Why are so many patients prescribed gabapentin?

(April 7, 2019)

In 2017, the anticonvulsant/nerve pain drug gabapentin was the eighth most-prescribed generic drug in the U.S., with 68 million prescriptions dispensed. Of those, 29 million prescriptions were for patients over 65 years old (Medicare Part D patients). In 2011, only 14 million prescriptions for gabapentin were filled for Medicare Part D patients. That is a doubling of gabapentin prescriptions filled by seniors in only six years.

Gabapentin (brand name Neurontin by Pfizer) is FDA-approved to treat two conditions: an adjunct therapy for partial onset seizures associated with epilepsy and nerve pain after shingles. Given that an increasing number of people over the age of 50 are receiving shingles vaccines, and that a sudden increase in seniors with epilepsy isn't likely, there must be other factors at play to account for the surge in the drug's use. Some attribute the increase in gabapentin use to the opioid addiction crisis, for these two reasons:

1. A reluctance of doctors to prescribe opioids like OxyContin, Percocet, or generics like oxycodone and oxycodone/acetaminophen combinations for pain. Gabapentin can serve as a substitute for the strong opioid pain killers for some kinds of pain, and some patients are receiving off-label prescriptions of gabapentin for different kinds of pain.  

However, for seniors under Medicare Part D, this doesn't seem to be a contributing reason for the spike in gabapentin Rxs, because the number of prescriptions written for generic opioids also increased for this age group between 2011 and 2017. For example, there were 6.7 million prescriptions for oxycodone/acetaminophen in 2011, while in 2017 the number jumped to 10 million prescriptions written for that generic. In fact, a report from the AHRQ says opioid use by seniors is a growing problem.
Click here to read patient experiences of
*gabapentin for pain

*Neurontin for pain (including surgery-related, migraine headache, nerve pain)

2. An increase in demand for gabapentin by those who are suffering from drug withdrawal, because the drug helps lessen their withdrawal symptoms. The problem with this new off-label use is that gabapentin has become a drug of abuse, even though it is not on the federal controlled substance list. It can intensify the effects of other drugs or alcohol to a dangerous level, and is often taken at three times the recommended dose. Kentucky, Ohio, and West Virginia have added gabapentin to their states' controlled substance schedules. *Read patient experiences of  using gabapentin to treat withdrawal to drugs or alcohol symptoms.

It could simply be that for seniors, the spike in prescriptions for gabapentin has more to do with increased awareness of off-label uses, and the fact that they are being prescribed more drugs overall. Another common off-label use of gabapentin is for fibromyalgia. Pfizer's newer drug Lyrica (pregabalin), which was scheduled to go off-patent in 2018, has FDA approval to treat fibromyalgia although it only has a satisfaction score of 2.8 (a bit less than somewhat satisfied) on AskaPatient. Click to read patients' experiences with Lyrica for fibromyalgia. For each of the additional uses below, average patient rating was a 3 (somewhat satisfied) or more.
*Anxiety (gabapentin)
*Anxiety (Neurontin)
*Bipolar (gabapentin)
*Bipolar (Neurontin)

Fast Facts about Gabapentin:

Year approved by FDA: 1993
Brand name version: Neurontin (Pfizer Pharmaceutical)
Number of generic manufacturers: 30 as of December 2017
Average rating score: 2.9 (somewhat satisfied)
Approved patient ages: approved for patients age 3 and up with epilepsy; approved for adult patients for treatment of nerve pain after shingles.
Average age of patient reviewing gabapentin on AskaPatient.com: 56
Top reasons patients reported taking it: fibromyalgia, restless legs syndrome, neuralgia, Parkinson's disease, anxiety, general pain, bipolar, and back pain.
Top side effects reported on AskaPatient: drowsiness, weight gain, dizziness, amnesia, insomnia, nausea.
Interesting off-label use: In the medical literature, there is anecdotal evidence of effectiveness of gabapentin for curing hiccups.

Sources and more reading:
- Center for Medicare Services: Medicare Part D Drug Spending and Utilization, Calendar Years 2013 to 2017 and Calendar Years 2011  to 2015 CMS Dashboard
- HDA Research Foundation 2018-2019 Fact Book HDA.org
- "Gabepentin abuse spikes in Kentucky and is often found in overdose deaths."  Bowling Green Daily News article explains why Kentucky added gabapentin (Neurontin) to its Schedule V drug list. February 17, 2018.
- "Perspective: FDA and the next wave of drug abuse: proactive pharmacovigilance." Commentary on FDA's social media monitoring to find out about patient use of gabapentinoids as well as botanicals like Kratom.
New England Journal of Medicine July 19, 2018.
- "New AHRQ Reports Highlight Seniors' Struggles with Opioids" September 18, 2018 report, Agency for Healthcare Research and Quality.