.2021 Oct;69(10):2842-2850.

doi: 10.1111/jgs.17312. Epub 2021 Jun 12.

Evidence of a gabapentinoid and diuretic prescribing cascade among older adults with lower back pain

Stephanie H Read^{1 2}, Vasily Giannakeas^{1 2}, Paula Pop³, Susan E Bronskill^{1 2 4 5}, Nathan Herrmann⁵, Simon Chen², Miles J Luke¹, Wei Wu¹, Lisa M McCarthy^{1 6 7}, Peter C Austin^{2 4 5}, Sharon-Lise Normand⁸, Jerry H Gurwitz⁹, Nathan M Stall^{1 2 3 4}, Rachel D Savage^{1 2}, Paula Rochon^{1 2 3 4}

Affiliations

¹ Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
² ICES, Toronto, Ontario, Canada.
³ Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁴ Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁵ Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.
⁶ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
⁷ Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada.
⁸ Harvard Medical School and Harvard Chan School of Public Health, Boston, Massachusetts, USA.
⁹ Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts, USA.

PMID:34118076
DOI: 10.1111/jgs.17312

Evidence of a gabapentinoid and diuretic prescribing cascade among older adults with lower back pain

Stephanie H Read et al. J Am Geriatr Soc.2021 Oct.

.2021 Oct;69(10):2842-2850.

doi: 10.1111/jgs.17312. Epub 2021 Jun 12.

Authors

Affiliations

¹ Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
² ICES, Toronto, Ontario, Canada.
³ Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁴ Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁵ Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.
⁶ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
⁷ Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada.
⁸ Harvard Medical School and Harvard Chan School of Public Health, Boston, Massachusetts, USA.
⁹ Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts, USA.

PMID:34118076
DOI: 10.1111/jgs.17312

Abstract

Background/objectives: Gabapentinoids are commonly prescribed to relieve pain. The development of edema, an established adverse effect of gabapentinoids, may lead to a potentially harmful prescribing cascade whereby individuals are subsequently prescribed diuretics and exposed to diuretic-induced adverse events. The frequency of this prescribing cascade is unknown. Our objective was to measure the association between new dispensing of a gabapentinoid and the subsequent dispensing of a diuretic in older adults with new low back pain.

Design: Population-based cohort study.

Setting: Ontario, Canada.

Participants: A total of 260,344 community-dwelling adults aged 66 years or older, newly diagnosed with low back pain between April 1, 2011, and March 31, 2019.

Measurements: Exposure status was assigned using dispensed medications in the 1 week after low back pain diagnosis. Older adults newly dispensed a gabapentinoid (N = 7867) were compared with older adults who were not newly dispensed a gabapentinoid (N = 252,477). Hazard ratios (HRs) with 95% confidence intervals (CIs) for dispensing of a diuretic within 90 days of follow-up among older adults prescribed gabapentin relative to those who were not.

Results: Older adults newly dispensed a gabapentinoid had a higher risk of being subsequently dispensed a diuretic within 90 days compared with older adults who were not prescribed a gabapentinoid (2.0% vs. 1.3%). After covariate adjustment, new gabapentinoid users had a higher rate of being dispensed a diuretic compared with those not prescribed a gabapentinoid (HR: 1.44, 95% CI: 1.23, 1.70). The rate of diuretic prescription among new gabapentinoid users increased with increasing gabapentinoid dosages.

Conclusions: We have demonstrated the presence of a potentially inappropriate and harmful prescribing cascade. Given the widespread use of gabapentinoids, the population-based scale of this problem may be substantial. Increased awareness of this prescribing cascade is required to reduce the unnecessary use of diuretics and the exposure of patients to additional adverse drug events.

Keywords: dose-dependence; drug safety; gabapentinoids; prescribing.

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References

REFERENCES

1. Pfizer Canada Inc. Product Monograph Lyrica (Pregabalin Capsules); 2016.https://www.pfizer.ca/lyrica-pregabalin-capsules.
1. Pfizer Canada Inc. Product Monograph: GD-gabapentin; 2018.https://www.pfizer.ca/pm/en/gabapentin.pdf.
1. Montastruc F, Loo SY, Renoux C. Trends in first gabapentin and Pregabalin prescriptions in primary Care in the United Kingdom, 1993-2017. JAMA. 2018;320(20):2149-2151.
1. Molero Y, Larsson H, D'Onofrio BM, Sharp DJ, Fazel S. Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden. BMJ. 2019;365:l2147.
1. Semel D, Murphy TK, Zlateva G, Cheung R, Emir B. Evaluation of the safety and efficacy of pregabalin in older patients with neuropathic pain: results from a pooled analysis of 11 clinical studies. BMC Fam Pract. 2010;11:85.

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Evidence of a gabapentinoid and diuretic prescribing cascade among older adults with lower back pain

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Evidence of a gabapentinoid and diuretic prescribing cascade among older adults with lower back pain

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