BMJ 2014;348:g1290 doi: 10.1136/bmj.g1290 (Published 5 February 2014)

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Letters

LETTERS DRUGS FOR NEUROPATHIC PAIN

Potential misuse of pregabalin and gabapentin Hannah Loftus specialist trainee year 5, genitourinary medicine, Alison Wright consultant in genitourinary medicine Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK

Kalso and colleagues summarise drugs used to manage neuropathic pain.1 However, they should have mentioned the potential misuse of pregabalin and gabapentin, which Spence highlighted last year.2 Reports of gabapentin and pregabalin being used alongside opiates to potentiate opiate effects are increasing.3 4 The drugs can also be used alone in higher than recommended doses to produce sedative and psychedelic effects.5 6 The consequences of overdose can be severe and unpredictable. Seizures are a recognised presenting feature in emergency departments and can require admission to intensive care.7 The half life of 5-7 hours necessitates prolonged monitoring of patients. A recent study suggested that patients at high risk of addiction were prescribed higher than the recommended dose of pregabalin.8

Although when used correctly gabapentinoids can provide great relief for patients with neuropathic pain, the potential for misuse should be considered before they are prescribed. Quantities supplied should be limited because of the possibility of misuse.

Competing interests: None declared. 1 2 3 4 5

6 7 8

Kalso E, Aldington DJ, Moore RA. Drugs for neuropathic pain. BMJ 2013;347:f7339. (19 December.) Spence D. Bad medicine: gabapentin and pregabalin. BMJ 2013;347:f6747. (8 November.) Baird CR, Fox P, Colvin LA. Gabapentinoid abuse in order to potentiate the effect of methadone: a survey among substance misusers. Eur Addict Res 2013;20:115-8. Grosshans M, Lemenager T, Vollmert C, Kaemmerer N, Schreiner R, Mutschler J, et al. Pregabalin abuse among opiate addicted patients. Eur J Clin Pharmacol 2013;69:2021-5. Schifano F, D’Offizi S, Piccione M, Corazza O, Deluca P, Davey Z, et al. Is there a recreational misuse potential for pregabalin? Analysis of anecdotal online reports in comparison with related gabapentin and clonazepam data. Psychother Psychosom 2011;80:118-22. Smith BH, Higgins C, Baldacchino A, Kidd B, Bannister J. Substance misuse of gabapentin. Br J Gen Pract 2012;62:406-7. Millar J, Sadasivan S, Weatherup N, Lutton S. Lyrica nights—recreational pregabalin abuse in an urban emergency department. Emerg Med J 2013;30:874. Bodén R, Wettermark B, Brandt L, Kieler H. Factors associated with pregabalin dispensing at higher than the approved maximum dose. Eur J Clin Pharmacol 2014;70:197-204.

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Potential misuse of pregabalin and gabapentin.

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