Hospital Initiation of Gabapentinoids and Long-Term Continuation in Primary Care: A Retrospective Cohort Study

Background and Rationale Gabapentinoids, comprising gabapentin and pregabalin, are widely prescribed for neuropathic pain and other chronic pain presentations (1). Although originally developed as antiepileptic drugs, these medicines are now used for a range of other indications, including off‑label use for anxiety disorders (2). Gabapentinoid prescribing has increased in recent years, and population-level studies have highlighted potentially high‑risk patterns of use, including long-term prescribing and co‑prescribing with other central nervous system depressants, alongside associated harms (3). Because long‑term therapy can begin with treatment initiated for short‑term use, it is important to understand the circumstances that may precipitate ongoing gabapentinoid prescribing, particularly initiation during hospital care and continuation after discharge into primary care (4). Previous research on medication use at hospital discharge revealed that 41% of opioid-naïve patients initiated on opioids in hospital continued these medications in general practice, and 8% remained on treatment for over a year (5). While Irish-specific evidence on post-discharge gabapentinoid continuation is limited, research from other health systems have examined initiation during hospitalisation and subsequent persistence in primary care, reporting non-trivial rates of ongoing use and highlighting safety concerns such as co-prescribing with CNS depressants, higher initial doses, and longer discharge supplies (6, 7, 8, 9, 10). In Ireland, analogous work on other medicine classes shows that the transition from hospital to community can shape long-term therapy: studies of opioids demonstrate notable continuation after discharge (5), and investigations of benzodiazepines (11) and proton-pump inhibitors (12) likewise suggest sustained prescribing beyond the acute episode following hospital discharge. Given the limited Irish evidence on hospital-initiated gabapentinoid prescribing and its continuation in primary care, this study aims to address an important gap in the literature. Findings will support safer prescribing at the hospital–community interface by identifying discharge-prescribing and patient factors associated with long-term continuation, thereby informing targeted medication review, deprescribing initiatives where appropriate, and quality-improvement efforts to improve transitions of care (e.g., discharge communication and follow-up planning).