HWN Suggests

Millions Take Gabapentin for Pain. But There’s Scant Evidence It Works

The gabapentinoids are symbolic of three currently challenging problems in the practice of medicine: a deadly national epidemic of opioid addiction prompting doctors to seek alternative drugs for pain; the limited training in pain management received by most doctors; and the influence of aggressive and sometimes illegal promotion of prescription drugs, including through direct-to-consumer advertising.

Gabapentin and Lyrica... have been approved by the Food and Drug Administration to treat only four debilitating pain problems: postherpetic neuralgia, diabetic neuropathy, fibromyalgia and spinal cord injury. Even for these approved uses, the evidence for relief offered by the drugs…

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  Stop Prescribing Gabapentin and Pregabalin

The real mystery is why medical providers are still writing for gabapentin and pregabalin. Do providers not keep up with the literature or has the phobia to prescribe opioids become such a leviathan that providers are willing to prescribe a useless, expensive medication with significant side effects and abuse potential just so they can say it was a nonopioid?

Articles of Interest

FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR)

When used with CNS depressants or in patients with lung problems.

Gabapentin and Pregabalin for Pain — Is Increased Prescribing a Cause for Concern?

An increasing prevalence of diseases for which gabapentinoids are FDA-approved — or a growing tendency for clinicians to prescribe them for these conditions — probably can’t explain the recent rise in gabapentinoid use. Rather, we suspect that clinicians who are desperate for alternatives to opioids have lowered their threshold for prescribing gabapentinoids to patients with various types of acute, subacute, and chronic noncancer pain

Gabapentin Presents High Potential for Misuse

The FDA approved gabapentin in 1993 as a non-controlled substance and it has remained a non-controlled substance at the federal level. The drug was created as an anticonvulsant and used to treat seizure disorders. The medication has also been used to treat hot flashes, neuropathic pain, pain, postoperative nausea, substance abuse issues, and vomiting.

Gabapentin: The most dangerous drug in America?

Pharmacist Tom Viola was caught by surprise when he read online that the prescription drug gabapentin was causing alarm as a new drug that's being abused. What he learned may surprise you.

Gabapentinoids: A Deeper Look

However, to everyone’s surprise, gabapentin has no activity in any part of the GABA system and no affinity to the GABA receptors, and it is not involved in any aspect of GABA transport or metabolism. Rather, it binds to the α2δ subunit of a voltage-dependent calcium channel. Its activity at this channel is quite complex, but it is believed that the final physiological effect is decreased neuronal release of excitatory neurotransmitters glutamate and norepinephrine on ascending neurons in the central nervous system (CNS).

Give Gabapentin Its Due

Mark Mosley, MD, wrote in his editorial, “Stop Prescribing Gabapentin and Pregabalin,” that we EPs should stop prescribing gabapentin. (EMN 2018;40[5]:6; http://bit.ly/2I3YaMO.) Whoa, give gabapentin its due. My experience is that I can get patients struggling with pain issues off opioids by prescribing gabapentin with naproxen twice a day for a week or two or even just as needed. James R. Roberts, MD, also wrote in his May column that gabapentin produces a “pleasant euphoria and calmness.” (“Medications Surprisingly Linked with Opioids,” EMN 2018;40[5]:8; http://bit.ly/2jm5WUh.) Gabapentin is effective! If those effects are helpful in getting someone off opioids or not to try opioids, why not use gabapentin?

Narrative Review: The Promotion of Gabapentin: An Analysis of Internal Industry Documents

Although news articles have described some practices used to market gabapentin, to our knowledge there has been little systematic investigation of the overall structure of promotion for this drug. In this paper, we use public documents obtained through litigation to describe how marketing strategies and tactics for gabapentin were developed and used in the mid- and late 1990s.

New on the streets: Gabapentin, a drug for nerve pain, and a new target of misuse

Ciera Smith, 22, arrived at Rural Women’s Recovery Program on April 5. Smith said she misused gabapentin to give her energy and keep up with her 2-year-old daughter.

Newer Anticonvulsants

The newer anticonvulsant agents include: Gabapentin, Lamotrigine, Levetiracetam, Oxcarbazepine, Pregabalin, Tiagabine, Topiramate and Vigabatrin. These are generally less toxic in overdose causing sedation and non-specific neurological symptoms and patients do well with supportive care.

PharmD Pearls: Gabapentin For Hiccups

Treatment response within 24 hours...