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DEAR DR. ROACH: You have commented on gabapentin before. This seems to be a miracle drug that they're giving out to everyone for everything. However, I'm absolutely convinced that this drug made both of my parents crazy. Both were given gabapentin in the hospital, and I absolutely felt that it altered their mental state. For the record, both were in their 80s and were hospitalized after falls.
-- K.W.
ANSWER: Gabapentin (Neurontin and others) is frequently used for several conditions. It's only indicated by the Food and Drug Administration for a particular type of seizures and postherpetic neuralgia, which is the sometimes-devastating pain syndrome that can occur after an episode of shingles (especially in older people).
However, gabapentin is often used off-label, meaning without an FDA indication. There's nothing wrong with this, but you're right that it seems to be used for a lot of conditions -- the most common of which is nerve pain from many causes, not just nerve damage by shingles.
Its effectiveness in cases of neuropathic pain is moderate in my experience. Some people get excellent results even at modest doses (such as 300 mg three times daily or less), while others need very high doses to receive a benefit (900 mg three times daily or more). The sedation from gabapentin can be disabling, so very slowly increasing the dose helps prevent this.
Other conditions that gabapentin may be used for include alcohol use disorder; itching from chronic kidney disease; cough (due to laryngeal neuropathy); tremors; severe anxiety; depression; restless legs syndrome; hot flashes; and many others.
The side effects of gabapentin are significant. While I'm never sure what people mean by "crazy," frequently found side effects on a person's neurological and psychiatric health include emotional lability (such as going from angry to happy very quickly); hostility or aggressive behaviors; problems with concentration; restlessness and hyperactivity; and agitation. (These all come directly from the FDA package insert.)
Depression, memory impairment, stuttering, hallucinations and suicidal tendencies are also reported. There's an increased risk of being diagnosed with cognitive impairment or dementia after multiple prescriptions for gabapentin.
With all of these issues, physicians need to be very sure that the benefits outweigh the risks of prescribing gabapentin.