What the new findings about gabapentin could mean for your practice in 2026
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This is something that certainly needs further exploration, discussion, and, most importantly, ongoing research and clinical trials.
—Mariya Kotova, PharmD
Research published in 2025 has sparked debate about the safety of gabapentin, but experts say the risks can be balanced with good prescribing practice.
The nerve drug was found to be associated with an increased risk of dementia and mild cognitive impairment, but experts say the reality is more nuanced. []
“The key word is association. This study does not establish causality. The relative risks sound big; however, absolute risks are still low in midlife. Absolute risks were on the order of about 1 additional dementia diagnosis per 100 patients over 10 years in some subgroups. Importantly, the study could not account for dose, duration, pain severity, functional impairment, or healthcare utilization, all of which strongly confound dementia risk,” Sean Mackey, MD, PhD, chief of the division of Stanford Pain Medicine, tells MDLinx.
Dr. Mackey continues: “It raises a signal worth studying further, but it should not be interpreted as proof that gabapentin causes dementia. It should not be used to scare people or set policy … For absolute, catastrophic harm to an appropriately selected, monitored pain patient, the risk is small. I would not put gabapentin in the same risk neighborhood as high-dose opioids, benzos, or Z-drugs."
Prescribing recommendations
Gabapentin is an increasingly popular treatment option for chronic pain, particularly neuropathic pain. [] Unlike opioids, gabapentin has a relatively low risk for addictive potential.
A study published last year examined the use of gabapentin for treating chronic low back pain. [] The researchers found that six or more gabapentin prescriptions for lower back pain were associated with a 29% increased risk of dementia and an 85% increased risk of mild cognitive impairment.
Non-elderly adults aged 18–64 who were prescribed gabapentin were found to have over twice the risk of dementia and mild cognitive impairment compared to those who were not prescribed gabapentin.
A cautious, individualized approach is best
Although experts argue that the research establishes only an association between gabapentin and dementia or mild cognitive impairment, pharmacists recommend that physicians take a careful approach when prescribing the drug.
“Clinicians should take a cautious, individualized approach, using the lowest effective dose, titrating slowly, and reassessing cognitive function regularly. [Prescribing] gabapentin should be avoided or minimized in patients with existing cognitive impairment or high fall risk, and alternative agents or nonpharmacologic therapies should be considered when appropriate,” Katie Henn, PharmD a clinical pharmacist at the University of Kansas Medical Center’s Parkinson’s Disease and Movement Disorders Clinic, tells MDLinx.
“For conditions with no therapeutic alternatives, prescribers should use the lowest effective dose and discontinue therapy if ineffective. In older adults, extra caution is warranted. Sedation, dizziness, and impaired coordination increase the risk of falls and fractures, which can have significant downstream consequences. Gabapentin is also renally eliminated, so doses must be reduced in patients with impaired kidney function to prevent drug accumulation and toxicity,” Dr. Henn adds.
Between 2010 and 2024, gabapentin prescriptions in the US more than doubled. The number of individuals dispensed gabapentin also more than doubled. []
Experts say more research is needed to confirm the risks associated with the drug.
“There's a lot of emerging evidence from the 2022–2023 period, and I think given the current literature and kind of heterogeneity of this literature, so to speak, this is something that certainly needs further exploration, discussion, and, most importantly, ongoing research and clinical trials,” Mariya Kotova, PharmD, a pain management and palliative care pharmacist at UC Davis Health, tells MDLinx.
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