I can’t think of a good reason to use gabapentin and pregabalin together, but I have seen it a few times. Here’s the med list and what I would look at.
- Dulaglutide 0.5 mls once weekly
- Gabapentin 100 mg TID
- Omeprazole 20 mg BID
- Trazodone 100 mg HS
- Ibuprofen 800 mg TID
- Aspirin 81 mg once daily
- Plavix 75 mg daily
- Pregabalin 75 mg TID
- Metformin 850 mg BID
- Asking more questions about the gabapentin and pregabalin together would be my first step in this scenario. I certainly have seen cases where we are tapering off of one and onto the other due to ineffectiveness. I try to give the provider the benefit of the doubt in situations like this when I don’t know for sure, but definitely have to ask the patient and/or provider if there is a gameplan to transition to one or the other.
- The next item that would raise some concern would be to investigate the ibuprofen use as well as aspirin and Plavix. There is certainly an increased risk in GI bleeding when a patient is on more medications that can inhibit platelet effects. That’s a pretty substantial dose of ibuprofen as well. CBC monitoring would be very important as well as patient symptoms (bruising/bleeding).
- This patient is on a few meds that can cause GI side effects. Dulaglutide, metformin, as well as the above mentioned ibuprofen could all certainly impact GI status and may be contributing to the need for BID PPI. Further questioning on this would be very important to me.
What else would you look at with this medication list?
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