MHRA has no plans to curb pregabalin prescribing by GPs

Exclusive The MHRA has confirmed that it does not currently plan to take regulatory action on pregabalin prescribing by GPs.

It comes after GPs in Northern Ireland were last month told they should no longer initiate prescriptions of pregabalin for neuropathic pain following a ‘significant increase’ in deaths related to the drug.

The drug was removed from the country’s formulary as the preferred option for the treatment of neuropathic pain but GPs will still be able to prescribe pregabalin where they deem it to be ‘clinically appropriate’.

Now the MHRA has confirmed to Pulse that it has no plans to limit prescribing of gabapentinoids, including pregabalin and gabapentin.

A spokesperson told Pulse MHRA is ‘looking into the situation in Northern Ireland’ but ‘not currently considering regulatory action’.

Adding that there was no ‘urgent’ action under consideration, MHRA added that gabapentinoids do remain ‘under review’ and the ‘medicines safety watchdog actively monitors any suspected adverse drug reactions’.

The Department of Health and Social Care said, regarding England, that it deferred to the MHRA.

Northern Ireland’s Health and Social Care Board (HSCB) also told Pulse it had ‘no plans’ for similar action regarding the prescribing of gabapentin, as it has taken with regards to pregabalin.

And representatives for the other devolved nations told Pulse that they are not considering limiting the prescribing of either pregabalin or gabapentin.

A Welsh Government spokesperson said: ‘This is not something we are planning on doing at the moment.

‘All medicines prescribed should take into account both the risks and benefits of the treatment and be in line with the guidance on managing neuropathic pain. 

‘We expect all health boards to work with primary and secondary care to reduce unnecessary and inappropriate prescribing.’

And a spokesperson for the Scottish Government told Pulse that there are ‘currently no plans to restrict the appropriate prescribing’ of pregabalin or gabapentin.

They said: ‘Since 2018, the Scottish Government has used a quality prescribing guide on chronic pain, which supports prescribers to select the most appropriate treatment to manage pain.

‘This is supported by supplementary guidance to review gabapentinoid prescribing to minimise harm.

‘We support person-centred decision-making for treatment between both the prescriber and the patient.’

Both gabapentinoids were reclassified as class C drugs in the UK in April 2019 following a rise in the number of deaths linked to them.

In April, NICE’s first-ever guideline on chronic pain recommended that GPs should not prescribe gabapentinoids to patients with chronic primary pain because they could be ‘harmful’.

NICE is developing a guideline on medicines associated with dependence or withdrawal symptoms, due to be published in November 2021.

Public Health England’s landmark 2019 review into prescription drug addiction concluded that one in four adults – over 11m adults in England – received a prescription for antidepressants, opioids, gabapentinoids, benzodiazepines or z-drugs in the previous year.

At the time, public health officials said they recognised the ‘great pressure’ GPs are under to provide access to addictive medication and said alternative treatments needed to be considered.

Existing MHRA advice asks healthcare professionals to check the patient for a history of drug abuse before prescribing gabapentinoids and to observe patients who have been prescribed them for signs of drug abuse and dependence.

Meanwhile, PCNs have been required to offer structured medication reviews (SMRs) to patients taking opioids and gabapentinoids since April.

Click to complete relevant pain relief CPD modules on Pulse learning.