Monday, May 24, 2021

Off-Label Psychiatric Use of Gabapentin Found to Be Frequent, Risky

An analysis in Psychiatric Services in Advance reports that over 99% of prescriptions for the anticonvulsant gabapentin are off label, including many prescriptions for psychiatric disorders. In addition, nearly 60% of the patients prescribed gabapentin were also found to be taking central nervous system depressants (CNS-D) such as benzodiazepines, a combination that the Food and Drug Administration (FDA) recently warned against.

To better understand gabapentin prescribing for psychiatric disorders, Brianna Costales, B.S., and Amie J. Goodin, Ph.D., M.P.P., of the University of Florida analyzed data from the National Ambulatory Medical Care Survey (NAMCS)—an annual survey of office-based physicians that captures national practices in outpatient medicine.

The authors specifically focused on data gathered from 2011 to 2016, which included 205,417 office visits involving patients aged 18 and older. Of these visits, 5,732 involved a prescription for gabapentin. Compared with those who were not prescribed gabapentin, the patients who were prescribed gabapentin were older (average age of 59.8), about 87% were White, and more than 60% were female.

Only 0.6% of all gabapentin prescriptions were for an approved indication, namely, focal seizures or shingles-related neurological pain. In contrast, 5.3% of all gabapentin prescriptions were for a depressive disorder, 3.5% were for an anxiety disorder, 1.8% were for bipolar disorder, and 0.7% for alcohol use disorder.

Costales and Goodin also found that for 33.1% of the visits in which gabapentin was prescribed, the patient was also taking one CNS-D drug; 25.3% of gabapentin visits involved a patient taking two or more CNS-D drugs. Antidepressants were the most common CNS-D being taken, followed by opioids and benzodiazepines. In December 2019, the FDA issued a safety warning advising against concomitant use of gabapentin and CNS-D drugs due to risks such as sedation, breathing problems, and respiratory arrest.

“[T]he FDA also warned that elderly patients are at an increased risk when co-prescribed gabapentin and CNS-D drugs,” Costales and Goodin wrote. “Our sample had a large representation of older patients, which highlights the need for providers to be aware of this risk when considering whether to continue gabapentin when a patient is also prescribed a CNS-D medication.”

Costales and Goodin added that gabapentin has carried a warning for suicidal behavior and ideation in its package insert since 2008. “These added risks warrant a reevaluation of gabapentin’s risk-benefit profile in psychiatry, specifically to prevent unintended consequences of exacerbating a psychiatric disorder.”

To read more on this topic, see the Psychiatric News article “Suicide Attempts Involving Gabapentin, Baclofen Rising.”

(Image: iStock/LumiNola)

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