In October last year, PHARMAC opened a consultation on the funding of pregabalin in New Zealand.1 Up until now, pregabalin has not been subsidised for use in New Zealand. Now,…
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Pregabalin has recently been made available fully funded in New Zealand. Experience from countries where pregabalin has been used widely, such as the UK, has demonstrated that pregabalin is liable to misuse and is sought after by users from prescribers such as GPs. Pregabalin is misused on its own at high dose, or in combination with other drugs. When used in combination with other drugs, particularly opioids, its synergistic effects may lead to increased risk of overdose. Prescribers, particularly GPs, need to be aware of this misuse potential and to be careful when prescribing to individuals with a history of substance or alcohol misuse, or to patients who present requesting a prescription specifically for pregabalin. All patients prescribed pregabalin should be reviewed regularly to ensure efficacy and safety.
Pregabalin has not been used widely in New Zealand to this point as it has not been funded, but from May 2018 it will be available fully subsidised. This paper intends to highlight the issue of pregabalin misuse, a concern that will be unfamiliar to most clinicians in New Zealand.
A review of the literature of papers documenting the misuse of gabapentin and pregabalin was conducted with a specific focus on pregabalin.
There is a growing body of evidence regarding the potential of misuse of pregabalin. It produces a range of sensations, including euphoria, sedation and dissociation. It is commonly used in conjunction with other drugs, most notably sedatives and opioids, which leads to an additive effect. Although generally safe when taken alone, pregabalin is a growing feature of drug-related deaths.
Prescribers need to be alert to the potential of pregabalin misuse. This should be achieved through prescribing with great care (not prescribing to new or unknown patients; not in response to direct patient requests for it by name; supplying in limited quantities), regular review of patients and stopping treatment, by slow withdrawal, when lack of efficacy is seen.