3.3.1 Deprescribing interventions
All studies implemented deprescribing interventions that targeted either
the patient or the clinician. Randomised trials aimed to reduce or cease
gabapentinoids dose and evaluated safety. Both randomised trials
implemented pharmacological based interventions to patients. (31, 32)
One trial evaluated the effect of an electronic decision support tool in
deprescribing potentially inappropriate medications within older
patients, including gabapentinoids, classed as an “intermediate risk
medication”. (31) The electronic decision support tool provided
individualised deprescribing reports to treating physicians within three
days of patient admission, suggesting opportunities where potentially
inappropriate medications could be deprescribed and tapering
instructions were indicated. This large trial (n = 6,633 with 925
receiving gabapentinoids) compared the intervention tool, MedSafer, to
usual care and whilst focused on prompting the medical team to act on
identified opportunities to deprescribe, patients or caregivers were
also given educational pamphlets on deprescribing of selected classes of
medications (e.g. gabapentinoids, antipsychotics, proton pump
inhibitors). The other randomised trial was an industry funded, three
arm trial of lorazepam (3 – 4 mg/day) and high dose (450 – 600 mg/day)
and low dose pregabalin (150 – 300 mg/day and) to evaluate the
prevalence and severity of discontinuation symptoms during the placebo
phase in 412 patients with generalised anxiety disorder. (32)
The two observational studies employed education-based,
clinician-focussed interventions to reduce gabapentinoid prescribing
rates within their respective settings. (27, 28) One study validated the
efficacy of a previously developed program, “The 10 Footsteps
programme”, in which clinicians underwent bi-weekly health training to
improve confidence and motivation when helping manage pain patients, and
in particular ‘high-risk’ pain patients. (28) The definition of a
‘high-risk’ pain patient was not stated within the text’s abstract. The
other observational study focused on a small cohort of 30 patients and
involved the presentation of data and leaflets to general practitioners
and nurse prescribers to change clinician prescribing trends and reduce
the rate of gabapentinoid prescribing within the practice. (27)