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Gabapentin remains an enigma: one of the most widely prescribed and abused drugs yet one with relatively little scientific justification for its use.  Approved as an add on for partial seizures in adults and children, it gained a certain following for treatment of severe nerve pain following in the aftermath of shingles – post-herpetic neuralgia (PHN).

Even for post-herpetic neuralgia, gabapentin fails to live up to expectations.  Only moderate quality evidence exists regarding this indication.  Unfortunately studies indicate only 15% of individuals benefit by a 50% reduction in pain compared to those receiving a placebo.  And typically the investigations lasted only two to three months in PHN where symptoms persist for months to years.

Gabapentin finds a certain cache as therapy for pain.  However it fails to control acute pain, post-operative pain or HIV related neuropathic pain.  Similarly it lacks merit in combating anxiety, depression, bipolar disorder, obsessive compulsive disease and hot flashes.  Gabapentin does not assist in smoking cessation, alcohol withdrawal, irritable bowel syndrome or multiple sclerosis.  Gabapentin soothes neither low back pain nor sciatica.

An estimated 90% or more prescriptions are directed to off label use – treatment for conditions not authorized by the FDA.  Even for partial epilepsy it fails to provide relief in nearly 80% of patients.

Interestingly Gabapentin decreases the concentration of hydrocodone in the bloodstream.  Superficially this interaction may appear beneficial, however this combination often results in problems.  When these people discontinue Gabapentin, hydrocodone levels substantially increase which potentially predisposes to respiratory compromise.

In spite of this harmful interaction with hydrocodone, an estimated 50% of opioid abusers add Gabapentin to their drug cocktail.  Actually Gabapentin ranks as one of the most widely abused drugs in American prisons.

Among the complications of Gabapentin are dizziness, drowsiness and fatigue.  Some individuals develop hostility, agitation and loss of libido.  Sudden discontinuation of the drug may lead to suicidal thoughts and behaviors.  Other common withdrawal symptoms include anxiety, insomnia, nausea, vomiting, excessive sweating, confusion, disorientation and flu-like episodes.

Internal company documents made public during one of the many lawsuits filed against the makers of Gabapentin reveal a top corporate executive referring to the drug as “The snake oil of the 20th century.”  A former executive in the neuroscience division found “negligible evidence” for its use as an antidepressant.

The cash price for one month of the brand name Neurontin averages approximately $600 with generics available for less than $100.  Readily available coupons bring the monthly cost to $10-20.

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