Gabapentin is the seventh most prescribed medication in the U.S. with 69 million prescriptions in 2019. Gabapentin is an anticonvulsant medication that is often prescribed as an alternative to opioids or when opioid doses are being reduced. It is also a drug that is addictive and often abused.
The only pain condition the FDA has approved gabapentin for is the treatment of postherpetic neuralgia (post-shingles pain). However, it is frequently prescribed for all kinds of pain, including sciatica, back pain, burn injury and arthritis, despite the lack of evidence that it is effective for those conditions.
Gabapentin’s Criminal Past
Gabapentin (brand name Neurontin) was initially approved in 1993 solely for use with other drugs to control seizures in people with epilepsy. In 2004, Neurontin’s manufacturer, Warner-Lambert, pled guilty to illegal and fraudulent promotion of unapproved uses for the drug, agreeing to pay more than $430 million in fines. This was because Neurontin was aggressively promoted for many conditions for which its effectiveness was not proven, including nerve pain, fibromyalgia, and migraine headaches. This fine, a small fraction of Warner-Lambert’s profits from the drug, did little to deter the company from continuing similar activities with Neurontin and other drugs. Warner-Lambert was acquired in 2000 by Pfizer, a company that was fined $2.3 billion for illegal off-label promotion of their products in 2009.
Gabapentinoid Prescriptions have tripled despite lack of safety and effectiveness
Ever since opioids have fallen out of favor due their risks of addiction and overdose, prescriptions for gabapentinoids for pain management have skyrocketed, more than tripling between 2002 and 2015. But gabapentinoids have their own risks of addiction and overdose. Especially troubling has been an increase in use among patients who also take opioids and/or benzodiazepines as all three suppress breathing, increasing the risk of accidental overdose.
A recent study found that gabapentin is even more risky than experts previously believed. A study published in the CDC’s Morbidity and Mortality Weekly Report in May 2022 found that gabapentin was present in the systems of almost 10% of individuals who died of overdose between 2019 and 2020.
According to the study, when gabapentin is “used with other central nervous system depressants such as opioids, there is risk for respiratory depression, potentially resulting in death.”
Gabapentin side effects
- A study of almost 192,000 participants who received at least two consecutive prescriptions for a gabapentinoid found that 8.9% experienced an unintentional overdose. The same study found that 5.2% of participants were treated for suicidal behavior or died from suicide. Increased suicidal behavior was found in patients age 55 or younger, with the highest rates in patients aged 15-24.
- A study published in the British Medical Journal (BMJ) in June 2019 found that “gabapentinoids are associated with an increased risk of suicidal behaviour, unintentional overdoses, head/body injuries, and road traffic incidents and offences.” Another serious concern is that gabapentinoids may block new synapse formation in the brain. This may be the reason for the frequent reports of impaired cognitive functioning by patients taking these drugs.
- Other commonly reported side effects include dizziness, sleepiness, balance problems, blurred vision, coordination problems, nausea, vomiting, diarrhea, headaches, increased pain (including pain in extremities, back pain and joint pain), brain fog, depression, anxiety and insomnia. Some patients may experience weight gain.
Lyrica (pregabalin), another drug that is in the same class of drugs known as gabapentinoids, is associated with similar problems.
There are safer, more effective alternatives to gabapentinoids but if you are currently taking these drugs, do not stop abruptly! It can be life-threatening. Taper slowly under a doctor’s supervision. Experts recommend no more than a 10% reduction per month.
Here are alternative treatments worth trying for pain relief:
Some products that can help with neuropathic pain:
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