Reclassification and prescribing patterns of gabapentinoids

Having originally been developed as an anti-seizure medication, gabapentinoids include gabapentin and pregabalin, which are now prescribed primarily for neuropathic pain, seizures and anxiety, but also for fibromyalgia, restless legs syndrome and complications of MS (Chan et al, 2023).

First introduced in the UK and the US in 1993, the number of doses of pregabalin and gabapentin taken daily have risen dramatically, increasing more than four times around the world between 2008 and 2018 (BBC, 2024). The global increase in both the abuse of and deaths resulting from pregabalin in particular is concerning, with in excess of 8 million prescriptions dispensed in England alone in 2022 (BBC, 2024).

Gabapentin is indicated for peripheral neuropathic pain such as painful diabetic neuropathy and post-herpetic neuralgia, while pregabalin is indicated for both peripheral and central neuropathic pain. It blocks pain by interfering with pain messages that travel through the brain and down the spine (NHS, 2021). Gabapentin is also used as a monotherapy for partial seizures, both with and without secondary generalisation, and both gabapentin and pregabalin are used as adjunctive therapies for this purpose by reducing abnormal electrical activity in the brain, thus preventing seizures in epilepsy (NHS, 2021).