Gabapentinoid Polypharmacy Among Medicare Beneficiaries During the Poststroke Recovery Period

Area of Science:

• Neurology
• Pharmacology
• Public Health

Background:

• Gabapentinoids (gabapentin, pregabalin) are frequently prescribed for neuropathic pain.
• Understanding their use post-stroke is crucial for patient safety, especially concerning concurrent use with other CNS-acting medications.

Purpose of the Study:

• To examine trends in gabapentinoid prescriptions among US Medicare beneficiaries after acute ischemic stroke (AIS).
• To assess the concurrent use of gabapentinoids with opioids and benzodiazepines in this population.

Main Methods:

• Analysis of new outpatient gabapentinoid prescriptions in Medicare beneficiaries aged 65+ hospitalized for AIS (2009-2022).
• Examination of concurrent opioid and benzodiazepine prescriptions within 30 days of gabapentinoid initiation.
• Standardization of trends by age, discharge, and stroke severity (mRS).

Main Results:

• 4.9% of 153,728 stroke survivors initiated gabapentinoids within 6 months post-discharge.
• Gabapentinoid initiation increased from 3.8% in 2009 to 5.9% in 2022.
• Concurrent opioid use remained low (~1% of population), while benzodiazepine use was 8.6% among initiators.

Conclusions:

• Gabapentinoid use increased significantly in older adults post-AIS from 2009 to 2022.
• Despite increased initiation, concurrent opioid prescribing with gabapentinoids remained consistently low.
• Geographic variations in gabapentinoid initiation and concurrent opioid use were observed.