Gabapentin is a frequently used medication for neuropathy, RLS, and various other pain syndromes. In this article, I discuss my top 5 reasons to avoid gabapentin use and pick an alternative.
Sedation
While the sedative nature of gabapentin can be beneficial when patients struggle with insomnia, it can also be a negative if patients are already feeling sedated from their medications or medical condition. In patients who are already complaining of low energy, seek out alternatives to gabapentin to avoid exacerbating this condition.
Fall Risk
Gabapentin’s neurological effects such as sedation and ataxia can increase the risk of falls. This can be especially problematic in our geriatric patient population. Be a little more cautious of using gabapentin in this patient population and if you do, be cautious with starting and titration dosages.
Poor Renal Function
Gabapentin is primarily eliminated through the kidney so as renal function declines, gabapentin concentrations and the likelihood for toxicity goes up. Pay attention to patients who have a history of CKD and be extra careful with the initiation and titration of gabapentin. Dose reductions may also be necessary as renal function declines over time (frequent board exam question!)
Taking Opioids and Drug Abuse History
Opioid overdose has obviously been a major issue over the last decade or so. Gabapentin has been shown to increase the risk of opioid overdose death by lowering a patient’s tolerance. Here’s an article from a few years back that substantiated this risk and why we should avoid using gabapentin with opioids whenever possible. In addition to the additive effect on opioids, it is also important that there is a potential for gabapentin abuse and misuse. It would be best to avoid this agent in patients with this history as well.
Weight Gain and Fluid Retention
While less common than sedation, weight gain and fluid retention (edema) are two possible reasons to avoid gabapentin. I especially keep an eye out for this when I know patients have a history of heart failure and edema. Weight gain is another adverse effect that is not incredibly common but important to pay attention to in patients on more aggressive dosages. I wouldn’t call obesity, heart failure, or edema a contraindication to use but more of a consideration if we have other options available that might have a lower chance of causing these issues.
There you have it; my top 5 reasons to avoid gabapentin. Have you seen any other major concerns with this medication?
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