Gabapentinoid Treatment AgreementGabapentinoid Treatment Agreement • September 4th, 2019
Patient Name: GP Name: Condition(s) being managed with gabapentinoids: Gabapentinoid medication being trialled: Directions: Next review due: Patient declaration:In signing this agreement, the patient agrees to the following conditions: 1. My GP is responsible for prescribing a safe and effective dose of gabapentinoid medication.2. I will follow the directions given to me by my GP; I will not change my dose without my GP’s agreement.3. I will not use any gabapentinoids which my GP has not prescribed.4. I will only obtain my gabapentinoid medication from my regular GP.5. I understand that no early prescriptions will be provided.6. I agree to attend reviews with my GP.7. I understand that if my pain is not reduced within 4-8 weeks, or my side effects are unacceptable, my trial will be unsuccessful, and my gabapentinoid treatment will be gradually reduced and stopped.8. I understand if my pain is reduced by at least 30-50% within 8 weeks and I tolerate the gabapentinoids well, my tr
