Retrospective Cohort Study of the Prevalence of Off-label Gabapentinoid Prescriptions in Hospitalized Medical Patients
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.
© 2019 Society of Hospital Medicine
CONCLUSION
Gabapentinoid use was frequent in our cohort of hospitalized medical patients, with a high prevalence of off-label use, subtherapeutic doses, and coadministration with opioids and benzodiazepines. Deprescribing at discharge was uncommon and often triggered by an adverse event. The identification of gabapentinoids during hospitalization is an opportunity to reevaluate the indication for the drug, assess for effectiveness, and consider deprescribing to help reduce polypharmacy and ideally ADEs.
Acknowledgment
For the purposes of authorship, Dr. McDonald and Dr. Lee contributed equally.
Disclosures
Dr. Emily McDonald and Dr. Todd Lee have a patent pending for MedSafer, a deprescribing software, and both receive research salary support from the Fonds de Recherche Santé du Québec. Dr. Gingras, Dr. Lieu, and Dr. Papillon-Ferland have nothing to disclose.
