Talk:Gabapentin/Archive 1

Archive 1

Archive 2

Structure

Would whoever made the nice ball-and-stick structure please redo it with either the zwitterionic or H-bonded structure? They are much more stable. Thank you. Laburke (talk) 22:05, 13 May 2011 (UTC)

The handsome 3 dimensional molecular model shows co-valent bonding of nitrogen to THREE hydrogen atoms whereas the stick model shows -NH2. David P West (talk) 00:09, 13 February 2012 (UTC)

Oh! I see. I just became less ignorant concerning zwitterions & inner salts. Thanx. David P West (talk) 00:18, 13 February 2012 (UTC)

I

—{{}}I have been prescribed gabapentin for my rehmatoid arthritis pain. This is the first time I have been without pain for over five (5) years. The drug has little or no adverse side effects and is much safer than some other drugs used to treat pain.

It's quite an unusual choice, as the RA pain is initially inflammatory and later simply frictionate. Gabapentin is typically used in neuropathic pain (pain due to compression or damage to nerves). Nevertheless: good to hear, and I hope the benefits will be sustained! JFW | T@lk 20:20, 6 November 2005 (UTC)

I was given it for disc pain - one of my lumbar region discs has a major issue which has yet to be diagnosed. It is helping me "function" while I wait for my MRI, medical evaluations, etc (YAY! US Medical system for being so slow), and for chiropractic care to hopefully work.

I did want to mention side effects, but not being a professional in the health care arena, i didn't want to edit the page: Side effects include short term memory difficulties (I can't remember if I took my medicine, or why I got up, etc), constipation, and a slight tired feeling where you kind of want to take a nap. For the first 3 days, until my body got used to the drug,a side effect was a complete and total high - I was totally stoned. This effect wore off as my body got used to the medicine.

Gabapentin & PTSD

As a non-professional, I didn't want to edit this page, but hopefully one or more of you are monitoring a RSS of the discussion page...

For context, I'm an individual with a 25+ year history of chronic anxiety &-> depression disorder(s) (mostly social) who has responded very dramatically to Gabapentin in the last six months, so of course I'm enthusiastic about the drug. A few comments about possible edits to the article.

1. I found the information about the off-label use of Gabapentin very interesting.. is that a 90% prescription rate for psychiatric purposes? If so, the article 'buries the lead' in this respect, and the introduction should make more mention of the topic.
2. My impression is that, in Canada at least, Gabapentin is being looked at seriously with specific regards to PTSD. I don't know if that's true elsewhere, of if the results have be anything other than the usual (vaugely promising, but mostly inconclusive). Pending node-local standards of attribution (ie, if you can verify this to your satisfaction), PTSD should probably get a specific mention in the list of anxiety disorders.
3. Secondhand, I've heard of research with regards to the treatment of fibromyalgia with Gabapentin.
4. One of the reasons that doctors are so willing to casually try Gabapentin is that it has a substantial history of use with well-understood and medically insignificant side effects, due to the original epilepsy population. This puts it in a different category than most modern psychiatric drugs, and would be significant information to psychiatric clients looking up the entry. And, of course, it's excreted by the kidney rather than the liver.

I'm afraid I have to run at the moment, but I hope I've been not-non-helpfull... my intent is to keep an eye out for replies. Thank you for reading this comment.

ml 12:10, 29 April 2006 (UTC)~

Gabapentin is actually being prescribed off-label for fibromyalgia. There are currently studies being run, and my doc prescribed it for me. This should be added somewhere, but I'd rather not have it immediately reverted.... Arinna 20:31, 25 June 2007 (UTC)

Gabapentin for hot flushes

Quick PubMed search found one mention of gabapentin use for hot flushes in a male patient undergoing antiandrogen treatment for prostate cancer: PMID 11895055

and several trials of gabapentin for hot flushes in postmenopausal women/women undergoing treatment for breast cancer. These seemed the most interesting:

Guttuso T Jr, Kurlan R, McDermott MP, Kieburtz K (2003). "Gabapentin's effects on hot flashes in postmenopausal women: a randomized controlled trial". Obstet Gynecol. 101 (2): 337–45. PMID 12576259.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Pandya KJ, Morrow GR, Roscoe JA; et al. (2005). "Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial". Lancet. 366 (9488): 818–24. PMID 16139656. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

I'll leave a relevance assessment/rewording in the article to other editors. Fvasconcellos 19:26, 20 November 2006 (UTC)

Just a question

If i had siezures when i was a baby, will this medication make me have siezures again? The only time i have them now is when i have a fever & go to sleep. If anyone can answer my question, please post it as a comment so i know what will happen if i start taking this medication!!! —The preceding unsigned comment was added by 12.72.235.233 (talk) 20:34, 13 May 2007 (UTC).

That would be something to ask your doctor..... Arinna 20:32, 25 June 2007 (UTC)

Gabapentin and Fibromyalgia

My doc prescribed this for my fibromyalgia, and I read somewhere that there are studies being done to prove it's effectiveness for that use. It is currently being prescribed off-label for fibro... could this be added anywhere? Arinna 20:31, 25 June 2007 (UTC)

According to the clinical study by Lesley Arnold and others (et al) entitled "Gabapeentin in the treatment of Fibromyalgia" (I.D.I.S. # 574153) there was a 30% reduction in the BPI Brief Pain Inventory scale, ans was an iprovement over placebo in the Medical Outcomes Study but also was inconclusive in the mean tender point pain threshold and the Montgomery Asberg Depression rating. Also there was some evidence that gabapentin would influence sleep, which would traditionally be to the advantage of those with fibromyalgia who report problems sleeping. —Preceding unsigned comment added by 216.30.201.151 (talk) 00:45, 26 October 2007 (UTC)

Under Clinical Uses

"Outrageously expensive"? Isn't that a rather opinionated turn of phrase for a wikipedia article?

eveningscribe 14:32, 29 June 2007 (UTC)

It's an interesting phrase to be sure. Here a box of 100 600mg pills costs $215, or $30 with an authoritative prescription (that's 22 days worth). In contrast a box of 20 20mg oxycontin costs $70 ($5.95 with authority) (10 days worth). Given the difference in abuse potential and general 'strength' I think the double the price rate is a bit steep. WierdJohn (talk) 07:02, 9 December 2007 (UTC)

Low-sodium diet

I have a question I someone can answer:) I have been put on a NO sodium diet and need to know whether Gabapentin contains salt of any kind? any ideas on where I might find an answer? —The preceding unsigned comment was added by 201.170.80.144 (talk • contribs) 17:47, 12 August 2007 (UTC)

Gabapentin is not marketed as a sodium salt; some excipients/inactive ingredients may contain sodium, though. Your local pharmacist should certainly be able to provide an answer. Fvasconcellos (t·c) 23:08, 12 August 2007 (UTC)

"abuse potential"

what does the article mean by this? according to the Drug Abuse article, the term is pretty broadly defined, and it's unclear what definition the article uses. is it referring to the potential for addiction? someone clarify. 71.60.151.41 14:47, 29 September 2007 (UTC)

A lot of care needs to be taken with words like, "abuse", "addiction", and "dependence". In the context of gabapentin, there has been some research that has suggested that it can be "abused". This simply means that it is possible for people to use it (often in doses exceeding normal treatment) to "feel good" when there is no underlying condition. In other words: people might "use" it in a way that they should not be doing for effects different than what it was intended for.

In terms of "physical dependence", there is some risk of seizure if someone has been on high doses for some time and suddenly stops taking the medication...so, it needs to be tapered gradually. There may also be some mild withdrawal symptoms. Generally, though, the research suggests that gabapentin really doesen't precipitate a "physical withdrawal syndrome".

As far as "psychological dependence" is concerned, this is anyone's bet as just about any activity can cause this in the right person. Generally, though, there doesn't seem to be too great a potential for this to happen, either.

Lastly, then, we look at "addiction". Is it possible with gabapentin? Well, the answer is mixed. First, it would be impossible for an abuser to increase dosing beyond a certain point (maybe 5000mg per day) and achieve any increased benefit (this is due to the decreasing bioavailability of gabapentin as dose increases....see the PI sheet on this for more info). So, the "depth" potential of addiction is pretty shallow. Also, a user is unlikely to physically "crave" the medication if they stop taking it (other than to prevent the chance of a seizure). They may psychologically crave it, "I need it to get by today"...but even the chances of that are pretty modest.

These are all of the reasons why gabapentin isn't scheduled...it's really a borderline case and pretty darned hard to become "addicted" to in any bad way.

By the way, pregabalin (Lyrica) was scheduled (DEA Schedule V....the lowest / least risk of scheduled medications) because it has a much better bioavailability and was shown to be somewhat "liked" in a study done with prisoners. Again, it probably has a pretty low chance of ever being "addictive"...but it's not a "zero" chance.

Unless you have a super - high risk profile for abusing drugs, I wouldn't worry about gabapentin. Heck, it's used (in one protocol) to *treat* cocaine and alcohol addicts through detox...and these folks (by definition) have a pretty high disposition toward drug abuse. So, take that for what it's worth. —Preceding unsigned comment added by 68.9.32.49 (talk) 14:22, 1 October 2007 (UTC)

I believe the abuse/misuse potential is grossly under-stated. I work in a pharmacy in Boston and probably half of the patients on this drug clearly have no neropathic pain, are not diabetic, and are just looking for a way to get high. The only mood disorders they have is when they get mad at me when we won't fill it for them because "someone stole their meds." I'm amazed this drug isn't a schedule V because that would make it just that much harder to get, since the laws get much stricter when you're dealing with a controlled, verses almost uncontrolled drugs.Gleb Budilovsky (talk) 21:48, 20 January 2009 (UTC)

Yes, Gleb, I'm sure we all know exactly how easy it is for an untrained person to figure out which people have "real" pain or "real" mood disorders by watching them stand in line for a couple of minutes while they're on medications that adequately treat their medical conditions.

But this isn't a chat board for your opinions or personal experiences. If you can find a reliable source that discusses this issue, then we can use that to expand the article. Editors' personal experience cannot be used. WhatamIdoing (talk) 20:42, 21 January 2009 (UTC)

"are not diabetic"? Gleb, either you're entirely ignorant or you're confusing two different drugs. Regardless, based on personal experience, I will tell you that it is simply not possible to "get high" by taking Gabapentin. 69.49.44.11 (talk) 02:22, 29 March 2009 (UTC

Presumably, Gleb was referring to diabetic neuropathic pain. I agree that sources are required for any useful contribution, but it's unreasonable to dismiss those points entirely without investigating them. Jddriessen (talk) 12:09, 1 May 2009 (UTC)

I take gabapentin, and honestly it does have a great, long-lasting buzz . . . the first couple times you take it. Then, nothing. Your tolerance builds so fast even a massive dose won't re-capture the effects, unless you abstain for a week or more. The high does seem to happen to everyone, but even for those for whom it does, attempts at long-term abuse will be frustrated. 98.246.184.50 (talk) 17:14, 11 June 2009 (UTC)

I can certainly confirm this. When I start taking gabapentin again, I'm more stoned than on any drug I personally have ever taken. I have to stay at home or even in bed because I become a very wise swami with all the answers of the universe, and then, unfortunately for the world, I fall asleep. But only the first pill! — Preceding unsigned comment added by 24.130.0.5 (talk) 21:00, 5 September 2014 (UTC)

A quick google of "gabapentin abuse" may just link one to erowid and certain forums and it may just link one to personal reports of abuse. It is an abused drug, it just isn't dangerous or noteworthy. It is possible to get physically hooked, actually, just not so much mentally. Diminishing recreational returns are fast and steep. Two nice days equal one regular day, and under constant use thereafter it's more regular days. The body will notice if the mind won't, says a google search of "gabapentin withdrawals," where recreational users report the withdrawals of gabapentin are hell. These users whose reports I read were mostly using it to stave off opiate withdrawals, so that may be the link. Or it may not, as no one seemed to mention if they stopped the GABA after their opiate withdrawals would have subsided anyway. I don't doubt there is any even slightly psychoactive drug that people won't try to abuse and keep abusing even in the face of much better more destructive more pleasurable and more longer lasting drugs available cheaply and quickly off the streets. Attacking a pharmacist is stupid. She probably knows more from looking at people awaiting their scrips than the doctors of those patients do. I've had a fun time once or twice watching the scrip counter and overhearing scrip names and watching people pep up at the very sight of their medication, and I keep sleezy friends, and those sleezy friends look and act just like some scrip-holders who salivate at the sound of "hydrocodone." A peek at timestamps reveals certain habits or non-habits and unless there is concomitant use of other medications, such as for arthritis, neuropathy, or other chronic conditions, it's obvious who's doctor shopping and who genuinely needs to be on stuff. It's just not encyclopedic, and it's not a pharmacist's business beyond the actual business, and neither is it anyone elses business to tell that woman she doesn't know what she's talking about when she's probably been able over the course of time to form a formulaic if discriminatory profile of users and abusers. But nowadays you can't really tell who's using and who's not since it seems half the damned country is. Yalk (talk) 16:24, 17 July 2010 (UTC)

I have taken gabapentin 300 mg 1 every 2 hours or thereabouts, for about 5 years now for severe diabetic neuropathy in my feet. I feel I am qualified to say that it has no psychoactive effects at all except for on exception which I will detail in a moment. All the effects are physical. It somehow dampens down the nerve messages in my feet, and I'm thankful because my feet feel like they're in freezing electrified water without the pills. I also notice when I'm outside that i see sparkles because my rods and cones in my eyes are over-reacting or something, and my eyes are sensitive to light. Also they cause my breath to suddenly indraw involuntarily, like a sigh, but only every so often. All the effects are physical except every now and then, about 4 times in the last 5 years I have felt euphoric. Not really something to base abuse of the drug on. The article states it causes people to be social and overly talkative, I imagine this is an effect brought on by the person and not the drug. — Preceding unsigned comment added by 207.6.77.130 (talk) 03:34, 26 September 2011 (UTC)

Muscle relaxant

Some other articles link here mentioning this as a muscle relaxant, yet there's no info on the article about that...? --212.159.16.241 (talk) 00:03, 9 December 2007 (UTC)

Gabapentin and Breastfeeding?

The article doesn't mention what category gabapentin is for breastfeeding. Anybody know? I had a prescription but went off while I was pregnant and want to know if I can take this now. 71.197.31.63 (talk) 05:01, 9 December 2007 (UTC)MMurray

dosage- how much/how long

I have been put on 300mg x times a day, this is my saecond day. I have Trigeminal Neuralgia and the pain is still there. How long do you have to give the drug to take effect before you concider increacing the dosage.does anyone has any experience with this ?--Tn pain (talk) 04:37, 12 March 2008 (UTC)

You really need to have this conversation with your health care team. Call your doctor tomorrow, and let him/her know that you're not exactly happy with the results so far. Gentgeen (talk) 05:22, 12 March 2008 (UTC)

Last Line of "Clinical Uses" Section Looks to Be Redundant

It looks like the last line of the Clinical Uses section should be deleted because the information is already in the 10th paragraph. Or perhaps they should be merged.

Ex2golem (talk) 18:05, 27 August 2008 (UTC)

Thank you for your suggestion. When you feel an article needs improvement, please feel free to make those changes. Wikipedia is a wiki, so anyone can edit almost any article by simply following the edit this page link at the top. The Wikipedia community encourages you to be bold in updating pages. Don't worry too much about making honest mistakes — they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. You don't even need to log in (although there are many reasons why you might want to).

I have removed the duplicate sentence and split the excessively long section into others. You might like to look at the suggestions at WP:MEDMOS#Sections for more ideas about organizing the article. WhatamIdoing (talk) 20:10, 27 August 2008 (UTC)

Side affects of Gabapentin question

I do not wish to edit this page but I have a question.

I have been taking Lyrica for Fibromyalgia, the side affects of falling asleep while talking to someone or while eating or driving (with no warning) has made it impossible for me to take it during the day. Taking this medicine for over a month has not changed this. I have tried this with 75 mg dosage as well as 50 mg dosages. I take 50 mg at night and none during the day and am able to stay awake but the pain is dibilitating and really has affected my life. Also the weight gain is terrible and I don't need this either. I believe it adds to the stress on my muscles. I have two choices, I can take the Lyrica during the day and stay home and sleep or I can not take it and hurt so badly I can barely function. I don't like either choice.

My insurance company has suggested Gabapentin as a replacement. I read one of the comments on this discussion page and am led to believe the sleepiness disappears after taking Gabapentin for a couple of weeks, is this the norm? Also what about weight gain? I saw nothing about this on the discussion page. I have talked to my pharmacist and got wishy-washy answers. I hope you can help me to make an informed decision about whether to ask my doctor to change my medication.64.24.48.2 (talk) 23:24, 28 September 2008 (UTC)

This is not an appropriate place to ask such questions, or even a safe place to ask such questions. Please take this question to your own qualified physician. This is not a general chat board, and Wikipedia does not give medical advice. Asking this question here is likely to get you an answer by a young student pretending to be an experienced physician. WhatamIdoing (talk) 18:37, 29 September 2008 (UTC)

You may want to check out whether there is a) any substance to the rumors that Pfizer tried to suppress studies that found side-effects and/or counterindications, and b) see whether this applies to you; then discuss this with your MD. I have not found anything yet (not that I have looked), the news just came in. Some editor might want to check it out. Dysmorodrepanis (talk) 17:41, 9 October 2008 (UTC)

U.S.-centric

If you read through this article, it only makes references to the legal status of gabapentin in the United States' Controlled Substances Act. We need more data about the legal status of the drug worldwide.--Metalhead94 (talk) 19:58, 25 October 2008 (UTC)

Gabapentin vs. "other benzos" ?

That line toward the bottom about use of Gabapentin rather than "other benzos" implies that it's a benzodiazapine! It is not. Plus, slang like "benzos" should not be used in the interests of accuracy. I'm not doing any editing today but I do suggest somebody remove the word "other." 63.22.170.236 (talk) 15:03, 19 February 2009 (UTC)Ellie

Epilepsy

Does it actually work for epilepsy? Or is it not used to treat that any more? 129.31.243.59 (talk) 18:13, 14 April 2009 (UTC)

I can't say for sure since I am not sure (yet) as to whether I have been professionally diagnosed as having epilepsy, rather than a seizure disorder (accompanied by about a half a dozen other disorders (PTSD?, TBI, bipolar, and others I can't recall due to recent grand mals; all prior to gabapentin use...). But to quote www.epilepsy.com/medications: "Brain cells need to work (fire) at a certain rate to function normally. During a seizure, brain cells are forced to work much more rapidly than normal. Gabapentin helps prevent brain cells from working as fast as a seizure requires them to. In this way, seizures can be stopped when they are just beginning." Hope this helps some. —Preceding unsigned comment added by 71.97.147.217 (talk) 03:56, 12 May 2009 (UTC)

Uncommonly used, its anti-seizure effect is kinda weak. 202.146.15.12 (talk) 07:30, 30 May 2009 (UTC)

Does Gababentin cause weight gain? —Preceding unsigned comment added by 141.110.70.59 (talk) 22:16, 28 July 2009 (UTC)

overdose on gabapentin

im wondering what would happen if you were to take to many gabapentin in a short period of time. not meaning to just not 8 hours in between taking them —Preceding unsigned comment added by 123.3.164.32 (talk) 01:56, 31 July 2009 (UTC)

http://www.ncbi.nlm.nih.gov/pubmed/12645962 This study examined the effects of gabapentin consumption ranging from 50mg to 35,000mg (35g). Although sedation, dizziness, vomiting and other effects occurred, none of them were severe enough to warrant medical attention.

"CONCLUSION: In this cases series, gabapentin exposures caused no or minimal toxicity."

There are also many anecdotal reports of doses up to 52 grams with no life-threatening medical problems. Gabapentin is a drug of diminishing returns. the more you take, the less is actually usable by your body. — Preceding unsigned comment added by Thor214 (talk • contribs) 05:17, 15 January 2011 (UTC)

"Outcome Reporting in Industry-Sponsored Trials of Gabapentin for Off-Label Use"

[2][3] -Shootbamboo (talk) 01:45, 15 November 2009 (UTC)

Akathasia is not "rare"

This article states that restlessness associated with anti-psychotic medications is rare. This is simply not the case, particularly with the older, 'typical' anti-psychotic drugs such as Haloperidol. See this article: http://www.ncbi.nlm.nih.gov/pubmed/10647977?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=2&log$=relatedreviews&logdbfrom=pubmed This should be changed. —Preceding unsigned comment added by 92.15.30.72 (talk) 14:35, 13 December 2009 (UTC)

Gabapentin is not an antipsychotic, it is an anticonvulsant and mood stabaliser.--Literaturegeek | T@1k? 01:01, 27 July 2010 (UTC)

Gabapentin for Panic Disorder

From the article it appears that you dismiss Gabapentins use in anxiety-related illnesses, yet in the referenced document ^ Chouinard, G (May 2006). "The search for new off-label indications for antidepressant, antianxiety, antipsychotic and anticonvulsant drugs". J Psychiatry Neurosci 31 (3): 168–176. ISSN 1180-4882. PMID 16699602. statements are made about its possible effectiveness with severe cases of Panic Disorder, would it not be appropriate to include this within the article as at the moment is appears misleading. —Preceding unsigned comment added by 87.115.163.68 (talk) 16:09, 29 July 2010 (UTC)

I don't see why not.--Literaturegeek | T@1k? 01:45, 4 August 2010 (UTC)

Some errors and disputes

This article contains a number of claims that have not been supported by the data. Gabapentin is NOT approved for neuropathy, but rather only post-herpetic neuralgia. Plus, a number of off-label uses are suggested where more recent data show no benefit or no superiority to extant interventions. Pfizer has been found guilty not only of promoting off-label use illegaly, but also, beyond just scientific misconduct, actual fraud in suppressing negative data that contradicted the indications for which they were pumping up sales. It is important that both clinicians and patients have a clear idea of the data, the risks and the benefits.

Suggested changes below have so far been rejected, however the article as it currently reads may result in misuse of the drug. JaguDorje (talk) 23:34, 9 August 2011 (UTC)

I do not think the article says any longer that it is FDA approved for neuropathy. If there are recent review articles that are not reflected currently would be happy to see them reflected. Doc James (talk · contribs · email) 00:01, 10 August 2011 (UTC)

Medical uses

Gabapentin is approved adjunctive therapy in the treatment of partial seizures with and without secondary generalization in patients over 12 years of age with epilepsy and post-herpetic neuralgia. It has been used off-label by physicians for a variety of conditions.

US FDA Approved Indications

Gabapentin was originally approved by the U.S. Food and Drug Administration (FDA) in 1994 for use as an adjunctive medication to control partial seizures (effective when added to other antiseizure drugs). In 2002, an indication was added for treating postherpetic neuralgia (neuropathic pain following shingles). As part of a case (CIVIL ACTION NO. 04-cv-10739-PBS) brought by Kaiser Foundation Health Plan against Pfizer, it was noted that "The general neuropathic pain indication cannot be granted for Neurontin based on the clinical trials in painful diabetic peripheral neuropathy (DPN) and postherpetic neuralgia (PHN)." In addition, the FDA black box warning states that "Antiepileptic drugs (AEDs), including Neurontin, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication."

Gabapentin (administered orally) is one of two medications (the other being flumazenil, that is administered intravenously) used in the expensive Prometa Treatment Protocol for methamphetamine, cocaine and alcohol addiction, however data for treatment of methamphetamine showed no benefit and the drug itself poses a risk for being addictive. Gabapentin is administered at a dosage of 1200 mg taken at bedtime for 40–60 days. Though the combination of flumazenil infusions and gabapentin tablets is a licensed treatment, there is no prohibition against a physician prescribing gabapentin outside the Prometa protocol, however Pfizer has been convicted for promotion of off-label use, which is illegal. There have been reports by methamphetamine addicts that gabapentin alone in doses of 1200 mg at bedtime taken for 40–60 days has been effective in reducing cravings or desire to use methamphetamine, although this is from a commercial website. It also attenuates the severity of withdrawal symptoms experienced by those physically dependent on opioid analgesics, such as heroin, morphine, and oxycodone. One study also demonstrates a significant reduction in the severity of benzodiazepine withdrawal syndrome.

Positive, However Disputed

Gabapentin has been used to treat a variety of conditions for which it was not approved. Such "off-label" use is a purview of physicians. It is, however, illegal for the manufacturer to suggest, recommend or promote such off-label use; Pfizer has been convicted of such efforts (see below). While there may be some indications for which the drug is useful, it is difficult to be certain as the manufacturer had not only promoted off-label use, but further was found having violated the RICO act by fraudulently suppressing publication or awareness of studies that showed no benefit or greater risk of harm.

Gabapentin is frequently used to treat various types of neuralgia and it is approved for this indication. While one study showed small benefit for prevention of frequent migraine headaches, these data are in dispute; its effects on neuropathic pain are not supported by this trial as they used a forced titration to increase the dose beyond its FDA-approved indication, resulting in unblinding of the study and an increase in side effects. In the Saris opinion, it was found that controlling for the two most common side effects wiped out any statistically significant effect, rendering the drug clinically useless. Given the serious uncertainty that arises from the misleading efforts, a study showing benefit for nystagmus should be viewed with skepticism. While it is often prescribed off-label (that is, at the discretion of a physician) for various conditions, this use is probably frequently due to the widespread illicit marketing Pfizer was convicted of, which was communicated via promotional messages through advisory boards, consultants’ meetings, and accredited continuing medical education events posing as independent third-party organizations, co-opting opinion leaders, educational enterprises and academia in their marketing campaign.

Gabapentin is widely, but possibly falsely, believed to help patients with post-operative chronic pain (usually caused by nerves that have been severed accidentally in an operation and when grown back, have reconnected incorrectly) and nerve pain associated with spinal cord injury. It is doubtful whether it is effective in reducing pain and spasticity in multiple sclerosis, and, additionaly whether it has a superior risk/benefit profile in treating Complex Regional Pain Syndrome, as these are all in dispute.

Gabapentin is approved in the treatment of postherpetic neuralgia and pain. Because dermatological patients suffer pain from painful tumors, after surgery, in conjunction with neuropathic ulcers, during dressing changes involving serious medical conditions, its applications seem manifold, however, again, none of these have been tested in randomized, controlled trials that have been undertaken independent of the company's financial influence and thus, if used for these indications, must be done with great caution and care. FDA, despite frequent attempts by Pfizer, has never approved use of doses in excess of 1800 mg/day (see Saris decision).

While the studies that show benefit for some symptoms of opiate withdrawal,, these should be scrutinized in light of the fraud that litigation has revealed was committed. Further, tests for smoking cessation treatment have had mixed results.

Additionally, gabapentin has been prescribed to menopausal patients being treated with anti-androgenic compounds to reduce the incidence and intensity of the accompanying hot flashes, though two other studies showed no greater efficacy than low-dose transdermal estrogen or a variety of other agents, as evaluated in a meta-analysis, including clonidine, paroxetine, venlafaxine, gabapentin and black cohosh, that each may be beneficial in the treatment of menopausal vasomotor symptoms. Again, claims that Gabapentin may help deepen sleep, positively affecting deep, slow wave sleep, and reducing arousals during the night may be true, however such studies should be viewed with skepticism.

Negative

Gabapentin has been prescribed in the mental health context. Numerous trials show that it is not effective as a mood-stabilizing treatment for bipolar disorder and so has no therapeutic advantage in having fewer side-effects over better established bipolar drugs such as lithium and valproic acid. Indeed, for such conditions, there was a higher rate of suicidal ideation, despite Pfizer's efforts to promote the use of gabapentin in the treatment of bipolar disorder. Gabapentin has probably little or no usefulness in the treatment of anxiety disorders such as social anxiety disorder and obsessive-compulsive disorder, in treatment-resistant depression, and for insomnia. Gabapentin can also cause weight gain.

A double blind, randomized controlled trial found gabapentin ineffective for the treatment of idiopathic subjective tinnitus. JaguDorje (talk) 23:34, 9 August 2011 (UTC)

We need to use review articles not primary research articles. Second we do not give drug doses. Third we do not organize content on medications via whether or not indications are FDA approved or not. This is a global information source rather than a US specific one. Doc James (talk · contribs · email) 00:00, 10 August 2011 (UTC)

References
References

Biased?

I am an emergency medicine professor who has been an MD for ten or so years. There are more off label uses of medications than I could ever count, but that does not make them "wrong". Our FDA is beyond messed up, mostly bc of big pharma companies, so getting an approved use doesn't mean it's any safer. Check avandia and phenergan. Horrible patient issues for approved uses and not withdrawn off market for thousands of bad outcomes. With experience and years of patient treatments, I can say professionally that gabapentin is one of the more effective drugs for neuropathic pain. Better than opiods often. And yes I use it off label, just like hundreds of other drugs. Most drugs these days aren't even marketed for the purpose for which they were developed. Linezolid was supposed to be an antidepressant not an antibiotic. Is Eli Lilly hiding stuff? Absolutely. They're awful. Just check out their paxil problems. But I will not deny the patient a chance at pain relief because the drug company didn't tell us everything or wasn't smart enough to figure out the best uses of a particular drug. I have little faith in drug company research and much more in years of patient observation.

Please try to limit the bias in the article. The off label uses and legal issues dominate what should be an article with clear benefits vs side effects and concerns. If I were a lay patient, I'd have no idea what I was reading.

Lastly, I have had the pleasure of being a pain patient this past year after a spinal accident. I can personally say that the type of pain from a spinal radiculopathy cannot be adequately described. I've worked through kidney stones, broken bones, migraines and 104+ fevers, and nothing has put me down like this nerve pain. It is excruciating, and it has solidified my belief in off label use for patients who get no relief from FDA approved drugs, which are just as dangerous in this day and age. Neurontin has saved many patients from unrelenting pain. I simply hope this article can be revised not to terrify patients looking for relief. An unbiased honest dual-sided explanation of risks and benefits would be more suited to Wikipedia. Thank you for your time. Drtyson (talk) 23:51, 26 February 2012 (UTC)

We allow "off label" discussion. Content just needs to be supported by high quality refs. Doc James (talk · contribs · email) 22:21, 1 June 2012 (UTC)

Biased

This page has so much BS about not trusting the manufacturer, criticizing off-label Rx of this drug neurontin - as far as I can tell, ALL of the off-label uses are justified. This drug has mild effects on ALL nerves because it acts on Ca channels which are present on all neurons at the presynaptic terminal; this explains analgesia, anxiolytic, and basically all other effects. Whoever wrote this page needs to lay off the warnings about an essentially innocuous drug with many legitimate off-label applications. And the poor pharmacist who doesn't like filling bottles for people with Rxs should find another job.Nixietech (talk) 23:18, 7 April 2012 (UTC)

We here at Wikipedia use high quality evidence from secondary sources in the "medical uses" section. Feel free to present evidence. Doc James (talk · contribs · email) 22:20, 1 June 2012 (UTC)

Gabapentin Side Effects I Had

collapsing personal experience report per WP:FORUM and WP:OR

I am a 65-year of age female, normally very healthy, but now tending to back problems I received from an auto accident. I have been going through severe pain with a disk protrusion, penetrating pain down my leg. Overall, I've been mostly bedfast. Lots of meds were given to me by doctor, ER, and pain clinic, along with one [thus far] lumbar epidural. None hardly made a difference. I was given a new script yesterday for gabapentin 600 mg. I took 1/2 pill about 4 p.m. Since I was lieing down, I could not tell if it helped the nerve pain or not. I seemed ok, nothing unusual. I awoke close to 4 a.m. and noticed I was in quite a bit of pain, unusual for lieing flat on my back that usually soothes me. I took anothe 1/2 pill approximately 5 a.m. I went back to sleep for a few hours, awoke hallucinating like crazy, talking out of my head, slurring so much I could only get words out of my mouth slowly and not in sentences, not in my normal tone of voice, feeling numbness on my lips one side of my face, wobbly, seeing things and people that were not there, etc. This med is 'pure dope' the way I see it, dangerous, and should have never been approved by the FDA. Please be careful with it. It is still in my system at this writing. If my personality does not fully return within the next hour, I am going to ER, especially for fear of a stroke.

Betty — Preceding unsigned comment added by 206.29.182.191 (talk) 20:18, 18 March 2012 (UTC)

Hi Betty, sorry to hear about your bad experience. Unfortunately, this talk page is not for reporting people's personal experiences, only discussing the Wikipedia article and the available literature and sources about the drug. If you have concerns, please see your doctor, psychiatrist, or pharmacist. Thanks and good luck. Ocaasi ^{t | c} 20:43, 18 March 2012 (UTC)

Has this drug never been prescribed for relief of sinus pressure or sinus issues — Preceding unsigned comment added by 199.188.86.198 (talk) 02:28, 30 March 2013 (UTC)

charlene

hi i just s it a good med for painstared takin gabapentin,is it a good pain medication — Preceding unsigned comment added by 71.54.34.134 (talk) 04:19, 11 February 2014 (UTC)

workplace while taking meds

Should a person taking gabapentin be allowed to work? Im taking 200 mg a day and it works for my condition wondrfully. I feel much better. But im drowsier and not as quick with my thoughts at all. Lower concentration and i wont drive anywhere that isnt close to home at all. B — Preceding unsigned comment added by 173.218.97.168 (talk) 21:36, 21 March 2014 (UTC)

Mechanism of Action

The Pharmacology section states: "The mechanism of action is simply unknown.". However the following section is titled: "Mechanism of action". This seems contradictory. — Preceding unsigned comment added by Alan8 (talk • contribs) 03:52, 14 April 2014 (UTC)