There are a lot of off label usage of Gabapentin.
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 concerns for safety mounting, it is prudent to examine the efficacy of gabapentin across its many uses to understand the risk-benefit balance. Reviews on off-label indications such as migraine, fibromyalgia, mental illness, and substance dependence have found modest to no effect on relevant clinical outcomes.
This high-quality evidence has often been overshadowed by uncontrolled studies and limited case reports. Furthermore, the involvement of gabapentin in questionable marketing schemes further calls its use into question. Overall, clinicians should exercise rigorous appraisal of the available evidence for a given indication, and researchers should conduct larger, higher-quality studies to better assess the efficacy of Gabapentin for many of its off-label uses.
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Use only the brand and form of gabapentin that your doctor has prescribed. Check your medicine each time you get a refill at the pharmacy, to make sure you have received the correct form of this medication. Do not stop taking Gabapentin unless your doctor tells you to. If your treatment is stopped it should be done gradually over a minimum of 1 week. If you stop taking gabapentin suddenly or before your doctor tells you, there is an increased risk of seizures.
Off-label prescription use and gabapentin’s reputation
Even before gaining recent attention for its role in the opioid epidemic, gabapentin had acquired something of a dubious reputation.
While initially only approved for seizures and neuropathic pain, it was widely prescribed and marketed for other conditions and symptoms. Those include bipolar disorder, migraines, insomnia, and anxiety.
It’s also sometimes prescribed for chronic pain.
Pfizer, the developer of gabapentin, was involved in a lawsuit over their marketing of the drug for these off-label treatments.
The company eventually paid out more than $400 million in 2004 to settle fraudulent claims it made about the drug’s uses.
It’s common and legal for some drugs to be prescribed off-label. However, it’s illegal for drug companies to market drugs to treat unapproved conditions.
Gabapentin has several potential therapeutic uses and may represent a safer option versus alternative agents in some of these indications, so the intent of this analysis is not to condemn its use.
However, it is prudent to recognize that gabapentin has seen high rates of off-label use and increased prescribing in recent years, which fails to align with current evidence regarding efficacy. Indeed, most of the evidence for off-label use is limited to a few small, low-quality studies, often with data only weakly supporting use.
Higher quality evidence, which indicates gabapentin nonefficacy, is often lost in the shuffle. Given the increasing reports of abuse and evidence of potential harms associated with gabapentin use, it is important to realize the potential risks associated with this medication and weigh these risks against this lack of reliable evidence purporting its efficacy for many of its off-label uses.
Thus, we urge clinicians to apply a more stringent appraisal of the available evidence for a given indication when prescribing gabapentin off-label and call for larger, higher-quality studies to be conducted to better assess the efficacy of gabapentin for many of its off-label uses.