What to consider before writing a new gabapentin script, according to the latest research
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It is not well supported for nonspecific mechanical low back pain. It should not be used as a default ‘safe alternative’ to opioids.
—Sean Mackey, MD, PhD
Prescribing gabapentin may be appropriate when first‑line therapies are ineffective or not tolerated—or when alternative options are limited by cost or access—provided risks and benefits are carefully weighed and patients are monitored appropriately.
—Katie Henn, PharmD
Gabapentin prescriptions have more than doubled since 2010. [] Given its association with an increased risk of dementia, here's a quick refresher on what the drug should actually be prescribed to treat—and where it is more likely to do more harm than good.
Gabapentin prescriptions on the rise
“Gabapentin is FDA‑approved for the treatment of postherpetic neuralgia and as adjunctive therapy for partial seizures. In clinical practice, it is also commonly used off‑label for several conditions, including neuropathic pain (eg, diabetic peripheral neuropathy), fibromyalgia, certain anxiety or mood disorders, and alcohol use disorder,” Katie Henn, PharmD, a clinical pharmacist at the University of Kansas Medical Center’s Parkinson’s Disease and Movement Disorders Clinic, tells MDLinx.
“Additionally, gabapentin enacarbil, a prodrug formulation, is FDA‑approved for the treatment of restless leg syndrome, whereas immediate‑release gabapentin is frequently used off‑label for this indication. Prescribing gabapentin may be appropriate when first‑line therapies are ineffective or not tolerated—or when alternative options are limited by cost or access—provided risks and benefits are carefully weighed and patients are monitored appropriately,” Dr. Henn adds.
CDC research found thatgabapentin prescriptions in the US increased from 24,186,175 in 2010 to 58,868,142 in 2024. []
The number of patients receiving gabapentin also increased from 5,764,112 in 2010 to 15,541,680 in 2024. The largest increase occurred between 2010 and 2016. Gabapentin dispensing rates were highest among females and adults aged 65 and older. The majority of gabapentin was prescribed by primary care clinicians.
Experts say it is important for physicians to monitor side effects in patients prescribed the drug.
Gabapentin and health risks, explained
“Gabapentin is classified as a central nervous system (CNS) depressant, meaning it slows brain activity and can impair alertness, coordination, and breathing. Common side effects include dizziness, drowsiness, fatigue, and ataxia, which can affect balance and reaction time,” Dr. Henn says.
“In rare but serious cases, gabapentin has been associated with respiratory depression. The risk is highest when gabapentin is combined with other CNS depressants, such as opioids and benzodiazepines, and in patients with underlying respiratory disease or advanced age,” Dr. Henn adds.
“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 continues.
Last year, gabapentin came under scrutiny after research found that it is associated with an increased risk of dementia. []
But experts say that prescribing the drug may still be appropriate in some cases.
“It is most appropriate when treating clearly neuropathic pain, where evidence of benefit exists. It is not well supported for nonspecific mechanical low back pain. It should not be used as a default ‘safe alternative’ to opioids,” Sean Mackey, MD, PhD, chief of the division of Stanford Pain Medicine, tells MDLinx.
“Gabapentin has helped many patients, particularly those with neuropathic pain. The current dementia data should prompt clinical vigilance, not alarm. History teaches us that many early safety signals from administrative databases fade with better-controlled studies, while others, like high-dose Vioxx, ultimately prove real. Right now, gabapentin belongs firmly in the category of ‘Use thoughtfully, monitor closely, and keep studying,’” Dr. Mackey adds.