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Several of the hot topics in geriatrics are pain management, medication reduction/deprescribing, and use of off-label medications. Best-practice use of gabapentinoids — gabapentin (Neurontin) and pregabalin (Lyrica) — comfortably fits into all three categories. Methods: National Ambulatory Care Medical Survey data (2011-2016) were used to identify encounters involving gabapentin (gabapentin visits) for adults (ages ≥18) (N=5,732). FDA-approved uses and off-label psychiatric use indications were identified with ICD-9-CM and ICD-10-CM diagnosis codes. CNS-D drugs examined were opioids, benzodiazepines gabapentinoids off-label for pain should be aware of the limited evidence and should acknowledge to patients that the potential benefits are uncertain for most off-label uses.” The only pain-related indication that is approved by the U.S. Food and Drug Administration (FDA) for gabapentin is for postherpetic neuralgia. For pre- This study examined off-label use of gabapentin for psychiatric indications and its concomitant use with CNS-D prescription drugs in a nationally representative sample of ambulatory care office visits. Less than 1% of outpatient gabapentin use was for FDA-approved indications. Gabapentin’s off-label uses—meaning prescribing gabapentin for a problem not on the FDA approval list for this medication—that physicians are finding include: Alcohol withdrawal; Anxiety; Cocaine withdrawal; Fibromyalgia; Headaches; Hiccups; Hot flashes; Hyperhidrosis; Insomnia; Migraines; Mood disorders; Pain syndromes; Peripheral Gabapentin is widely used in the United States for a number of off-label indications, often as an alternative to opioid therapy. Increasing evidence has emerged suggesting that gabapentin may not be as benign as once thought and may be associated with substance abuse in concert with opioids. The authors concluded that gabapentin is associated with reduction in acute pain associated with postherpetic neuralgia and peripheral diabetic neuropathy (the later indication is not approved by the FDA), and that there is limited evidence to support the use of gabapentin for other types of neuropathic pain and pain disorders. 1 This Editorial Observations: This report summarizes the limited published evidence to support off-label gabapentinoid uses, describes clinical cases in which off-label use is problematic, and notes how review articles and guidelines tend to overstate gabapentinoid effectiveness. Vedula SS, Bero L, Scherer RW, et al. Outcome reporting in industry-sponsored trials of gabapentin for off-label use. N Engl J Med. 2009;361(20):1963-1971. Goodman CW, Brett AS. A clinical Like gabapentin, it is sometimes used with opiates, with toxic or even lethal results. Similarly, when in combination with alcohol or nervous system depressants, there is the possibility of greater toxicity. Choosing gabapentin and pregabalin: These drugs are widely used off-label as an alternative to benzodiazepines for anxiety disorders. We examined reporting practices for trials of gabapentin funded by Pfizer and Warner-Lambert's subsidiary, Parke-Davis (hereafter referred to as Pfizer and Parke-Davis) for off-label indications Off-label gabapentin (Neurontin) got a bad rep when it missed the mark in bipolar disorder, but there may be something worth salvaging in this drug. Here, we weigh its pros and cons for anxiety, substance use disorders, sleep, pain, and hot flashes, and compare it to its underutilized cousin, pregabalin (Lyrica). There is minimal or no evidence for the use of gabapentin as an off-label therapy for other types of neuropathic pain, low-back pain, radiculopathy, or fibromyalgia. In addition to being used to treat pain, gabapentin is used off label to treat anxiety, alcohol use disorder (AUD), alcohol withdrawal, depression, substance use disorders (SUDs), sleep problems, and more. SUMMARY: Gabapentin is approved by the U.S. Food and Drug Administration (FDA) for adjunctive therapy in treatment of partial seizures and postherpetic neuralgia. Various off-label (unapproved) uses have been reported, and the use of gabapentin for off-label purposes has reportedly exceeded use for FDA-approved indications. Perhaps one of the more promising off-label uses for Gabapentin is for the treatment of anxiety disorders. There is mounting evidence that Gabapentin may be an effective intervention for various types of anxiety including: generalized anxiety disorder, social anxiety disorder, and panic disorder. off-label experimentation with gabapentin commenced for neuropathic pain, bipolar disorder, and migraine prophylaxis (6). The sustained upward trend in off-label prescribing of gabapentin is concerning, considering the minimal high-quality evidence for many off-label uses. Recent attention to off-label use of gabapentin is largely Gabapentin is widely used in the United States for a number of off-label indications, often as an alternative to opioid therapy. Increasing evidence has emerged suggesting that gabapentin may not be as benign as once thought and may be associated with substance abuse in concert with opioids. With co We selected gabapentin (Neurontin), a medication reported to be widely used off label, as a specific example to explore specialist physicians' experiences with off-label prescribing. For gabapentin, the only pain-related indication approved by the US Food and Drug Administration (FDA) is postherpetic neuralgia. For pregabalin, FDA-approved indications related to pain are limited to postherpetic neuralgia, neuropathic pain associated with diabetic neuropathy or spinal cord injury, and fibromyalgia.
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