Off-Label Gabapentin: What the Science Says?>

Off-Label Gabapentin: What the Science Says

by Frieda Wiley  

The anticonvulsant drug gabapentin is prescribed to treat many symptoms and conditions beyond those for which it's approved by the FDA. Here are some common off-label uses and how the evidence stacks up for each:

  • Alcohol and cannabis withdrawal—shows some success for supervised alcohol withdrawal; one clinical trial supports use to reduce cannabis withdrawal symptoms
  • Chronic cough—more effective than placebo in one trial for calming unexplained long-term cough; the American College of Chest Physicians recommends it in some cases for chronic cough
  • Diabetic neuropathy—some studies show moderate benefit; most results are mixed
  • Essential tremor—some evidence that it helps reduce limb tremor when first-line treatments fail
  • Fibromyalgia—little evidence; may be tried as an alternative to pregabalin when cost is an issue
  • Low back pain and sciatica—no evidence; shown to be ineffective in one large trial
  • Migraine prevention—limited evidence supports its use
  • Menopausal hot flashes—comparable to the antidepressant venlafaxine (Effexor) in some trials; may be considered if antidepressants don’t work; as effective as estrogen in one small trial, but has more side effects; effective for nocturnal hot flashes
  • Other (nondiabetic) neuropathic pain—limited evidence; may be used for pain associated with multiple sclerosis or stroke when first-line treatments aren’t well tolerated or ineffective
  • Other pain syndromes—no evidence for complex regional pain syndrome, traumatic nerve injury, burns, chronic prostatitis/chronic pelvic pain syndrome, or other pain syndromes
  • Restless legs syndrome—limited evidence supports its use
  • Psychiatric disorders—evidence shows modest effect for social anxiety disorder; no evidence supports use for bipolar disorder

This article first appeared in the September 2019 issue of UC Berkeley Health After 50.