Characterization of Outpatient Gabapentinoid Prescribing for Pain

Area of Science:

• Neurology
• Pharmacology
• Endocrinology

Background:

• National guidelines recommend minimum effective doses for gabapentin and pregabalin in diabetic peripheral neuropathy (DPN).
• Real-world studies indicate that recommended gabapentinoid doses are often not achieved.
• Existing guidelines may not adequately account for renal insufficiency in dosing strategies.

Purpose of the Study:

• To characterize gabapentinoid prescribing patterns in primary care patients.
• To evaluate adherence to recommended minimum effective doses of gabapentin and pregabalin for DPN.
• To identify factors influencing gabapentinoid dosing in a real-world setting.

Main Methods:

• Retrospective chart review of adult outpatients initiated on gabapentin or pregabalin.
• Study period: October 1, 2017, to October 1, 2020, with 12-month follow-up.
• Inclusion of 1,221 patients from two internal medicine clinics at an academic medical center.

Main Results:

• 1,079 patients (88.4%) received gabapentin, and 142 (11.6%) received pregabalin.
• Only 22.4% of patients on gabapentin and 33.3% on pregabalin met minimum effective doses (1800 mg/day and 300 mg/day, respectively) with adequate renal function.
• A significant proportion of patients did not achieve guideline-recommended dosing targets.

Conclusions:

• Current gabapentinoid prescribing for DPN frequently falls short of recommended minimum effective doses.
• Optimization of gabapentinoid dosing strategies is necessary to ensure patients receive adequate treatment trials.
• Further research is needed to address dosing challenges, particularly in patients with renal insufficiency.