiu A, et al. Experience from therapeutic drug monitoring and gender aspects of gabapentin and pregabalin in clinical practice. Seizure. 2015;28:88-91. https://doi.org/10.1016/j.seizure.2015.02.017
22. Pauly NJ, Delcher C, Slavova S, et al. Trends in Gabapentin Prescribing in a Commercially Insured U.S. Adult Population, 2009-2016. J Manag Care Spec Pharm. 2020;26(3):246-252. https://doi.org/10.18553/jmcp.2020.26.3.246 
23. Zhou L, Bhattacharjee S, Kwoh CK, et al. Trends, Patient and Prescriber Characteristics in Gabapentinoid Use in a Sample of United States Ambulatory Care Visits from 2003 to 2016. J Clin Med. 2019;9(1):83. https://doi.org/10.3390/jcm9010083
24. Fillingim RB, King CD, Ribeiro-Dasilva MC, et al. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009;10(5):447-485. https://doi.org/10.1016/j.jpain.2008.12.001
25. Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013;111(1):52-58. https://doi.org/10.1093/bja/aet127
26. Al-Zadjali N, Al-Khaldi S, Samir N, et al. Characteristics of Chronic Pain Patients Attending a Primary Health Care Center in Oman. Oman Med J. 2017;32(6):461-466. https://doi.org/10.5001/omj.2017.89
27. Kwok H, Khuu W, Fernandes K, et al. Impact of Unrestricted Access to Pregabalin on the Use of Opioids and Other CNS-Active Medications: A Cross-Sectional Time Series Analysis. Pain Med. 2017;18(6):1019-1026. https://doi.org/10.1093/pm/pnw351
28. Montastruc F, Loo SY, Renoux C. Trends in First Gabapentin and Pregabalin Prescriptions in Primary Care in the United Kingdom,1993-2017. JAMA. 2018;320(20):2149-2151. https://doi.org/10.1001/jama.2018.12358
29. Eguale T, Buckeridge DL, Winslade NE, et al. Drug, patient, and physician characteristics associated with off-label prescribing in primary care. Arch Intern Med. 2012;172(10):781-788. https://doi.org/10.1001/archinternmed.2012.340
30. Gingras MA, Lieu A, Papillon-Ferland L, et al. Retrospective Cohort Study of the Prevalence of Off-label Gabapentinoid Prescriptions in Hospitalized Medical Patients. J Hosp Med. 2019;14(9):E1-E4. https://doi.org/10.12788/jhm.3203
31. Radley DC, Finkelstein SN, Stafford RS. Off-label prescribing among office-based physicians. Arch Intern Med. 2006;166(9):1021-1026. https://doi.org/10.1001/archinte
32. Shanthanna H, Gilron I, Rajarathinam M, et al. Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2017;14(8):e1002369. https://doi.org/10.1371/journal. pmed.1002369
33. Hamer AM, Haxby DG, McFarland BH, et al. Gabapentin use in a managed medicaid population. J Manag Care Pharm.2002;8(4):266-271. https://doi.org/10.18553/jmcp.2002.8.4.266
34. Mack A. Examination of the evidence for off-label use of gabapentin. J Manag Care Pharm. 2003;9(6):559-568. https://doi.org/10.18553/jmcp.2003.9.6.559
35. Cairns R, Schaffer AL, Ryan N, et al. Rising pregabalin use and misuse in Australia: trends in utilization and intentional poisonings.Addiction. 2019;114(6):1026-1034. https://doi.org/10.1111/add.14412

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