Abstract
Background: The UK government reclassified gabapentin and pregabalin as ‘controlled drugs’ from April 2019. This study aimed to describe the trends in gabapentinoid prescribing before and immediately after reclassification, in the UK Clinical Practice Research Datalink, an electronic primary care health record broadly representative of the UK.
Methods: Separately for gabapentin and pregabalin, we calculated annual incident and prevalent prescribing rates from year of UK approval (April 1997 and 2004 respectively) to September 2019, and monthly incident and prevalent prescribing rates (October 2017–September 2019). Significant changes in temporal trends were determined using joinpoint regression. We also described potential prescribing indications, prior pain-related prescribing, and co-prescribing with potentially interacting medicines.
Findings: Incident gabapentin prescribing increased annually, peaking in 2016–17, at 625/100,000 patient years before falling steadily to 2019. Incident pregabalin prescribing peaked at 329/100,000 patient years in 2017–18 and did not fall significantly until 2019. Prevalent gabapentin and pregabalin prescribing increased annually to 2017–18 and 2018–19 respectively, before plateauing. Gabapentinoids were commonly co-prescribed with opioids (60%), antidepressants (52%), benzodiazepines (19%), and Z-drugs (10%).
Interpretation: Following a dramatic rise, incident gabapentinoid prescribing has started to fall but the specific impact of reclassification on prescribing rates remains unclear. Limited change in prevalent gabapentinoid prescribing during the 6 months following their reclassification as controlled drugs suggests little immediate impact on continued gabapentinoid prescribing for existing users.
Funding: National Institute for Health and Care Research (NIHR) Research for Patient Benefit Programme. NIHR Applied Research Collaboration West Midlands. NIHR School for Primary Care Research.
Methods: Separately for gabapentin and pregabalin, we calculated annual incident and prevalent prescribing rates from year of UK approval (April 1997 and 2004 respectively) to September 2019, and monthly incident and prevalent prescribing rates (October 2017–September 2019). Significant changes in temporal trends were determined using joinpoint regression. We also described potential prescribing indications, prior pain-related prescribing, and co-prescribing with potentially interacting medicines.
Findings: Incident gabapentin prescribing increased annually, peaking in 2016–17, at 625/100,000 patient years before falling steadily to 2019. Incident pregabalin prescribing peaked at 329/100,000 patient years in 2017–18 and did not fall significantly until 2019. Prevalent gabapentin and pregabalin prescribing increased annually to 2017–18 and 2018–19 respectively, before plateauing. Gabapentinoids were commonly co-prescribed with opioids (60%), antidepressants (52%), benzodiazepines (19%), and Z-drugs (10%).
Interpretation: Following a dramatic rise, incident gabapentinoid prescribing has started to fall but the specific impact of reclassification on prescribing rates remains unclear. Limited change in prevalent gabapentinoid prescribing during the 6 months following their reclassification as controlled drugs suggests little immediate impact on continued gabapentinoid prescribing for existing users.
Funding: National Institute for Health and Care Research (NIHR) Research for Patient Benefit Programme. NIHR Applied Research Collaboration West Midlands. NIHR School for Primary Care Research.
| Original language | English |
|---|---|
| Article number | 100579 |
| Number of pages | 10 |
| Journal | The Lancet Regional Health - Europe |
| Volume | 27 |
| Early online date | 13 Feb 2023 |
| DOIs | |
| Publication status | Published - Apr 2023 |
Bibliographical note
Funding:This project was funded by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Reference PB-PG-1217-20011). Christian Mallen Sara Muller, and Ram Bajpai are supported by the NIHR Applied Research Collaboration West Midlands and Christian Mallen also by the NIHR School for Primary Care Research. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Keywords
- Pharmacoepidemiology
- Pregabalin
- Gabapentin
- Gabapentinoids
- Primary care
- Prescriptions