Gabapentinoid Polypharmacy Among Medicare Beneficiaries During the Poststroke Recovery Period

To describe patterns of gabapentinoid (Gabapentin and Pregabalin) use and concurrent use with other central nervous system (CNS) acting pain medications (opioids and benzodiazepines) among US Medicare beneficiaries following acute ischemic stroke (AIS).

We analyzed new outpatient gabapentinoid prescriptions in older stroke survivors between 2009 and 2022. We calculated the percent of new gabapentinoid initiators within 6 months of stroke discharge and analyzed concurrent pain medications prescribed within 30 days of gabapentinoid initiation. We presented trends and geographic patterns standardized by age, discharge destination, and modified Rankin Scale (mRS) to control for variations in the sample composition by age and stroke severity over time.

We analyzed a 20% sample of US Medicare beneficiaries aged 65 years or older who were hospitalized for AIS. We included those who met Medicare enrollment criteria, had no prior stroke, no prior gabapentinoid use within 6 months, and were discharged home within 30 days of hospitalization.

Among 153,728 stroke survivors, 4.9% received new gabapentinoid prescriptions within 6 months postdischarge. Of the 7595 gabapentinoid initiators, 1579 (21%) had concurrent opioid and 653 (8.6%) had concurrent benzodiazepine prescriptions. In the sample, the median age was 78 years (Quartile Range: 72-84), 55% were female, and 81% were non-Hispanic White. The standardized percentage of gabapentinoid initiators increased from 3.8% in 2009 to 5.9% in 2022 (crude: 3.6% in 2009 to 5.8% in 2022). Despite increases in the number of gabapentinoid initiators, the percentage of concurrent opioid users remained low over time, around 1% of the study population. We observed variation in gabapentinoid initiation and concurrent use with opioids by geography.

From 2009 to 2022, poststroke gabapentinoid use increased in older adults, but concurrent use with opioids remained low over time.