Gabapentin and pregabalin are used to treat epilepsy and neuropathic pain while pregabalin is also indicated in the treatment of generalised anxiety disorder. The advice from NHS England and Public Health England states that while gabapentin and pregabalin may be of benefit in these conditions, their use may lead to dependence and there is a potential for misuse or diversion.
Practitioners should prescribe gabapentin and pregabalin appropriately to minimise the risk of misuse and dependence, bearing in mind the fact that patients with a propensity to misuse, divert or become dependent on them may be more likely to have the conditions for which these drugs are beneficial.
PHE prescribing advice
Both gabapentin and pregabalin are associated with significant euphoric effects and there is a growing illegal market for both drugs. If dependence, misuse or diversion is suspected the patient should be reviewed and the prescriber’s concerns discussed sensitively and documented clearly.
In the case of dependence or abuse specialist advice may be required which may lead to controls being implemented regarding access to, and maximum daily use of, the relevant drug or in some cases to a planned withdrawal of the drug. In the case of diversion the drugs should be stopped.
Less harmful, alternative drugs can often be first-line treatments for the conditions for which pregabalin and gabapentin are now used, and may be tried preferentially in higher risk settings or in patients who may be more likely to be harmed by the drugs. Where gabapentin and pregabalin are being used off-licence to treat non-neuropathic pain, alternatives should be considered as there is little evidence to support this practice.
Prescribers should inform patients about the potential for gabapentin and pregabalin to lead to abuse or dependence and if there are features in the patient’s history that may increase the likelihood of these occurring they should be discussed openly with the patient.