July 27, 2018
Gabapentin abuse

Applicable to: Mercy Care Complete Care, Mercy Care Long Term Care, Mercy Care RBHA, Division of Developmental Disabilities
CNS depressants are often misused or abused in conjunction with opioid analgesics. They are purported to enhance the euphoric effects of the opioids. Gabapentin is among this group of medications. It is unclear whether these reinforcing euphoric effects are additive or synergistic when done in combination. Gabapentin is not classified as a controlled substance by the Drug Enforcement Administration (DEA); however, certain states have included this drug in their list of controlled substances. Gabapentinoids are CNS depressants and increase the risk for respiratory depression, coma, and death when combined with opioids ( 1, 2 ).

The number of emergency room visits involving nonmedical use of gabapentin increased by 90% in the U.S. since 2008 according to the Drug Abuse Warning Network (DAWN). Gabapentin has the potential for suicidal thoughts and behaviors. Unlike opioids, there is no antidote in the case of an overdose.   Dependency can develop with gabapentin and abrupt discontinuation can increase the likelihood of seizures. 

As such Mercy Care has implemented a 3,600 mg per day limit on gabapentin effective August 1, 2018.  The 3,600 mg limit is calculated based on all current gabapentin products in the member’s claim history, i.e., a cumulative dose limit calculation. The usual effective dose of gabapentin is 1800mg/day. Doses of 3600mg/day have been administered to a small number of patients for a relatively short duration and have been well tolerated according to package labeling. Prior authorization is required for dose to exceed this limitation.

1.           Schifano F, Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern? CNS Drugs. 2014;28(6):491-496
2.           Smith RV, Havens JR, and Walsh SL. Gabapentin Misuse, Abuse and Diversion: a Systematic Review. Addition. 2016 Jul; 111(7)1160-1174. https://www.ncbi.nlm.nih.gov/pubmed/27265421. (Accessed on 3/29/18).

As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy
Care website.

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