Prescribing Patterns and Off-Label Use of Gabapentinoid Agents at Dhulikhel Hospital, Nepal: A Cross-Sectional Study

Sumana Adhikari,1 Durga Bista,1 Rohit Shrestha,2 David Woods3 1Department of Pharmacy, Kathmandu University, Dhulikhel, Bagmati State, Nepal; 2Orthopedics and Traumatology Department, Dhulikhel Hospital, Dhulikhel, Bagmati State, Nepal; 3Faculty of Medicine, Vilnius University, Vilnius, LithuaniaCorrespondence: Durga Bista, Department of Pharmacy, Kathmandu University, P.O. Box 6250, Dhulikhel, Bagmati State, Nepal, Email [email protected]: Gabapentinoids are mainly prescribed for neuropathic pain and certain seizure disorders, but their off-label use has increased significantly. This rise raises concerns about the insufficient evidence supporting some applications, as well as potential risks of misuse, dependence, and adverse effects. The study aims to examine the prescribing patterns and off-label use of gabapentinoids at Dhulikhel Hospital (DH), Nepal, focusing on understanding the extent of off-label practices and patient knowledge regarding their medications.Patients and Methods: A cross-sectional survey of 385 adult patients prescribed gabapentinoids was conducted at the outpatient pharmacy of DH. Data were collected via patient interviews and prescriptions. Off-label use was assessed according to the licensed indications of the US Food and Drug Administration (FDA) and the UK British National Formulary (BNF). Statistical analysis was performed using Statistical Package for the Social Sciences version 26.Results: Among patients prescribed gabapentinoids, 73.0% received gabapentin while 27.0% were prescribed pregabalin. Most patients were middle-aged females with comorbid conditions, primarily orthopedic outpatients. Off-label use was prevalent, with 96.1% of prescriptions being off-label by FDA indications and 28.1% by BNF indications. Pregabalin was prescribed at a sub-therapeutic dose (75 mg/day) for neuropathic pain. Patient knowledge about gabapentinoids was found to be poor, particularly regarding side effects and drug interactions.Conclusion: This study highlights the extensive off-label and sub-therapeutic use of gabapentinoids at Dhulikhel Hospital and reveals significant gaps in patient knowledge. This emphasizes the need for stricter prescribing guidelines, improved healthcare provider education, and better patient information to optimize the use and minimize risks. The frequent prescription of low-dose pregabalin for neuropathic pain raises the possibility that it may be used for night-time sedation rather than for pain management, indicating the need for further investigation.Keywords: off-label use, gabapentin, pregabalin, Nepal, prescribing patterns, patient education