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.
The researchers assigned the exposure status using dispensed medications in the 1 week after low back pain diagnosis. Older adults newly dispensed a gabapentinoid (N = 7867) were compared with older adults who were not newly dispensed a gabapentinoid (N = 252,477).
Key findings of the study include:
- Older adults newly dispensed a gabapentinoid had a higher risk of being subsequently dispensed a diuretic within 90 days compared with older adults who were not prescribed a gabapentinoid (2.0% vs. 1.3%).
- After covariate adjustment, new gabapentinoid users had a higher rate of being dispensed a diuretic compared with those not prescribed a gabapentinoid (HR: 1.44).
- The rate of diuretic prescription among new gabapentinoid users increased with increasing gabapentinoid dosages.
"Increased awareness of this prescribing cascade is required to reduce the unnecessary use of diuretics and the exposure of patients to additional adverse drug events," concluded the authors.
The study titled, "Evidence of a gabapentinoid and diuretic prescribing cascade among older adults with lower back pain," is published in the Journal of the American Geriatrics Society.