Gabapentin warnings
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Gabapentin Warnings: Misuse, Abuse, and Safety Concerns
Gabapentin Misuse and Abuse Potential
Prevalence of Gabapentin Misuse
Gabapentin, initially presumed to have no abuse potential, has seen widespread off-label prescription use. However, recent studies indicate a significant prevalence of misuse. In the general population, misuse rates are around 1%, but this figure rises dramatically to 40-65% among individuals with prescriptions and 15-22% among opioid abuse populations2. The misuse often involves taking larger doses than prescribed or using the drug without a prescription, primarily for recreational purposes, self-medication, or intentional self-harm2.
Risk Factors and Motivations
Individuals with a history of substance abuse are particularly at risk for gabapentin misuse. The drug is often used to achieve effects similar to opioids, benzodiazepines, and psychedelics, and is frequently combined with other substances such as opioids, benzodiazepines, and alcohol2. The motivations behind gabapentin misuse include getting high, alleviating opioid withdrawal symptoms, and potentiating the effects of methadone3.
Safety Concerns and Side Effects
Interactions and Contraindications
Gabapentin can interact with various substances, including morphine, caffeine, losartan, ethacrynic acid, phenytoin, mefloquine, and magnesium oxide, which can exacerbate its side effects or lead to adverse reactions3. Some of the notable side effects include teratogenicity, hypoventilation, respiratory failure, and myopathy. Additionally, gabapentin is contraindicated in conditions such as myasthenia gravis and myoclonus3.
Overdose and Fatalities
While pure overdoses of gabapentin are relatively safe, the risk of fatality increases significantly when the drug is mixed with other psychoactive substances, particularly opioids and sedatives1. This has led to increased scrutiny and calls for stricter regulation.
Regulatory Actions and Warnings
FDA and UK Government Warnings
In response to the growing concerns, the FDA issued a class warning in 2008 for antiepileptic drugs, including gabapentin, regarding the risk of suicidal thoughts and behavior4. Similarly, the UK government has proposed reclassifying gabapentin as a class C controlled substance following a rise in deaths linked to its use5. This reclassification aims to tackle misuse and addiction more effectively.
Conclusion
Gabapentin, while effective for its intended uses, poses significant risks of misuse, abuse, and dangerous interactions, particularly among individuals with a history of substance abuse. Regulatory bodies have responded with warnings and reclassification efforts to mitigate these risks. Patients and healthcare providers must exercise caution, particularly in populations at higher risk for substance abuse.
Sources and full results
Most relevant research papers on this topic
How addictive are gabapentin and pregabalin? A systematic review
Gabapentinoids show limited addictive power, with pregabalin being more addictive, and should be avoided or administered with caution in patients with substance use disorders.
Systematic Review
Highly CitedGabapentin misuse, abuse and diversion: a systematic review.
Gabapentin misuse is prevalent globally, with substance abuse populations at a higher risk for misuse/abuse, primarily for recreational purposes and self-medication.
Systematic Review
Rigorous JournalHighly CitedReview about gabapentin misuse, interactions, contraindications and side effects
Gabapentin is a potential drug of abuse for recreational use, opioid withdrawal, and methadone effects, with potential interactions and side effects.
Systematic ReviewRigorous JournalHighly CitedGabapentin and suicide attempts
Gabapentin may increase the risk of suicide attempts in patients with various indications, as evidenced by a study of patients with various epilepsy types.
Observational StudyUK government to reclassify pregabalin and gabapentin after rise in deaths
Pregabalin and gabapentin could be reclassified as class C controlled substances after an increase in deaths linked to their use, following safety warnings and concerns about misuse and addiction.
Very Rigorous JournalOutpatient Off-Label Gabapentin Use for Psychiatric Indications Among U.S. Adults, 2011-2016.
Off-label gabapentin use for psychiatric indications is prevalent, with 1% of outpatient visits for approved indications, and high concomitant use of CNS-D drugs highlights the need for improved safety communication.
Observational StudyNotes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths — 23 States and the District of Columbia, 2019–2020
Gabapentin-related overdose deaths in 23 states and the District of Columbia increased by 5% from 2018 to 2019, with a higher incidence in unintentional or undetermined cases compared to the previous year.
Gabapentin for chronic neuropathic pain in adults.
Gabapentin at 1200 mg daily or greater provides moderate to substantial pain relief for adults with chronic neuropathic pain conditions like postherpetic neuralgia and painful diabetic neuropathy.
Systematic ReviewVery Rigorous JournalHighly CitedSafety of Gabapentin Prescribed for Any Indication in a Large Clinical Cohort of 571,718 US Veterans with and without Alcohol Use Disorder
Gabapentin is associated with falls or fractures and altered mental status, requiring monitoring in patients with and without alcohol use disorder.
Observational StudyVery Rigorous JournalGabapentin
Gabapentin significantly reduces daily pain and improves overall health in patients with postherpetic neuralgia, with mild to moderate adverse events.
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