Gabapentin use continues to rise despite lack of evidence, concerns over coprescribing

Key takeaways:

• Gabapentinoid use increased from 2015 to 2021.
• Their use was likelier among those who used other medications for chronic pain.
• Experts concluded that continuation should be reconsidered at regular intervals.

Gabapentinoid use has continued to increase in the last several years despite a “dearth of evidence” that supports the drug’s use, according to researchers.

“Recent research has highlighted continued increases in gabapentin prescriptions, especially in combination with opioids, in the United States,” Michael E. Johansen, MD, MS, a family physician at OhioHealth, and Donovan T. Maust, MD, MS, an associate professor in the department of psychiatry at the University of Michigan Medical School, wrote in the Annals of Family Medicine.

Johansen and Maust sought to update a 2015 report they wrote on gapapentinoid use in the U.S. by evaluating data collected in the Medical Expenditure Panel Survey from 488,383 individuals.

Overall, the proportion of adults who used gabapentinoids increased from 4% (95% CI, 3.6-4.4) in 2015 to 4.7% (95% CI, 4.4-5.1) in 2021.

The researchers noted that gabapentinoid use increased among all age groups between 2002-2004 to 2019-2021.

Only 37.6% (95% CI, 35.6-39.8) of gabapentinoid users between 2018 to 2021 refrained from using other medications for chronic pain, suggesting that coprescribing is more common than not.

Between 2017 to 2021, the medical conditions with the highest proportion of gabapentinoid use were musculoskeletal pain and diabetes, “but these conditions had lower ORs of use than some other conditions such as polyneuropathies and fibromyalgia,” Johansen and Maust wrote.

The percentage of those continuing to use gabapentinoid year over year was greater than those who stopped between 2011-2012 and 2017-2018, although this difference decreased from 2018-2019 and 2019-2020.

The researchers acknowledged some limitations in the study. For example, there were changes to the survey’s design in 2020, in addition to an underreporting of short-term opioid and muscle relaxants.

Johansen and Maust explained that the use of gabapentin jointly with other sedating medications “is concerning in light of the [FDA’s] 2019 warning about coprescribing of gabapentinoids with other central nervous system depressants.”

“While these clinical scenarios can be challenging, continuation should be reconsidered at regular intervals,” they concluded.

References:

• An update on a 2015 report shows that gabapentinoid usage in the U.S. has continued to climb. https://www.eurekalert.org/news-releases/1031576. Published Jan. 22, 2024. Accessed Jan. 22, 2024.
• Johansen M, Maust D. Ann Fam Med. 2024;doi:10.1370/afm.3052.