The Medicines and Healthcare Products Regulatory Agency (MHRA)  has issued an update for prescribing of gabapentinoids (pregabalin/gabapentin), benzodiazepines and z-drugs.

This is based on a review that concluded that existing product information and packaging did not sufficiently communicate the risks of addiction, dependence, withdrawal and tolerance associated with these drugs.

Updates will be rolled out in the following months to the warnings on: summary of product characteristics; patient information leaflets; and outer packaging.

Actions for prescribers

• Discuss treatment duration and stopping strategies with patients before initiation, using non-judgemental language. This will reduce the risk of addiction, dependence and drug withdrawal syndrome.
• Provide advice to patients on the risk of addiction, dependence, tolerance or withdrawal.
• Monitor for signs of tolerance or misuse, and taper doses gradually when stopping.
• Provide regular support 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.

Additional resources 

Available to support safer prescribing and reduce risks of addiction, dependence and withdrawal.

• NICE guidance, NG215.
• Visual summary.
• MHRA safety leaflet for benzodiazepines
• MHRA safety leaflet for gabapentinoids
• MHRA safety leaflet for z-drugs
• patient decision aid on stopping benzodiazepine or z-drug treatment

Refer to the MHRA update for full details and supporting information.

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

For local addiction services, see the directory of services on the topic page.