Thread by @Drug_Evidence

THREAD: Bring it down safely! ↘️💊

1/6 6⃣tweets about our new TI Therapeutics Letter 134: Finding the lowest effective dose for non-opioid #analgesics

👉🏾 Full Letter: ti.ubc.ca/letter134

#MedEd #medsafety #prescribing #BetterPrescribing

2/6 Consistent evidence that minority of pts get clinically meaningful pain relief from any dose of:
✅#Cyclobenzaprine (at best 1/4)
✅#Duloxetine (at best 1/6)
✅#Gabapentin / #Pregabalin (at best 1/6)

👉🏾ti.ubc.ca/letter134

#MedEd #ptsafety #BetterPrescribing #prescribing

3/6 Gabapentin, pregabalin, duloxetine:

A 2021 Canadian systematic review found NNT (numbers needed to treat) of 6-7 for "clinically meaningful benefit" (defined as ≥30% reduction in pain or pain & function)

👉🏾ti.ubc.ca/letter134

#MedEd #BetterPrescribing #deprescribing

4/6 Watch the Ceiling!👀

For duloxetine, #gabapentin, pregabalin:

@CochraneLibrary systematic reviews on treating chronic neuropathic pain or #fibromyalgia show exceeding “evidence-informed ceiling doses” doesn't↘️ mean pain scores

👉🏾ti.ubc.ca/letter134

#MedEd #ptsafety

5/6 Dose matters:

Cyclobenzaprine & duloxetine frequently cause anticholinergic effects including dry mouth, accelerated tooth decay, difficulty swallowing due to reduced salivation; delayed stomach emptying & constipation due to ↘️ gut motility

👉🏾ti.ubc.ca/letter134

6/6 Therapeutics Letter 134: Finding the lowest effective dose for non-opioid analgesics

See table below on evidence-informed dosing

👉🏾ti.ubc.ca/letter134

#MedEd #ptsafety #BetterPrescribing #prescribing

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