null Widespread off-label use of epilepsy medications could put some patients at risk

Despite limited proven efficacy, gabapentinoids are frequently prescribed to treat pain
May 10, 2019

Source: MUHC. The off-label pervasive use of a type of anticonvulsant originally marketed to treat epilepsy – called gabapentinoids – could place some patients at risk, according to a new study led by a team at the McGill University Health Centre and published this week in the Journal of Hospital Medicine. These findings could have important clinical implications, as gabapentinoids, initially intended to treat epilepsy, are now commonly prescribed as a pain killer to the general population, including to elderly patients with multiple conditions. The study found that one in eight adults admitted to a hospital in Quebec had been prescribed the drug as part of their usual home medications. 

Dr. Emily McDonald is a member of the Infectious Diseases and Immunity in Global Health Program at the Research Institute of the MUHC “In certain cases, some patients may derive benefit from the off-label use of gabapentinoids, but the public also needs to know about their possible harms. This class of medications is becoming increasingly common, despite very little evidence that it helps with pain, and despite evidence that the medications increase the risk of falls, fractures and memory impairment,” says senior author Dr. Emily G. McDonald, a physician in General Internal Medicine at the MUHC and an assistant professor of Medicine at McGill University, as well as a scientist at the Research Institute of the McGill University Health Centre (RI-MUHC). 

The researchers studied a cohort of patients admitted to a 52-bed medical clinical teaching unit at the Glen adult site of the MUHC from December 2013 to June 2017 and found that more than 13 percent of the 4,103 hospitalized patients had been prescribed the drug before they were hospitalized.

“This is an older population with multiple medical conditions who is more likely to suffer complications from taking an unnecessary medication,” says Dr. Marc-Alexandre Gingras. “Even for approved indications, the doses were often lower than what is suggested to be effective. The drug was also co-prescribed with benzodiazepines and opioids, which in another study has shown to increase the risk of death.”

Regular reassessment

“These medications should be reassessed regularly and stopped gradually to avoid complications such as seizures,” adds Dr. McDonald, who says that at the MUHC, gabapentinoids are now flagged to the patient’s treating doctor so they can reevaluate the indication for the drug, assess its effectiveness and consider deprescribing to help reduce polypharmacy –  the concurrent use of multiple medications by a patient.

This is the first article to describe the high quantity of off-label use of gabapentinoids in hospitalized medical patients.  

About the study 

The study entitled Retrospective Cohort Study of the Prevalence of Off-label Gabapentinoid Prescriptions in Hospitalized Medical Patients was co-authored by Marc-Alexandre Gingras; Anthony Lieu; Louise Papillon-Ferland; Todd C Lee; Emily G McDonald.

DOI: 10.12788/jhm.3203

This work was made possible by funding from the C9 Patient Safety and Quality Improvement Fund. 

About the McGill University Health Centre

The McGill University Health Centre (MUHC) is one of the world’s foremost academic health facilities. Building on the tradition of medical leadership of its founding hospitals, the MUHC provides exceptional multidisciplinary patient-centric care. Affiliated with the Faculty of Medicine of McGill University, the MUHC continues to shape the course of adult and pediatric medicine by attracting clinical and research expertise from around the world, assessing the latest in medical technology, and training the next generation of medical professionals. In collaboration with our network partners, we are building a better future for our patients and their families; for our employees, professionals, researchers and students; for our community and above all, for life. 

For information: 
Gilda Salomone
Media relations
McGill University Health Centre

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