Paper Title
PREGABALIN PRESCRIPTIONS IN TAIWAN: UTILIZATION PATTERNS AND ADVERSE REACTIONS IN CKD PATIENTS

Abstract
Background: Pregabalin, a medication commonly prescribed for neuropathic pain, fibromyalgia, and epilepsy, has seen widespread use in Taiwan over the years. Given that Pregabalin is primarily excreted unchanged by the kidneys, its renal clearance-dependent metabolism poses significant risks for chronic kidney disease (CKD) patients. This study investigates Pregabalin prescription trends across different CKD stages in Taiwan, focusing on dosing patterns, duration, and the incidence of adverse drug reactions (ADRs). Methods: Data were analyzed from 2018 to 2021 using the Taiwan National Health Insurance Research Database (NHIRD). CKD stages (from stage 1 to end-stage renal disease, ESRD) were determined based on eGFR values. Parameters included initial dose, average prescription duration, and rates of emergency visits and hospitalizations due to ADRs such as encephalopathy, falls, fractures, and respiratory depression. Statistical methods included descriptive analysis and regression models to identify predictors of ADRs. Results: From 2018 to 2021, Pregabalin usage for conditions like Herpes zoster increased by 30.62%, while musculoskeletal disease prescriptions rose by 23.44%. The data show a consistent trend of lower initial doses and longer prescription durations with advancing CKD stages. For example, initial doses decreased from 111.05 mg in stage 1 to 88.81 mg in ESRD, while average prescription durations rose from 63.79 days to 107.81 days. ADRs, particularly respiratory depression (1.57% in stage 3, rising to 4.93% in stage 5), and hospitalizations for fractures and encephalopathy were notably higher in advanced CKD stages. Conclusion: This study highlights the complexities of Pregabalin use in CKD patients in Taiwan. Adjusted dosages, while routine, fail to eliminate the heightened risk of ADRs. Enhanced pharmacovigilance, personalized dosing regimens, and alternative therapeutic strategies are essential to reduce these risks and ensure safe pain management in this vulnerable population. Keywords - Pregabalin, National Health Insurance Research Database (NHIRD), Chronic Kidney Disease (CKD), Adverse Drug Reactions (ADRs)