Gabapentin Use Rises Rapidly Across the US Despite Known Risks
Prescribing trends reveal growing use among older adults and women, raising safety concerns
A CDC analysis published in Annals of Internal Medicine shows that gabapentin use in the United States more than doubled between 2010 and 2024, making it the fifth most prescribed drug in 2024. The sharp rise, especially among older adults and women, raises concerns about safety risks, particularly when combined with opioids.
Study Details
Gabapentin, originally approved for seizures and postherpetic neuralgia, has become a widely prescribed medication for off-label pain conditions. Researchers analyzed data from the IQVIA National Prescription Audit and Total Patient Tracker databases, which cover 94% of retail pharmacy prescriptions in the U.S., to evaluate prescribing patterns between 2010 and 2024.
Methodology
The study tracked prescription rates and patient demographics, assessing how prescribing trends changed over time. The analysis focused on dispensed retail pharmacy prescriptions and included prescriber type, patient age, and gender. Prescriptions filled in hospitals, long-term care, or mail-order settings were excluded.
Key Findings
Between 2010 and 2024, gabapentin prescriptions increased from 79.5 to 177.6 per 1,000 people. The number of individuals receiving gabapentin rose from 5.8 million to 15.5 million.
By 2024, gabapentin ranked as the fifth most prescribed U.S. medication, up from tenth in 2017.
Older adults saw the largest increase, with a 33.7% rise in prescribing rates from 2016 to 2024.
Women were prescribed gabapentin more often than men.
Primary care physicians were the top prescribers, but prescriptions from nurse practitioners and physician assistants rose nearly eightfold, likely reflecting expanded authority.
Despite state-level efforts to regulate gabapentin through drug monitoring programs or reclassification as a controlled substance, prescribing remains high.
Implications for Practice
Gabapentin remains valuable for seizure control and nerve pain but its widespread off-label use raises safety concerns. The FDA has warned about serious breathing problems in patients using gabapentin with opioids or in those with respiratory conditions. Drowsiness, dizziness, and coordination issues are common side effects, posing additional risks for older adults.
For healthcare providers, the findings highlight the need for careful patient selection and monitoring, particularly when prescribing gabapentin alongside opioids. For patients, awareness of potential side effects and open discussion with their healthcare team are key to ensuring safe use.