Clinicians who prescribe gabapentin for off-label uses should assess available evidence for a given indication, according to a review published in Substance Abuse: Research and Treatment.
Gabapentin has been approved by the US Food and Drug Administration (FDA) for epilepsy and postherpetic neuralgia. However, 95% of current gabapentin prescriptions are for a wide range of off-label indications including bipolar disorder, diabetic neuropathy, complex regional pain syndrome, attention deficit disorder, restless legs syndrome, trigeminal neuralgia, periodic limb movement disorders of sleep, premenstrual syndrome, migraine headache, and drug and alcohol withdrawal seizures.
The review authors noted that there is little evidence for known off-label indications for gabapentin, with the exception of restless leg syndrome. Studies in which the efficacy of gabapentin for bipolar disorder, panic disorder, obsessive compulsive disorder, cocaine dependence, chronic low back pain, and hot flashes was evaluated did not find evidence favoring the use of the drug.
Other studies in which its use for depression, social phobia, posttraumatic stress disorder, alcohol dependence, and sleep disorders was assessed had only weak evidence in favor of using the drug for these indications.
Restless leg syndrome was the exception; 9 studies were highlighted in the review, indicating an improvement in related symptoms with gabapentin treatment. While these studies are small, the results are promising.
“Given the increasing reports of abuse and evidence of potential harms associated with gabapentin use, it is important to realize the potential risks associated with this medication and weigh these risks against this lack of reliable evidence purporting its efficacy for many of its off-label uses,” the researchers wrote.
Peckham AM, Evoy KE, Ochs L, Covvey JR. Gabapentin for off-label use: evidence-based or cause for concern? [published online September 23, 2018]. Subst Abuse. doi:10.1177/1178221818801311