Revisiting Pregabalin: Risks and Safe Prescribing Practices

Optimising safety in prescribing for neuropathic pain

Deaths involving pregabalin are increasing

There are growing concerns worldwide about risk of harms and misuse with gabapentinoids. Pregabalin is now one of the top ten drugs most frequently implicated in overdose deaths in Victoria. Incidence of pregabalin poisoning is increasing partly because of pregabalin misuse and abuse. The pregabalin product information was recently updated to warn of the risk of misuse, abuse and dependence which can lead to overdose and death, especially when used with other central nervous system depressants. A recent study of patients prescribed pregabalin, using MedicineInsight data, showed that 38% were prescribed an opioid, 13% were prescribed a benzodiazepine and 4% were prescribed both an opioid and a benzodiazepine on the same day.

A 2020 survey by NPS MedicineWise found many consumers felt their early expectations of medicines for nerve pain were not met. Understanding of where to access information and advice, and when and how to stop the medicine, was often poor or very poor.

One in every seven patients prescribed pregabalin appears to be at high risk of misuse

Patients at increased risk of pregabalin misuse and harm include those with a history of drug seeking behaviour, mental health or substance use disorder (particularly opioid use disorder) patients with multiple pregabalin prescribers, those who are prescribed higher strengths of pregabalin, are younger (< 55 years), male, or unemployed.

NPS Sample Pregabalin Practice Review