In 2024, the anticonvulsant/nerve pain drug gabapentin was the fifth most-prescribed generic drug in the U.S., with 73 million prescriptions dispensed*. Ten years before, in 2014, 51 million prescriptions were dispensed.
Gabapentin (brand name Neurontin by Pfizer) is FDA-approved to treat two conditions:
as an adjunct therapy for partial onset seizures associated with epilepsy and nerve pain after shingles
or
post-herpetic neuralgia. It is now routinely
prescribed off-label for treating various kinds of pain and
other conditions. Some attribute the increase in gabapentin use to the opioid addiction crisis.
Opioid Addiction Crisis: Two Reasons for Increased Gabapentin Use
1. A reluctance of doctors to prescribe strong opioid pain killers like OxyContin, Percocet, or generics like oxycodone and
oxycodone/acetaminophen led doctors to prescribe gabapentin as a substitute
for many kinds of pain.
Click here to read patient experiences of
*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.
Alabama, Kentucky, North Dakota, Tennessee, Utah, Virginia, 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.
Discovery of New Off-Label Uses for Gabapentin
Another reason for the increase in gabapentin prescriptions is the discovery of additional off-label applications for the drug. For example, a common off-label use of gabapentin is as a treatment for fibromyalgia. Pfizer's Lyrica (pregabalin, which is a "gabapentinoid"), has FDA approval to treat fibromyalgia, but sometimes gabapentin is still used for that condition. The drugs are also used as treatment for Anxiety (Neurontin), Bipolar (gabapentin), and Bipolar (Neurontin).
Gabapentin/Neurontin is often used off-label for helping symptoms of multiple sclerosis, (neurontin for MS), diabetic neuropathy, Restless Legs Syndrome, post-surgical pain, in combination with oxycodone or other opiods for cancer, spine, or other pain.
The following chart shows how Gabapentin has increased in use while the opioid Hydrocodone/Acetaminophen combination has declined in use over the last ten years. 2018 appears to be the "break-even" point where both drugs were prescribed at the same rate, with around 67 million prescriptions each in 2018.
Medicare Patients and Increase in Gabapentin Prescriptions
For seniors with Medicare Part D (prescription drug coverage), in the late 2010s the growing opioid crisis didn'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. In 2015-2015, AHRQ (Agency for Healthcare Research and Quality) reported that 19% of older adults filled at least one opioid prescription and 7% filled four or more. But by the 2020s, the trend reversed. A briefing by AHRQ in 2021 reports that in 2020–2021, 12.8 percent of adults aged 65 and older filled at least one outpatient opioid prescription, and 4.4 percent had four or more prescription fills during the year.
The number of seniors being prescribed gabapentin has continued to increase. According to the CMS database, in 2020, 32.3 million prescriptions were for patients over 65 years old (Medicare Part D patients) while in 2011, only 14 million prescriptions for gabapentin were filled for Medicare Part D patients. As is the case for other patients, many seniors have been prescribed gabapentin as a substitute pain drug. Falls have been a commonly experienced adverse effect for seniors taking gabapentin.
Fast Facts about Gabapentin:
Year approved by FDA: 1993
Brand name version: Neurontin (Pfizer)
Number of generic manufacturers: 29 as of
October 2025
Average rating score: Gabapentin: 2.6 (less
than satisfied); Neurontin: 2.9; Gralise: 3.0; Horizant: 4.2
Approved patient ages: approved as adjunctive
seizure treatment 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.
Many older patients have reported falls. For Neurontin, falls is
the 7th most frequently reported side effect (link to report
including
falls side effect count for Neurontin) and
9th most frequently reported for gabapentin in the FAERS FDA
database.
Interesting off-label use: In the medical literature,
there is anecdotal evidence of effectiveness of gabapentin for
curing hiccups. Another example: "A Case Report on Hiccups
Improvement withi Gabapentin" (Cureus)
Recent Label updates for all Gabapentinoids: In May 2025, the FDA
required safety updates to the labels to warn about withdrawal
effects including agitation and suicidal ideation. Users are
advised to taper for at least a week when stopping the
medication. "New
Warnings for Gabapentinoids" Gabapentinoids include
gabapentin, Neurontin, Gralise, Horizant, Lyrica, Lyrica CR,
Pregabalin and Pregabalin CR. Pregabalin is generic for Lyrica.
Sources and More Reading:
-*Number of Prescriptions Dispensed:
The prescription totals in this article and the source of the data
for the graph, are taken from the HDA Research Foundation
Annual Fact
Books (2018-2025's 96th edition) which use the proprietary IQVIA National Prescription Audit, a sample-based commercial
audit of pharmacies, mail order, and other dispensing groups. A
recent letter published in the Annals of Internal medicine, "Trends
in Dispensed Gabapentin Prescriptions in the United States,
2010-2024," reports that gabapentin prescriptions increased from about 24 million in 2010 to almost 59 million in 2024. These
totals differ
from those in the IQVIA data because the numbers in the Annals
article came from All-Payer Pharmacy Dispensing Data, a national claims (payers) database.
Both of these sources identify gabapentin as the fifth-most frequently prescribed medication in the U.S.
The Annals of Internal Medicine research letter also states that
the number
of actual patients receiving prescriptions in 2024 at 15.5
million people.
- Center for Medicare Services: Medicare Part D Drug Spending and Utilization, Calendar Years 2013 to 2017 and Calendar Years 2011 to 2015
and
CMS Dashboard 2020:
CMS Dashboard
-
FDA Orange Book, database of generic medications
- "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.cms
- Investigative
News: This program includes interview with a
patient who became addicted to gabapentin. Michael Abrams from
Public Citizen explains the recent problems emerging from
off-label prescribing, and a neurologist explains why he is
opposed to making it a schedule 5 controlled drug.
Full Measure Cover Story on Gabapentin
- Legal Clarity: "In
What States is Gabapentin a Controlled Substance?" (August
29, 2025)
- People's Pharamacy. "The
Post-Opioid Pain Problem: Gabapentin and Tramadol Under Scrutiny"
(October 9, 2025)
- Pain News Network: "Over 15 Million
Americans Prescribed Gabapentin Despite Warnings" (September 30, 2025)
Original post: April 2019; revised in January 2023, October 2025
