Why the study?
Gabapentinoid prescriptions are increasing in North America, with frequent off-label use despite limited proven efficacy.
Gabapentinoids are frequently prescribed off-label in hospitalized medical patients, often at subtherapeutic doses and co-prescribed with opioids, with low rates of deprescribing.
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Rising off-label gabapentinoid use in inpatients warrants monitoring; leaves open optimal deprescribing strategies.
Gabapentinoid prescriptions are increasing in North America, with frequent off-label use despite limited proven efficacy. This retrospective cohort study describes prescribing trends among hospitalized patients with a focus on dosing and deprescribing. We examined consecutive inpatients between December 2013 and July 2017 on a 52-bed medical unit in Montréal, Canada. Prevalence of off-label use, median doses prescribed, and deprescribing trends were analyzed over time. Of 4,103 hospitalized patients, 550 (13.4%) were prescribed gabapentinoids preadmission, with two patients being coprescribed gabapentin and pregabalin (total 552 prescriptions). A minority (94/552, or 17%) were for approved indications. Although it was uncommon for gabapentinoids to be newly prescribed in hospital, preadmission gabapentinoids were also seldom deprescribed (65/495 patients discharged alive, or 13%). Given a high prevalence of use, limited efficacy, and potential harms, gabapentinoids may represent an ideal target for re-evaluation of indication and effectiveness in hospitalized adults, with consideration given to deprescribing.
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Gingras et al. (2019) studied this question.
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