Over a Decade of Trends in Gabapentinoid Prescribing and Daily Doses Among Patients Taking Opioids for Pain Management in Malaysia (2010-2020)

OBJECTIVES: Gabapentinoids (gabapentin and pregabalin) are indicated as first-line therapies for neuropathic pain and have witnessed a significant increase in prescriptions, particularly in the UK and the United States. They raise safety concerns about central nervous system depression, including drowsiness, dizziness, and possibly cognitive impairment. Furthermore, combining gabapentinoids with opioids can increase the risk of adverse outcomes associated with opioid use. This study evaluated the prescribing trends for gabapentinoids among opioid patients and examined their daily dose.

METHODS: This cross-sectional study was conducted from 2010 to 2020 using the prescription databases of a tertiary hospital in Malaysia. All prescriptions for gabapentinoids (gabapentin and pregabalin) that were prescribed for patients using opioids for their pain relief were included in this study. Annual number of patients and prescriptions were measured in repeat cross-sectional estimates. Monthly individual patient daily doses were categorized according to low, moderate and high (gabapentin: <600, 600 to <900, ≥900; pregabalin: <300, 300 to <450, ≥450 mg/day respectively). Descriptive statistics and linear trend analysis were performed using Stata version 15

RESULTS: A total of 4.1% (n=1441) of opioid patients were prescribed with gabapentinoids. Of these 1441 patients, (93.9%, n=1374 gabapentin patients, 6.1%, n=88 pregabalin patients) received a total of 12132 gabapentinoid prescriptions (88.7% gabapentin and 11.3% pregabalin). Gabapentinoid prescriptions increased from 534 to 1585 annually, representing a 196.8% increase (P < 0.005). Pregabalin prescriptions increased by 2215% from 13 to 301 (P<0.005), whereas gabapentin prescriptions increased by 146.4% from 521 to 1284 (P<0.005). Patients were mostly prescribed low doses of gabapentin (<600 mg/day) or pregabalin (<300 mg/day)

CONCLUSIONS: Over the 11-year study period, the usage of gabapentinoids among patients taking opioids for pain management increased significantly. Future study is needed to assess the clinical outcomes of this practice and determine the degree of co-prescribing.