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Recent reports highlighting serious adverse effects of antipsychotic medication in behavioral and psychological symptoms of dementia (BPSD) has led to calls for research on alternative agents. The authors describe the use of low-dose gabapentin to treat seven patients with a diagnosis of ICD-10 vascular or Mixed Vascular/Alzheimer Dementia with serious aggressive behavior. All seven patients Several case reports describe using gabapentin, an anti-epileptic and FDA-approved treatment for neuropathic pain, as an off-label treatment for BPSD. BPSD in some patients may be driven by unreported neuropathic pain, which gabapentin can treat effectively. We would like to show you a description here but the site won’t allow us. All anticonvulsants for BPSD including valproic acid, gabapentin, pregabalin, carbamazepine, phenytoin, topiramate, levetiracetam, zonisamide, oxcarbazepine, lamotrigine, and phenobarbital. Benzodiazepines excluded Clinically, mood stabilizers including carbamazepine (CBZ), valproate (VPA), gabapentin (GPN), topiramate (TOP), lamotrigine (LTG), oxcarbazepine (OXC) and lithium (Li) were used in treatment for bipolar disorders or epilepsy, and a few studies have shown their efficacy for BPSD. This seems particularly apparent in the case of valproic acid for BPSD, given the trials showing no benefit, and strongly suggested for gabapentin, given evidence for only limited benefits. Both valproic acid and gabapentin are associated with significant increases in the risk of adverse events, indicating that the risk–benefit balance needs Our findings suggest that gabapentin should be considered for treating aggressive behavior in patients with vascular or mixed dementia and that it is well tolerated in this context. B ehavioral and psychological symptoms of dementia (BPSD) are common symptom manifestations in dementia. Conclusions: Gabapentin may be a safe option for the treatment of BPSD in combination with antipsychotic medications. Gabapentin may also be effective as monotherapy in certain patients with BPSD. In the two cases presented, treating BPSD with gabapentin resulted in mixed findings. While the first case shows gabapentin as a potentially efficacious and well-tolerated treatment for BPSD, it is difficult to elucidate the role gabapentin played in the second patient's improved behavioral regulation. Gabapentin has the potential to be particularly helpful if the BPSD symptoms are in the context of neuropathic pain. Evidence for its use is supported by 14 case reports that showed positive Gabapentin and pregabalin could be considered for BPSD when medications having stronger evidence bases (risperidone, other antipsychotics, carbamazepine and citalopram) have been ineffective or present unacceptable risks of adverse outcomes. Several case reports describe using gabapentin, an anti-epileptic and FDA-approved treatment for neuropathic pain, as an off-label treatment for BPSD. BPSD in some patients may be driven by unreported neuropathic pain, which gabapentin can treat effectively. Gabapentin and pregabalin could be considered for BPSD when medications having stronger evidence bases (risperidone, other antipsychotics, carbamazepine and citalopram) have been ineffective or present unacceptable risks of adverse outcomes. In most of the reviewed cases, gabapentin was reported to be a well tolerated and effective treatment for BPSD. However, two case reports in which gabapentin was used in the context of agitation in dementia with Lewy bodies questioned the appropriateness of gabapentin for all types of dementia-related agitation. Gabapentin and pregabalin could be considered for BPSD when medications having stronger evidence bases (risperidone, other antipsychotics, carbamazepine and citalopram) have been ineffective or present unacceptable risks of adverse outcomes. DOI: 10.1111/bcp.13844. View this article. Full article (html) Enhanced article (html) PDF; References No controlled trials of gabapentin, lamotrigine or topiramate in the treatment of BPSD were found in our review of the literature. The summary of our findings for each of the drugs is described below. We have included case reports and case series to complete the review of available data. This report adds to an emerging literature that gabapentin may have a useful role in the pharmacological management of BPSD and that it may be an effective alternative to antipsychotic use in this situation. Data sources: A MEDLINE search (1966-August 2000) was performed to identify case reports and clinical trials discussing the efficacy of gabapentin in the treatment of BPSD. Discussion: Gabapentin, like other anticonvulsants, has been used with success in several psychiatric illnesses. Available literature indicates that the drug may have some Discover the efficacy of gabapentin for treating behavioral and psychological symptoms of dementia (BPSD) in a retrospective chart review. Findings suggest gabapentin as a safe option in combination with antipsychotic medications or as monotherapy for certain BPSD patients. In the two cases presented, treating BPSD with gabapentin resulted in mixed findings. While the first case shows gabapentin as a potentially efficacious and well-tolerated treatment for BPSD, it is difficult to elucidate the role gabapentin played in the second patient's improved behavioral regulation.
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