Pregabalin and gabapentin

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Pregabalin and gabapentin are to be reclassified as Class C controlled substances from April 2019, the government has announced.

The switch will come more than two years after the Advisory Council on the Misuse of Drugs recommended that the two medicines become controlled drugs and be placed under Schedule 3 of the Misuse of Drugs Regulations 2001 and Class C of the Misuse of Drugs Act 1971.

The medicines are used for treating neuropathic pain, seizures and anxiety, but illicit use of the drugs has increased in recent years. In June 2018, NHS Scotland figures revealed that gabapentinoids had been prescribed prior to a fifth of drug-related deaths in Scotland in 2016.

Following a consultation on the status of gabapentinoids which closed in January 2018, the UK government has now decided to reclassify the medicines but not to apply the requirements for safe custody.

It is illegal to possess controlled substances without a prescription or to sell or otherwise supply them to others. Under the new classification, pharmacists will not be able to accept electronic prescriptions for pregabalin and gabapentin, although an impact assessment from the government says that this “may be mitigated in the future if the Electronic Prescribing System (EPS) can be used to prescribe controlled drugs electronically instead”.

A pilot scheme prescribing Schedule 2 and 3 drugs using the EPS began in October 2018.

Prescriptions of pregabalin and gabapentin will also be limited to 30 days’ treatment, and repeat prescriptions will not be issued. Any prescription received must be dispensed within 28 days.

Ash Soni, president of the Royal Pharmaceutical Society (RPS), said in response to the reclassification that “these restrictions are designed to improve safety, and from that perspective will be recognised as a positive step by pharmacists”. But he emphasised that patients must be made aware of the changes so that they understand the new requirements for prescriptions, particularly regarding the time limits for dispensing and restrictions in prescribed quantity.

“It is likely that there will be some reduction in the prescribing of these drugs and pharmacies will need support in managing their stock holding to ensure they meet patient demand, without ending up with significant stocks that go out of date,” Soni added.

“Misuse of the gabapentinoids, often in combination with opioids, is becoming more prevalent and recognised in specialist drug and alcohol services”, said Graham Parsons, RPS spokesperson on misuse of drugs and chief pharmacist of the charity Turning Point.

“It is always a fine balance when drugs are reclassified. Prescribers must always be cautious that the pendulum does not swing too much in the other direction leading to patients with a genuine clinical need being denied evidenced-based pharmacotherapies.”

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  • Posted

    Hi Derek, Thanks for posting. I've been aware of this since its inception, and have contributed to the consultation, as I live with severe, chronic neuropathic pain (complex PHN), which I have had for many years. I am on pregabalin (lyrica, 3 x day) and duloxetine (1 x daily). At the time I spoke to my pharmacist about the repeat prescription issue, and he said there are people on other controlled drugs which are on repeat, so he thinks it's just a technicality (i.e. that it won't be on the normal repeat system, but can be requested every month from the pharmacy, or by the patient). I hope this is the case as it would be nonsensical to have to see a GP every month! Suzanne

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    • Posted

      Can I ask the cause of your neuropathy ?

      Mine is caused by having been prescribed Cipro And Fluroquinolone antibiotics for relatively minor infections. I don't have pain but the lack of feeling in my lower left leg causes walking/balance difficulties and the change of gait has affected my lower back. I have refused those drugs as I do not really have pain and their side effects can be serious and can worsen Fluroquinolone Toxicity Syndrome.

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    • Posted

      What a dreadful thing to happen to you at such a young age. I've not heard of any of the people I knew with shingles having that.

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    • Posted

      No chance that it was caused by medication ?

      I once had an old lady neighbour who had shingles three times.

      Keep fighting

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    • Posted

      No. It was caused by a prolonged period of stress (shared house stress and work stress) and getting run down, and then not be able to recover in a stress-free environment

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    • Posted

      I've been reading about your condition.

      Have you tried Capsaicin ? I'm using it at the moment on my knee and it seems to help more than other substances I have used,

      Capsaicin is the substance that makes chilli peppers hot. It's thought to work for nerve pain by stopping the nerves sending pain messages to the brain.

      Your GP can prescribe capsaicin as a low-dose cream. You apply it to the affected area a few times a day, but only when the rash has healed. It works by changing the way the nerve endings function.

      High-strength capsaicin patches can also be used to treat post-herpetic neuralgia. They're available at specialist pain clinics and are applied as a single treatment in the clinic or at hospital. If effective, the treatment can be repeated, usually every few months depending on how your symptoms have improved.

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    • Posted

      Hi Derek,

      I haven't and am aware of it. I no longer have 'just' PHN. Also I only had a rash of 2 spots, with the majority of the symptoms affecting me internally (up my spine). Ive tried lidocaine patches but they're too localised and surface level, and ate too cold. When I had shingles in 2004 I was on amitriptyline and co-codamol and my pain lasted 18 months. However 2 and a half years later it returned with additional pain in a new area (I queried shingles again but it did join top of old pain in spine so think it was a maladaptive repair. I also developed even more severe symptoms (deep spinal torture and allodynia to air movement and cold temps). Long story short, pain consultant queried diagnosis. was referred to a neurologist who initially said it was PHN, now they said it's gone beyond that (I also have sensitive ophthalmic nerves to cold for example) but was caused by shingles. I live in heat tech layers all year round but without pregabalin air movement still wound up my pain in public places so I'd be in tears. I with it I hold down a full-time professional job. I'm holding out for EMA401.

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