Many people are being prescribed pregabalin for short durations and in low doses inconsistent with its recommended indication of chronic neuropathic pain, an Australian study shows.
The pattern of pregabalin use revealed by PBS data suggests it is being used inappropriately for short term treatment of low back pain and in combination with opioids, according to researchers from the University of NSW.
Sampling of pregabalin PBS prescription dispensing data for more than 130,000 patients showed that after pregabalin was subsidised on the PBS in 2013 there was a three-fold increase in its use but also an increasing trend for it to be used for short duration treatment.
More than one in three patients (38%) only had one dispensing, and the proportion of patients discontinuing pregabalin within a year increased from 77% in 2013/14 to 86% in 2017/18.
This suggested either poor tolerability of pregabalin or that people were using for indications other than chronic neuropathic pain, the study authors said.
There was also evidence that many patients were not having pregabalin titrated up to an effective dose for neuropathic pain.
One third (37.5%) of patients were initiated on the lowest strength pregabalin capsule (25 mg) and only 31% later up‐titrating to a higher strength. The study authors noted that Australian guidelines suggest starting patients on doses of 75 mg pregabalin and that for neuropathic pain it is generally effective in doses of at least 150 mg or 300 mg daily.
Also of concern were the high rates of opioid use, which is not recommended in neuropathic pain, with 47% and 53% of patients being dispensed opioids within 180 days before and after pregabalin initiation.