Gabapentin—Hazard or Helpful?

September 14, 2024

By Hedva Barenholtz Levy, PharmD, BCPS, BCGP

Medication topics in the news are always of interest to me. This month, gabapentin wins the prize. Gabapentin was featured in a New York Times article on August 17, 2024 (“The Pain Killer Used for Just about Anything” by Paula Span), and on September 10th in a segment of “Here and Now,” a radio show on National Public Radio (“Gabapentin is FDA-approved for 2 conditions. Why is it prescribed for more than a dozen others?”).

Both news stories interviewed geriatrician Michael Steinman MD (geriatrician at the University of California, San Francisco, and a co-director of the US Deprescribing Research Network). The radio interview runs about 8 minutes; it is linked here. And here’s a link to the NYT article (access might be restricted). Both are worth accessing to learn more about the concerns regarding the widespread and likely overuse of gabapentin. For many patients, gabapentin is an effective drug. But for those who get started on the medicine and are still taking it years later without having a clear reason for taking it, it’s time to take a closer look.

Why Focus on Gabapentin

Gabapentin is one of the top drugs dispensed in the US. In 2022, it was ranked #10 (ClinCalc.com). Looking at just Medicare beneficiaries for that same year, over 7 million beneficiaries were prescribed gabapentin with a cost to Medicare of over $715 million (CMS.gov). With nationwide efforts to reduce use of opioid pain medicines, doctors have turned to gabapentin to treat pain, with mixed outcomes. ?

Here are some key points about gabapentin highlighted in the recent media coverage:

·?????? It is approved by the Food and Drug Administration (FDA) to treat seizures and nerve pain associated with an episode of Shingles.

·?????? It is used “off-label” for many other reasons, such as post-menopausal symptoms, fibromyalgia, itching, restless leg syndrome, low back pain, and other types of nerve pain.

·?????? It may or may not be clinically effective—everyone is different—and gabapentin is associated with important side effects like drowsiness, dizziness, and fall risk.

·?????? It can have dangerous interactions with opioid pain medicines and benzodiazepines (medicines used to treat anxiety or sleep).

·?????? Once gabapentin is prescribed, it often is continued long-term, whether or not it is effective.

Here are some of my concerns with gabapentin overuse:

·?????? Older adults are at increased risk of experiencing adverse drug events. Drowsiness, fatigue, and increased fall risk are particular concerns with gabapentin.

·?????? It can cause side effects that go unrecognized, which can impact quality of life and lead to new symptoms that are treated with yet more medication(s). An emerging adverse effect is leg swelling for which a water pill (diuretic) is added.

·?????? Gabapentin that is continued despite evidence of benefit leads to medication overload, inappropriate polypharmacy, and increased healthcare costs.?

When I work with older adults who take gabapentin, most always it is for “nerve pain.” I always ask “Do you think it is helping your symptoms?” Often the answer is no, yet the person has continued taking it for years, increasing the chance of side effects, interactions, and long-term consequences associated with inappropriate polypharmacy that I discuss in Maybe It’s Your Medications.?

In the radio interview, Dr. Steinman makes the important point that often we cannot know if a drug is helping or hurting until we stop taking it. Unnecessary medications should be avoided, of course, but the challenge sometimes is to know which ones are no longer needed or no longer of benefit. Thus, it is so important to have regular conversations with your doctors about your medications.

If you or a loved one is taking gabapentin, talk with your doctor to re-assess its effectiveness and identify any possible side effects. Do not stop taking gabapentin on your own. If you agree to stop it, develop a plan with your doctor for how to safely decrease the dose over time.

I hope this month’s information is helpful. Additional tips for talking about your medications and how to avoid unnecessary drug therapy are found in “Maybe It’s Your Medications” wherever books are sold.

This material is intended to encourage discussion with your health care provider.? It is informational only and does not replace the guidance of your health care team.

?

?

?