Neurontin Prescriptions Rise During Opioid Crisis

Introduction:

Prescriptions for nerve pain medicines like Neurontin and Lyrica have more than tripled in recent years, determined by increased use among chronically ill older adults and patients already taking opioids, a U.S. study recommends.

The extent of U.S. adults recommended Neurontin and other drugs in a similar group of medicines moved from 1.2 percent in 2002 to 3.9 percent by 2015, a period that also observed a surge in opioid overdoses and deaths.

The group of medicines, known as gabapentinoids, includes gabapentin (Neurontin, Gralise, Horizant) and pregabalin.

Study author Dr. Michael Johansen of the Heritage College of Osteopathic Medicine at Ohio University in Athens said, “About one of every 25 adults takes a gabapentinoid during a year, which matters since we have little information to help much utilization of this drug class and minimal information to help the long-term safety of the medicines”.

Use of Gabapentinoids 

More than six in 10 drug overdose deaths include opioids. During this worsening opioid epidemic, the CDC has asked doctors to prescribe other drugs for pain including acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) and additionally gabapentinoids. Gabapentin and pregabalin both have won U.S. Food and Drug Administration (FDA) approval for treating partial seizures and a kind of nerve pain caused by shingles.

A version of gabapentin has also been approved for restless leg syndrome, and pregabalin has additional approvals for fibromyalgia and nerve pain related to diabetes and spinal line injuries. While the FDA doesn’t allow drug companies to advance these medicines for other conditions, specialists are allowed to recommend the drugs for off-label, or unapproved uses.

Off-label utilization of gabapentinoids has been controversial, however, because these drugs can be addictive, they haven’t been demonstrated effective for many common unapproved utilizes and there’s limited long-term safety information, Johansen writes in JAMA Internal Medicine.

For his research, Johansen reviewed survey information from a nationally representative sample of 346,177 adults, including details on any medical conditions and prescriptions.

Generally, more than four out of five of prescriptions for gabapentinoids were for gabapentin, the investigation found. Prescription development was concentrated among older adults, diabetics, individuals with multiple chronic health problems and patients already taking opioids or benzodiazepines like Valium and Xanax.

Limitations:

One limitation of the analysis is that it depended on members to precisely report on any drug use, and it’s possible that a few people did not disclose opioid utilize. The research did include prescription records or data on drug costs.

Dr. Christopher Goodman, a researcher at the University of South Carolina School of Medicine in Columbia who wasn’t involved in the study said, “the utilization of gabapentinoids particularly seems to be outpacing any proven viability and the potential significant harms like addiction and overdose are only beginning to be explored”.

While a few patients may benefit by these drugs, they should consider different ways to deal with pain management like exercise, physical therapy and yoga that might be more safer and still give some relief, Goodman said by email.

Side Effects of Gabapentinoids:

Side effects of gabapentinoids include sedation, discombobulation, and trouble thinking, Dr. Chad Brummett, an opioid scientist at the University of Michigan in Ann Arbor who wasn’t associated with the investigation, said by email.

Risks of Gabapentinoids:

The risks are more awful at higher doses. Mixing these medications with opioids and benzodiazapines may make them considerably more dangerous, said Marissa Seamans, a scientist at the Johns Hopkins Bloomberg School of Public Health in Baltimore who wasn’t associated with the investigation.

“Gabapentinoids are progressively recommended to patients with opioids and benzodiazapines, which increases the risk of respiratory depression and death,” Seamans said by email.

“Clinicians and patients need to carefully monitor the dosage of these medications, their interactions, and potentially fatal side effects.”

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