Gabapentin is an anti-seizure medication prescribed to those with
epilepsy and certain types of pain.
It’s also commonly given for off-label uses (when a drug is prescribed for a condition other than what it’s approved for) like mood disorders and alcohol dependence, or neuropathic pain that don’t yet have approval from the U.S. Food and Drug Administration (FDA).
And its use is increasing. Since 2010, the number of gabapentin prescriptions dispensed annually in the United States has increased by about 150 percent to 73.1 million prescriptions written for patients in 2024.
“There are many potential reasons for this, including aggressive marketing campaigns, use for a wide variety of off-label conditions, efforts to reduce opioid use, and a general perception by prescribers that these medications are highly effective for pain deemed to be nerve-related — with a relatively safe profile,” says
Matthew Growdon, MD, MPH, an assistant professor of medicine at the University of California in San Francisco (UCSF), who has researched gabapentin prescribing.
But is gabapentin really an effective option for pain relief? The answer depends on the type of pain — along with a few other factors. Here’s what experts say about gabapentin, its recommended uses, potential risks and side effects, and who might want to try it.
Gabapentin (Gralise, Horizant, Neurontin) is approved by the FDA for three uses:
So how did gabapentin become commonly used off-label for other types of pain — despite not having FDA approval for those conditions?
“As opioid prescribing for chronic pain has declined over the past decade, there has been increased pressure on physicians to offer non-opioid alternatives for chronic pain,” explains
Kristen Klepac MacKenzie, MD, a pain management specialist at the Stanford Pain Management Center and a clinical assistant professor of anesthesiology and perioperative and pain medicine at Stanford Medicine in Stanford, California. “Since all pain is ultimately transmitted by nerves, nerve pain medication prescribing has risen in popularity,” she says. Very few new pain medications have become available in the past decade, leaving doctors with limited options, Dr. MacKenzie adds.
Gabapentin is different from
opioids in that it doesn’t interact with opioid nerve receptors in the body.
Instead, it works on calcium channels on the nerves, slowing their conduction and ability to transmit pain signals, MacKenzie says.
It’s also different from other types of pain-relieving medications, including over-the-counter (OTC) and prescription strength
nonsteroidal anti-inflammatory drugs (NSAIDs). “NSAIDs are only helpful for pain if there is ongoing inflammation in the body to target,” MacKenzie says.
Gabapentin falls under a class of drugs called
anti-convulsants, or anti-seizure medications.
It has a similar chemical structure as a
neurotransmitter known as
gamma-aminobutyric acid (GABA). Though gabapentin’s full mechanism isn’t known, it’s thought to have a calming effect on the brain, slowing overactive brain cells and normalizing the release of neurotransmitters — ultimately blocking pain signals.
Given the direct nerve connection, gabapentin is commonly prescribed off-label by clinicians to treat certain pain-related conditions, including the following:
But available data suggests that gabapentin is likely not effective in treating a wide variety of other chronic pain conditions, such as
sciatica,
migraine, and low
back pain, despite sometimes being prescribed for these purposes.
“It is not FDA-approved for general pain, musculoskeletal pain, or back pain — though it is used off-label for these,” adds
Joseph Liao, MD, a clinical assistant professor of anesthesiology, perioperative, and pain medicine at Stanford University School of Medicine in Stanford, California.
This is because there isn’t enough data backing its benefits for those other conditions, Dr. Growdon says.
“The evidence to support off-label gabapentin use for most clinical conditions (including painful conditions as well as others) is limited, with a lack of quality, unbiased, and often at-best-mixed data,” he says.
Here’s a breakdown of some of the conditions that involve nerve pain that gabapentin may be beneficial for treating, according to some evidence:
- Postherpetic neuralgia pain (PHN), or nerve pain that happens after a shingles infection occurs, is an FDA-approved use of gabapentin, which is available in capsule, tablet, and oral solution form. It’s considered to be a first-line option for this shingles complication.
- Restless legs syndrome (RLS), a condition that causes uncontrollable movement and painful sensations in the legs. Current medical guidelines from the American Academy of Sleep Medicine strongly recommend gabapentin as part of RLS treatment.
- Diabetic neuropathy pain, or pain that occurs as a result of damaged nerves from high blood sugar levels, may benefit from gabapentin. While gabapentin is not FDA-approved for this purpose, it’s still recommended by the diabetes professional medical association, and physicians often utilize it as a first-line treatment in these cases.“There is general consensus of effectiveness for gabapentin when used for painful diabetic neuropathy — though not without caveats,” Growdon says.
While clinicians and patients report that gabapentin may be effective at calming nerve pain for non-FDA-approved conditions like diabetic neuropathy, more scientific evidence is needed before it can be broadly — and officially — recommended. “The off-label use of gabapentin is commonplace for nerve pain conditions; however, specific studies for other pain conditions may be more limited despite its [possible] efficacy,” says Dr. Liao.
As with any medication, there are potential side effects that can come with taking gabapentin. Some include:
- Drowsiness
- Dizziness
- Headache
- Blurry vision
- Coordination difficulties
- Weight gain
- Swollen hands, legs, and feet
- Nausea or vomiting
- Fever
- Memory loss or confusion
- Difficulty speaking
- Double vision or unusual eye movements
- Skin rash or hives
- Swelling of the face, tongue, throat, lips, or eyes
- Difficulty swallowing or breathing
- Seizures
- Abnormal changes in mood or behavior
- Trouble urinating, dark-colored urine, or blood in your urine
- Yellowing of the skin and eyes (jaundice)
- Bluish tint to lips, skin, and nail bed color
Talk to your healthcare provider as soon as possible about any side effects you may notice while taking gabapentin. Seek immediate emergency medical care if you’re experiencing serious side effects like trouble breathing, confusion, abnormal dizziness, a bluish tint to skin, lips, or nails, or unresponsiveness.
Data also suggests that there can be a potential for misuse or dependence when taking gabapentin — particularly when combined with opioids or sedatives, Growdon says.
“We know that taking three or more centrally nervous system active medications increases the risk of falls in older adults, which can be a major cause of morbidity and even mortality among older adults,” Growdon explains.
With this in mind, gabapentin may not be the best choice for certain populations, including:
- Older adults, as the medication can increase drowsiness and risk of falling
- People with lung or respiratory conditions, as it can lead to serious breathing issues
- People with kidney disease, as it may not clear the body properly, which could lead to toxicity
- People who are pregnant, as while human research is limited, some evidence suggests a potential link to a higher risk of birth impacts, particularly in late pregnancy As with other medications, gabapentin use should be discussed in consultation with your healthcare provider to assess individualized safety during pregnancy.
Gabapentin may be a pain management treatment option for people with nerve pain-related conditions. “Patients with nerve-related pain conditions are potential candidates for gabapentin; however, evaluation by a medical professional is necessary before it can be prescribed,” Liao says.
But even if you’ve been diagnosed with neuropathic pain, it’s important to ask your healthcare provider about the specific potential risks and possible benefits of gabapentin.
“When discussing chronic pain with a primary care physician, focus on how the pain has changed your ability to do your activities of daily living, sleep, or exercise, and what an effective treatment would look like for you,” MacKenzie says.
In addition, a healthcare provider can advise you about available pain management approaches — including other nerve pain medications, physical therapy, topical treatments, and lifestyle modifications.
“Medication may be one part of this, but mindfulness, physical therapy, acupuncture, and other modalities may be effective ways to control pain without the side effects of medication,” says MacKenzie. “Sometimes, medication does help patients — even when prescribed off-label, like gabapentin. It is important to have a reward-risk discussion with your doctor to see if it is the right fit for you.”
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