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Gabapentin and pregabalin both exert high affinity to the α2δ subunit of the voltage-gated calcium channels which inhibits excitatory neurotransmitter release. The synergistic mechanism was described in rats given combinations of gabapentin and pregabalin. In this case series, we described 2 cases which may illustrate the synergistic effect of gabapentin and pregabalin in treatment resistant neuropathic pain. Low dose pregabalin was added to therapeutic gabapentin to achieve appreciable pain reduction in one case and improved quality of life in another case. Further research with more enrollment and longer study duration may help elucidate the appropriate dosing and potential associated side effects. [ABSTRACT FROM AUTHOR]

Introduction: The national opioid epidemic has garnered the attention of various health agencies. A leading strategy in mitigating risk from the opioid public health crisis, including opioid use disorder (OUD), is via increased promotion and access to the lifesaving opioid antagonist, naloxone. Pharmacists have been recognized as integral in addressing this emergency; however, literature evaluating outcomes from multifaceted clinical pharmacy specialist (CPS) interventions and involvement is lacking. The purpose of this quality improvement initiative was to evaluate the impact of a CPS initiative to increase naloxone prescribing proportions (number of patients with OUD with an active prescription for naloxone within the past year divided by the number of patients with OUD), patient access to care, and clinical interventions. Methods: Pain management CPSs, mental health CPSs, and clinical pharmacy leadership within a Veterans Health System spearheaded a variety of interventions to increase naloxone prescribing in patients with OUD including focused education with prescribers, naloxone informational letters, review of population management tools identifying patients with OUD indicated to receive naloxone, CPS naloxone prescribing, and automated naloxone drug orders integrated into electronic health record progress note templates. The preintervention and postintervention evaluation periods were three‐month time frames. Naloxone prescribing proportions were compared before and after implementation of these interventions. Additional outcomes evaluated were number of encounters, number of patients seen/reviewed, and number of clinical interventions completed by the CPSs. Results: There was a significant increase observed in naloxone prescribing proportions from 34.1% to 57.5% postintervention (P <.01). The total number of encounters, patients, and clinical interventions had an absolute increase of 58.0%, 88.4%, and 49.9%, respectively, postintervention. Conclusion: The observed improvement in naloxone prescribing proportions suggests the value of CPS involvement in initiatives for increasing naloxone prescribing to optimize patient safety and justify clinical pharmacy services. [ABSTRACT FROM AUTHOR]