Improving Information Supplied with Gabapentinoids (Pregabalin/Gabapentin), Benzodiazepines and Z-Drugs

- gabapentinoids (pregabalin and gabapentin), benzodiazepines and z-drugs are three

classes of medicines used to treat a variety of conditions such as neuropathic pain,

anxiety and insomnia. Specialist use of these medications for conditions such as epilepsy, or sedation during medical procedures are not included in this review

- all three classes of medications are known to pose risks of addiction, dependency, withdrawal and tolerance

- the Summary of Product Characteristics, Patient Information Leaflets and Outer Packaging of these medicines will have strengthened warnings to better communicate

the risks of addiction, dependency, withdrawal and tolerance to healthcare professionals and patients. Updates are in progress and will be rolled out over the coming months

- prior to starting treatment with these medicines, a discussion should be held with patients to put in place a strategy for reducing or ending treatment. By doing this the risk of addiction, dependence, and drug withdrawal syndrome is reduced. NICE

guideline, NG215, has resources that include visual summaries which are available to support these discussions. The Agency has also developed additional patient resources for , and which highlight key messages concerning these risks and should

be made available to patients when these medications are prescribed

- addiction and dependence are related but have distinct presentations. Healthcare

professionals are reminded of the importance of using non-judgmental language

when discussing these terms

- patients may find that treatment is less effective with chronic use and express a need to increase the dose to obtain the same level of symptom control as initially experienced. This could be a sign that the patient is developing tolerance. The risks of developing tolerance should be explained to the patient

- drug withdrawal syndrome may occur upon abrupt cessation of therapy or dose reduction. When a patient no longer requires therapy, it is advisable to taper the dose gradually to reduce symptoms of withdrawal. Tapering from a high dose may take weeks or months. Patients should be informed of this when the medication is first prescribed and should be encouraged to speak to their healthcare professional or prescriber before stopping their medicine. See NICE guideline NG 215 for identifying and managing withdrawal symptoms

- provide regular support especially to individuals at increased risk of drug withdrawal syndrome, such as those with current or past history of substance use disorder (including alcohol misuse) or mental health disorder

- addiction, dependence, withdrawal or tolerance in response to these medications can be reported via the Yellow Card scheme

- as these medicines carry risks of addiction, dependence and withdrawal reactions,

before starting treatment with these medicines, your healthcare professional should explain how long you might need to take them for, and how to stop safely. This helps