Gabapentinoid deprescribing in Sunderland
Anna Creber is a Senior Clinical Pharmacist in the Sunderland North Primary Care Network. She incorporated the patient checklist questions from our toolkit into her Structured Medication Review (SMR) invitation letters.
Anna’s Structured Medication Review (SMR) invitation letters were sent out to patients before conducting a SMR over the phone. The invitations were targeted at patients who the GP practice thought would benefit from a SMR, including those taking gabapentinoids.Where patients feel that their medicines aren’t working, Anna thinks that the deprescribing questions in our toolkit prompt patients to book a review. This was the case for one of her patients, a woman who wasn’t sure if her analgesic or antidepressant medications were working for her.
“The patient wasn’t sure if her medicines were or weren’t working, and she just wanted to have a discussion around it.”
Anna Creber, Senior Clinical Pharmacist
The patient was started on her pregabalin prescription four years ago for pins and needles, which she felt hadn’t got any better since starting the treatment. She was also prescribed mirtazapine which she had been taking for five years but felt that her mood was stable. The patient hadn’t previously booked an appointment to discuss her concerns with the practice.
The patient was also concerned that these medicines may have been the cause of her gradual weight gain. Through questioning, Anna also found that the patient was experiencing drowsiness, likely another side effect of her medicines.
“We did a structured medication review, but the patients’ priorities are most important, so we concentrated on those two medicines.”
Anna Creber, Senior Clinical Pharmacist
The patient was slightly nervous about stopping these medicines, but Anna reassured her that if the medicines weren’t working, and she was managing her pain in other ways, stopping the medicines was unlikely to make her feel any different. The reductions were framed as an experiment, with each dose reduction an opportunity for the patient to find out if her medicines were working. The patient was encouraged to contact Anna at any point if there were any problems, in addition to providing follow-up appointments.
The pregabalin was stopped over the course of one month, and the antidepressant over three months. Both medicines were stopped with no problems and the patient experienced no changes to her pain or mood. Anna also referred the patient to a social prescriber to access non-pharmacological management of her symptoms, including a weight reduction programme.
“The patient isn’t pain free, but because the pregabalin wasn’t having any impact, she’s not in a worse position. I think the patient was really pleased that someone was able to get her off the medicines.”
Anna Creber, Senior Clinical Pharmacist
As a result of Anna’s work with the patient, she thinks that they have achieved a positive outcome together. The patient is no longer experiencing side effects and has learned to manage her pain symptoms more holistically, rather than take medicines which aren’t working for her.
Anna and the other PCN Pharmacists in Sunderland North will continue to use the deprescribing toolkit to support their medication reviews. She thinks that using the toolkit encourages the clinical pharmacists to ask patients if their medicines are working and helps medication reviews to be patient centred.
“A lot of the time patients take medicines because the GP has prescribed them, sometimes these medicines don’t work. And if we don’t ask those questions, we might not get the answers from patients to properly review medicines.”
Anna Creber, Senior Clinical Pharmacist