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related to off-label gabapentin use; (3) review medical information pertaining to the off-label use of gabapentin; (4) outline alternatives to off-label use of gabapentin in an evidence-based fashion, where literature exists to support such alternatives; and (5) encourage key clinicians and decision makers in managed Medically Reviewed Gabapentin for Anxiety, Depression, and Bipolar Disorder. The prescription drug is being used off-label to treat common mental illnesses and even alcohol use disorder. Off-Label Uses. Gabapentin is used off-label use for fibromyalgia, bipolar disorder, anxiety disorders, resistant depressants, mood disorders, irritable bowel syndrome, alcohol withdrawal, postoperative analgesia, migraine prophylaxis, interstitial cystitis, painful diabetic neuropathy, social phobia, generalized tonic-clonic seizures, pruritus Off-label use of medications is common. Although common, many patients may not know that a medication is prescribed off-label. So why are medications used off-label? One reason may be that the FDA approval process is expensive and time-consuming. If the company would like to add an indication to a medication, an additional application is required. Gabapentin is often used as a hypnotic, and this is supported by small controlled and open-label trials where it improved sleep duration and quality (eg, increased slow-wave sleep) at 200–900 mg/day (Furey SA et al, J Clin Sleep Med 2014;10(10):1101–1109). In practice, this means gabapentin may not help your patients fall asleep faster, but Known off-label uses where doctors prescribe gabapentin include as a treatment for hot flashes, restless leg syndrome, mood disorders, anxiety, and to diminish nerve pain related to diabetes or “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 Off-label uses for gabapentin. Doctors often prescribe gabapentin off-label to treat conditions such as: pain from diabetic neuropathy, which is numbness or uncomfortable tingling caused by nerve damage from diabetes; nerve pain in the neck and back from conditions such as sciatica, a painful compression of the sciatic nerve This Special Communication 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. the medication may be used for some patients. • In a different dosage form than approved. For example, a medication that is approved for use with an oral tablet but prescribed with an oral solution. 1 Why are medications used off -label? Off-label use of medications is common. Although common, many patients It’s frequently used off-label to treat anxiety disorders and post-traumatic stress, as it enhances transmission of GABA. Gabapentin also reduced participants’ anxiety before surgery, and Gabapentin has the potential for abuse, especially in those with a history of other substance use disorders, including alcohol, opioid, and cocaine use disorders. 52 One systematic review of 106 studies concluded that while there is not “convincing evidence of a vigorous addictive power of gabapentinoidsin patients without a prior abuse Abstract. 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 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 attributable to a renewed interest in this medication as a chronic pain treatment in the wake of the opioid epidemic. The rise in gabapentin prescribing is multifactorial but thought to be due in part to efforts by the pharmaceutical industry to promote the use of the medication for off-label uses. (In 2004, the manufacturer of Neurontin, Pfizer, pleaded guilty to multiple counts of illegally promoting the off-label use of gabapentin, resulting in nearly $430 Radley et al. indicated that gabapentin was among the medications with the highest proportion of off-label use, with 83% of its use being off label.9 Gabapentin was initially approved in Canada in April 1994 as adjunctive therapy for the management of epilepsy among patients over 18 years of age who are not controlled by conventional therapy.11 Background: The gabapentinoid drugs gabapentin and pregabalin were originally developed as antiseizure drugs but now are prescribed mainly for treatment of pain. . For gabapentin, the only pain-related indication approved by the US Food and Drug Administration (FDA) is postherpetic neuralg Many gabapentin prescriptions are for off-label uses. Below, we’ll cover a few conditions where gabapentin may help. 1. Diabetic neuropathy. Gabapentin is a first-choice medication for diabetic neuropathy (nerve pain from diabetes). If you think gabapentin may help you, discuss this drug with your physician. Realize that off-label use is no guarantee for success, but that decision is for your doctor to make. Be aware that gabapentin is not a harmless drug, and its side effects can be worrisome. Allergic reactions with any drug are emergencies. While Gabapentin is FDA-approved for partial seizures and postherpetic neuralgia, its off-label uses are more extensive, especially in psychiatry. Gabapentin for anxiety disorders is notable, with doses between 900 and 3,600 milligrams per day showing effectiveness in reducing symptoms.
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