Harmful diuretic prescribing cascades in elderly on gabapentinoids for back pain: Study

Canada: Gabapentinoids are prescribed commonly for pain management. However, the use of gabapentinoids may lead to edema development, an established adverse effect. This may lead to a potentially harmful prescribing cascade where the patients are subsequently prescribed diuretics and get exposed to diuretic-induced adverse events. Not much is known about the frequency of this prescribing cascade.

Paula Rochon, Women's College Hospital, Toronto, Ontario, Canada, and colleagues aimed to measure the association between new dispensing of a gabapentinoid and the subsequent dispensing of a diuretic in older adults with new low back pain.

The study found the presence of a potentially inappropriate and harmful prescribing cascade. The researchers add that the population-based scale of this problem may be substantial given the widespread use of gabapentinoids. There is a need for increased awareness of this prescribing cascade to reduce unnecessary diuretics use and the patients' exposure to additional adverse drug events.

The population-based cohort study, published in the Journal of the American Geriatrics Society, included a total of 260,344 community-dwelling adults aged 66 years or older, newly diagnosed with low back pain between April 1, 2011, and March 31, 2019.