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Whats New in the
Patient Safety World
November 2025
Gabapentin
Prescribing Continues to Increase
Despite increasing concerns about gabapentinoids,
prescribing for gabapentin continues to increase. In fact, gabapentin is now
the 5th most prescribed drug in the US (Strahan 2025).
Strahan et al. analyzed gabapentin dispensing from retail pharmacies in the
United States from 2010 to 2024. The dispensing rate per 1000 persons increased sharply from 2010 to 2016, approximately
doubling. The rate of increase slowed after 2016 but gabapentin dispensing
nevertheless continued to rise.
Prescribing to older adults (≥65 years) increased more
than other age groups from 2016 to 2024. Most gabapentin was prescribed by
primary care clinicians but substantial increases in prescribing were observed
among advanced practitioners.
In another interesting study, Sun et al. (Sun 2025)
used a national 20% random sample of US Medicare beneficiaries to analyze
gabapentin use in stroke patients aged 65 years and older. Of those in whom gabapentin
was initiated within 30 days of discharge, 51.6% were still on gabapentin for
12 months or longer after initiation. It was not clear what the indications for
gabapentin were in this population. The authors conclude that there is a need
for clear prescription guidelines and more studies on the long-term safety and
effectiveness of gabapentinoid use among older
adults.
Our many prior columns on safety issues surrounding gabapentinoids are listed below. Strahan et al. note that gabapentin
is approved by the FDA for treatment of seizures and postherpetic neuralgia but
that it is widely prescribed for off-label uses such
as neuropathic pain. Quite frankly, it continues to be prescribed often as an
adjunct for pain of any kind. The continued increase, particularly in older
patients, is bothersome.
Gingras et al. (Gingras
2024) conducted a clinical trial attempting to increase gabapentinoid
deprescribing using a novel approach of direct-to-consumer educational
brochures intended to empower older adults to initiate a discussion on gabapentinoid risks and tapering with their clinician. Though
it was a before-and-after, single-site, unblinded study without a contemporaneous control, their results support the use of
direct-to-consumer educational brochures for deprescribing gabapentinoids
in hospitalized older adults. Among those who completed the study,
deprescription occurred in only 9.9% of patients in the usual care group vs 21.1%
in the intervention group (number needed to treat, 8). Doses of concurrent pain
medications did not increase and new pain medications
were not initiated. They concluded that further study in a multicenter cluster
randomized trial is warranted.
Some of our prior columns on safety issues with gabapentinoids:
- November 2017 Bad Combination:
Gabapentin and Opioids
- March 2019 Gabapentin and
Pregabalin on the Radar Screen
- January 2020 FDA Warning on Gabapentinoids
- February 25, 2020 More on Perioperative Gabapentinoids
- January 2021 Gabapentinoids Again
- June 2022 Gabapentin and
Overdoses
- September 27, 2022 More Bad News for
Gabapentin
·
December 2023 Postop
Gabapentin No Better Than Placebo
·
March 2024 Gabapentinoids
and COPD Exacerbation
References:
Strahan AE, Rikard SM, Schmit K, et al. Trends in Dispensed
Gabapentin Prescriptions in the United States, 2010 to 2024. Ann Intern Med
2025; Epub 30 September 2025
https://www.acpjournals.org/doi/10.7326/ANNALS-25-01750
Gingras M, Dubι R, Williams J, et al. Direct-to-Consumer
Educational Brochures to Promote Gabapentinoid
Deprescribing in Older Adults. JAMA Intern Med. 2024; 184(11):13861388
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2823923
Sun S, Donahue MA, Rocha Gabapentin RB, et al. Treatment
Patterns Among Older Patients After Hospital Discharge for Acute Ischemic
Stroke. medRxiv 2025; 09.23.25336477
https://www.medrxiv.org/content/10.1101/2025.09.23.25336477v1
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