Gabapentin is a medication approved by the FDA to treat seizures and postherpetic neuralgia, a chronic nerve pain condition commonly associated with shingles. It falls under the category of anticonvulsants and GABA analogs, which means it mimics the neurotransmitter gamma-aminobutyric acid (GABA) to reduce nerve excitability. An extended-release version of gabapentin, known as gabapentin enacarbil, is specifically approved for restless leg syndrome.
The mechanism of action of gabapentin involves calming overactive nerve activity in the brain and nervous system by interacting with calcium channels. Although primarily used for its approved indications, gabapentin is also prescribed off-label for various chronic pain conditions as a safer alternative to opioids. Consequently, there has been a significant surge in gabapentin prescriptions over the past decade, coinciding with the growing concern over the opioid epidemic and the shift towards prescribing non-opioid alternatives for chronic pain management.
A recent report published in September 2025 by CDC researchers in the Annals of Internal Medicine highlighted the rapid increase in gabapentin prescriptions in the United States. The number of prescriptions per 1,000 individuals more than doubled from 2010 to 2024, with the number of Americans using the medication nearly tripling during this period. In 2024, gabapentin ranked as the fifth most dispensed drug in US pharmacies.
However, a concerning discovery emerged from a 2025 study indicating that chronic low back pain patients prescribed gabapentin faced a heightened risk of cognitive impairment and dementia, particularly among younger age groups. The research, published in Regional Anesthesia and Pain Medicine, revealed that individuals with six or more gabapentin prescriptions exhibited a higher incidence of mild cognitive impairment and dementia compared to those not taking the medication. The risk was more than doubled for dementia and more than tripled for mild cognitive impairment in the 35 to 49 age bracket, with similar results observed in the 50 to 64 age group.
Furthermore, an analysis published in JAMA Network Open raised questions about prescribing cascades associated with gabapentinoid-induced edema. The study found that healthcare providers often failed to consider the effects of gabapentinoids when treating edema with diuretics, leading to potential harm in a significant proportion of patients.
International research echoed these concerns, with a 2025 review of qualitative studies in the European Journal of Pain highlighting global uncertainties among physicians regarding the initiation, monitoring, and tapering of gabapentinoid use.
Additionally, a British study published in BMJ in April 2025 revisited the association between gabapentin and self-harm, revealing fluctuations in self-harm risk before, during, and after gabapentin treatment. While the study did not establish a direct link between gabapentin and self-harm, it underscored the importance of vigilant monitoring for self-harm throughout the treatment process.
In conclusion, while gabapentin offers relief for various conditions, including chronic pain, it is crucial for healthcare providers to weigh the benefits against the potential risks and side effects associated with its use. Patient monitoring and informed decision-making play pivotal roles in ensuring the safe and effective administration of gabapentin.