Gabapentinoids are frequently prescribed for pain management, including in the post-stroke period. However, older adults are particularly vulnerable to serious adverse effects, especially at higher doses or in combination with opioids.

We analyzed claims data from a 20% sample of U.S. Medicare beneficiaries aged ≥ 65 years hospitalized for AIS between 2009 and 2022. We included individuals enrolled in traditional Medicare for ≥ 12 months before hospitalization, without prior stroke during this interval, and discharged home or to an inpatient destination for ≤30 days. After excluding those with prior gabapentinoid use, we analyzed outpatient prescriptions six months after stroke discharge by demographic and clinical characteristics. Outcomes included time to initiation, median total daily dose, median day supply, and opioid prescription.

Among 153,728 Medicare stroke survivors who had not been previously prescribed a gabapentinoid, 7,595 (4.9%) received a new prescription within 6 months of hospitalization. Patients most frequently received a first gabapentinoid prescription within 30 days (2,651; 34.9%) or between 120 and 180 days (1,729; 23%) of discharge. Among 16,809 prescription claims, gabapentin was more commonly prescribed (15,143; 90%) compared to pregabalin (1,666; 10%). Median total daily dose of gabapentin was 300mg/day, with a median day supply of 30 days. 39.5% (2,788) of gabapentinoid initiators and 21.1% (30,651) of gabapentin non-initiators had an opioid prescription within 6 months post-AIS, indicating potential concomitant opioid use (SMD = 0.312).

Among older Medicare beneficiaries, gabapentinoid initiation was most common in the first month following AIS discharge. Almost 40% of gabapentinoid initiators had at least one opioid prescription within 6 months post-AIS, concerning for concomitant use.