Gabapentin use on the rise, especially in older patients

I covered some of the hazards in my book, Radical Resilience.  I’m glad to see rising awareness of the hazards that come with a gabapentin prescription.  I blogged about it here.

Link to this medscape article here

Prescriptions for gabapentin have skyrocketed — from 24 million in 2010 to nearly 59 million in 2024 — making it the fifth most dispensed drug in the U.S. Yet the data paint a worrying picture: the steepest rise is in older adults and women, populations most vulnerable to its side effects.

As I discussed in Radical Resilience, gabapentin is far from benign. Neurocognitive decline, delirium, and gait instability are real concerns — especially when combined with opioids or in patients with declining kidney function. Geriatric specialists urge a return to the mantra: start low and go slow.

This story highlights a deeper problem: the inertia of prescription habits and the lack of safer, non-pharmacological pain strategies. It’s another reminder that prevention and system balance — not substitution — are the hallmarks of Doctor One medicine.

“Prescriptions for gabapentin have surged over the past decade, making the drug the fifth most dispensed medication nationwide in 2024, despite growing safety concerns for older adults, according to new federal data.

Researchers from the CDC found that gabapentin prescriptions increased from about 24 million in 2010 to nearly 59 million in 2024, according to a study published in the Annals of Internal Medicine. The number of patients receiving the drug more than doubled during that time, increasing from 5.7 million to over 15.5 million…

“Gabapentin should not be routinely prescribed to older adults due to a constellation of age-related risks and adverse effects,” said Awais Alam, MD, a geriatrician at Massachusetts General Brigham in Boston, who was not involved with the study.

“Although gabapentin alone is infrequently involved in fatal overdose, serious breathing difficulties may occur in patients with respiratory conditions or those using gabapentin in combination with opioids,” the researchers wrote.

“Once prescribed, there is a prescribing inertia,” he said. “I’ve had many experiences when a patient tells me gabapentin has been marginally effective or not effective, and yet they keep taking it because ‘my doctor prescribed it.’”

Because gabapentin is cleared through the kidneys, a decline in renal function due to age can result in the drug’s accumulation and toxicity, he said.

He urged clinicians to follow a cautious approach, especially after surgery. “When starting a pain medication postoperatively, it is best to stick with the geriatric prescribing mantra of ‘start low and go slow,’” Alam said.

Alam pointed to evidence linking concurrent gabapentin and opioid use with higher risks for hospitalization and opioid-related deaths.

“Alternative therapies with more favorable safety profiles should be considered when possible for older adults,” he said. ” (Acupuncture please!!!!)