Background: Gabapentin is a drug initially approved as a seizure drug but is now used for many off-label indications. The prescribing of gabapentin has grown exponentially in recent years, and much of it has been driven by off-label prescribing. With gabapentin prescription numbers rising, many are concerned that gabapentin lacks effectiveness and safety for many off-label uses.
Objective: The objective of this study is to evaluate off-label gabapentin prescribing at a family medicine clinic, compare off-label indications found to the current literature of effectiveness, and improve gabapentin prescribing quality and safety at our family medicine clinic.
Methods: A retrospective chart review of 100 patients taking gabapentin at the University of Utah Sugar House Family Medicine Clinic was performed. Patients were randomly selected, and patient charts via electronic health records were reviewed manually. Patients taking gabapentin for an off-label indication for at least three consecutive months and who were at least 18 years of age were included. Data collected included demographics, indication for use, concomitant sedating medications, and the total daily dose of gabapentin. Descriptive statistics were used to describe data along with a Fisher’s Exact test to analyze age vs. gabapentin dose and gabapentin dose vs. the number of concomitant sedating medications.
Results: In total, 100 patients were included in the study. The study population was mostly white/Caucasian (81%) and female (73%). The average age was 60 years (SD 13.2). The mean gabapentin dose for the study population was 1301mg (SD 1052mg). Seventy-eight percent (78%) of patients were taking a concomitant sedating medication along with their gabapentin. The average number of concomitant sedating medications was 1.89 (SD 1.5). The average creatinine clearance for the study population was 76 mL/min (SD 30.7 mL/min). A total of twenty-one unique indications for gabapentin were identified for the study population. The top five indications found were neuropathic pain (45%), other pain (21%), lower back pain (20%), sleep (8%), and anxiety (8%). Only neuropathic pain, hot flashes, restless leg syndrome, and anxiety were found to have strong evidence for effectiveness in current literature. A Fisher’s Exact test performed on age (≥50 and <50 years) vs. gabapentin daily dose (≥2400mg and <2400mg) showed a Fisher’s exact test statistic value of 0.2457 (p-value <0.05). A Fisher’s Exact test performed on gabapentin daily dose (≥2400mg and <2400mg) vs. the number of concomitant sedating medications (≥2 medications and <2 medications) showed a Fisher’s exact test statistic value of 0.0077 (p-value <0.05).
Conclusion: In this single clinic, retrospective chart review of patients prescribed off-label gabapentin; there were twenty-one off-label indications for gabapentin found. Many of the off-label indications found in the study lacked significant evidence for effectiveness. Also, patients were found to frequently be taking concomitant sedating medications with gabapentin. There was a statistically significant correlation between two or more concomitant sedating medications and daily doses of gabapentin equal to or exceeding 2,400mg, showing that patients with more sedating concomitant medications are using higher doses of gabapentin. The results of this study show prescribing trends at one family medicine practice setting and can be used to improve the quality of patient care by enhancing safety and evidence-based medicine.Recommend0 recommendationsPublished in