All three are taking the non-opioid pain drug for off-label uses.
The drug appears to provide relief for some patients with diabetic neuropathy but not with some other kinds of neuropathic pain.
Like any drug, gabapentin can also set off a “prescribing cascade,” in which problematic side effects lead to treatment with yet another drug.
With gabapentin, Ms. Cartwright enjoyed eight uninterrupted hours of sleep.
Patients should not stop gabapentin abruptly, he added, as that can lead to withdrawal symptoms like irritability, anxiety and insomnia.
Retired nurse Mary Peart, 67, of Manchester-by-the-Sea, Mass. started taking gabapentin one and a half years ago in an effort to lessen the pain and exhaustion associated with fibromyalgia. She said that the medication helps her walk her dog, climb stairs, and attend art classes.
That’s how she said, “I have a life.”. “My pain immediately returns if I miss a dose. “.
With transverse myelitis, Jane Dausch is a neurological patient who takes gabapentin as needed for pain in her feet and legs. Ms. Dausch, 67, a retired physical therapist from North Kingstown, Rhode Island, stated, “It seems to be effective at calming down nerve pain.”. I.
Amy Thomas has rheumatoid arthritis and takes gabapentin. She owns three bookstores in the San Francisco Bay Area. It’s probably helping me move around more easily, in addition to yoga and physical therapy, according to Ms. Thomas, 67.
For off-label purposes, all three of them are taking the non-opioid painkiller. The Food and Drug Administration has only authorized gabapentin for adult use in two conditions: epileptic seizures (1993) and postherpetic neuralgia (2002), which is the nerve pain that may persist following a shingles episode.
Despite this, a surprising number of other conditions, such as sciatica, diabetic neuropathy, lower back pain, and post-surgery pain, have led patients and medical professionals to turn to gabapentin (marketed under the brand name Neurontin).
Additionally: Dementia-related agitation. Fatigue. headaches. Itching is experienced. Bipolar illness. Alcoholism.
There is a ton of evidence showing these conditions work. Some diabetic neuropathy patients seem to get better with the medication, but not all neuropathic pain patients seem to benefit.
Gabapentin may lessen the itching related to renal failure, according to a few small studies. However, there is little evidence to support its efficacy in treating psychiatric disorders or low back pain.
Dr. Michael Steinman, a geriatrician at the University of California, San Francisco and co-director of the U.S. Geriatrics Initiative, said, “It’s crazy how many indications it’s used for.”. S. Research Network Deprescribing. It has turned into a drug for when we run out of options. “.
(Pregabalin, brand name Lyrica, is a related but less commonly used medication; it is also F. D. 1. -approved for fibromyalgia among other conditions. ( ).
What has caused this adaptable popularity? Dr. Joseph Ross, an internist and health policy researcher at Yale School of Medicine, stated that “the history of gabapentin is really a history of uses getting ahead of the evidence.”.
Early on, Warner-Lambert, the company that makes gabapentin, used forceful marketing strategies to promote off-label prescriptions of the medication, which the Justice Department considered unlawful and deceptive. In 2004, the company settled the government’s lawsuit for $430 million. But between 2002 and 2015, the use of gabapentin tripled.
It gained additional momentum when the abuse and usage of opioids reached crisis levels. Dr. Steinman stated, “People were looking for alternatives, and this was the drug they landed on often.”.
Based on Medicare data, he determined that five million seniors with Part D plans (12.2% of the population) had at least one gabapentin prescription in 2020. The percentage reached 12.8% the following year.
As of 2022, the latest year for which data is available, 5.7 million older adults were prescribed gabapentin. It is currently among the most frequently prescribed medications in the country.
However, geriatricians and other researchers have been warning about it for years. The reason for this is partially due to its adverse effects, which include fatigue, vertigo, and disorientation, as well as the possibility of interactions with other commonly prescribed drugs.
The use of gabapentin in combination with at least two other central nervous system acting medications, such as antidepressants, antipsychotics, benzodiazepines, and muscle relaxants, has been linked to an increased risk of falls and fractures, according to the Beers Criteria, a directory of potentially inappropriate drugs for older adults.
Combining gabapentin with opioids is especially dangerous because, in accordance with the Beers Criteria, it can result in “severe sedation-related adverse effects, including respiratory depression and death.”.
As with any medication, gabapentin can also initiate a “prescribing cascade,” wherein unfavorable side effects necessitate the use of yet another medication for treatment. For example, a diuretic such as Lasix may be prescribed for the 2–16 percent of gabapentin users who experience swelling in their legs, according to Dr. Matthew Growdon, a geriatrician at U.S. C. s. G.
Diuretics, however, can also cause abnormal electrolyte levels, falls, dizziness, and dehydration as side effects. Unaware of the patient’s gabapentin use, a healthcare provider may suspect heart failure due to the swelling.
In such case, Dr. Growdon advised “you’d want an echocardiogram.”. “You’re off to the races after that. “.
A taste of this was given to Nanci Cartwright when her nurse practitioner recommended that she take gabapentin for her restless legs syndrome. This caused uncomfortable, involuntary movements that caused her to wake up multiple times during the night and force her out of bed.
Ms. Cartwright, 73, a retired executive assistant in Santa Fe, New Mexico, claimed that the insomnia that resulted was getting worse. M. The medication may also help her leg pain, which is likely caused by a compressed nerve, according to her nurse practitioner.
Ms. Cartwright slept through eight hours straight thanks to gabapentin. She remembered, “Unfortunately, I also slept the next day.”.
She started to feel sleepy and needed naps. She compared it to being “underwater.”. “I despised that sensation.”. The hobbies and walks on the neighborhood trails that she had once loved had become irrelevant to her. She had swollen calves and ankles.
She gradually reduced her intake of gabapentin because she was unable to find a dosage high enough to treat her symptoms without causing unwanted side effects. She had quit taking the drug after three weeks.
However, older patients frequently keep taking gabapentin for years or even decades after they lose memory of why they started taking it or its intended purpose.
Dr. This drug is “sticky,” according to Steinman. He co-authored a study published in 2022 on elderly patients who had surgery—most frequently hip and knee replacements—and were given a gabapentin prescription. “Posibly their surgical pain has long since resolved,” he said, one in five patients filled the prescription more than three months later.
Long-term gabapentin users ought to consult with their doctors, according to Dr. Growdon. Could it be causing symptoms or interacting with other drugs they take? Can they reduce the dose? Why are they taking it? Is it still helping?
He claimed that while writing a prescription or renewing one is quick and simple, “to stop something or lower the dose is fighting upstream,” which calls for much more thought and time.
He also said that patients should avoid stopping gabapentin suddenly because this can cause withdrawal symptoms like agitation, anxiety, and insomnia. As Ms. Cartwright did, tapering off gradually is a safer option. At higher doses, it could take several weeks or even months.
