Over 15 Million Americans Prescribed Gabapentin Despite Warnings
/By Pat Anson
The use of gabapentin (Neurontin) continues to soar in the United State, often for chronic pain and other health conditions the drug is not approved to treat, according to a new analysis by CDC researchers.
In 2024, gabapentin was the fifth most prescribed drug in the U.S., with prescriptions nearly tripling since 2010, according to findings published in the Annals of Internal Medicine. The number of patients prescribed gabapentin reached 15.5 million in 2024, up from 5.8 million in 2010.
Gabapentin was originally developed as an anti-convulsant. It was first approved by the FDA as a treatment for epilepsy and later for neuropathic pain caused by shingles. But it is also routinely prescribed off-label for depression, ADHD, migraine, fibromyalgia, bipolar disorder, cancer pain, postoperative pain, and many other conditions.
Off-label prescribing is legal and, in some cases, appropriate. But for gabapentin it has reached extreme levels, with studies estimating the drug is prescribed off-label up to 95% of the time. Gabapentin has been used to treat so many different health conditions that a drug company executive called it “snake oil.”
"This study highlights a slowed, but continued, increase in gabapentin dispensing from retail pharmacies in the United States," wrote lead author Gery Guy Jr., PhD, of the CDC National Center for Injury Prevention and Control. "As gabapentin dispensing continues to increase, particularly among older populations, prescribing physicians and advanced practitioners should be alert to the potential adverse effects of gabapentin."
Side effects from gabapentin include mood swings, depression, dizziness, fatigue and drowsiness. A recent study found that gabapentin raises the risk of dementia.
Gabapentin has also become a street drug, after drug users found it can heighten the effects of heroin, cocaine and other illicit substances. Nearly 10% of overdose deaths in 2020 involved gabapentin, with most of those deaths also involving illicit opioids. A recent analysis of drug tests found gabapentin in over 13% of urine samples that tested positive for fentanyl.
“Although gabapentin alone is infrequently involved in fatal overdose, serious breathing difficulties may occur in patients with respiratory conditions or those using gabapentin in combination with opioids,” said Guy.
The CDC has a checkered history with gabapentin. The agency’s 2016 opioid prescribing guideline promoted gabapentin and its sister drug pregabalin as non-opioid alternatives for neuropathic pain, without any mention of their possible side effects.
The CDC’s revised 2022 opioid guideline is a bit more cautious. It says gabapentin can produce “small to moderate improvements in chronic pain and function,” but can also cause blurred vision, cognitive effects, sedation, and weight gain.
Medical experts say doctors need to do a better job warning patients about the side effects of gabapentin, and the medication should be stopped if a patient reports little or no benefit. They also think medical guidelines have exaggerated the effectiveness of gabapentin and should be revised.
