Gabapentin: link to side effects and dementia risk?
Gabapentin is an FDA-approved prescription drug that is primarily used as an anticonvulsant to treat neuropathic pain and to control epileptic seizures. However, it is also often prescribed “off-label” — for pain relief or as a treatment for fibromyalgia, sciatica, insomnia, anxiety, hot flashes, and low back pain. The drug is popular because it does not cause the severe addiction seen with opioids. Like any medication, gabapentin has possible side effects, including nausea, dizziness, fatigue, headache, memory problems, and speech difficulties.
However, a new study shows that people who have had six or more prescriptions of gabapentin for low back pain are at higher risk of mild cognitive impairment and dementia.
Can gabapentin increase the risk of dementia?
The study, published in the journal Regional Anesthesia & Pain Medicine , used data from the TriNetX health research network . The researchers analyzed information from more than 26,000 adults with chronic pain, chronic pain syndrome, chronic low back pain, or lumbar radiculopathy. The data was compared to a control group of the same number of participants who were not taking the medication. The participants were then divided into five age groups: 18–34, 35–49, 50–64, 65+, and a general group of 18–64. The results were followed up ten years later to see how many of them developed mild cognitive impairment (MCI), Alzheimer’s disease, or vascular dementia.
“There is currently some controversy about whether gabapentin increases the risk of dementia in patients,” Nafis B. Eghrari, the study’s first author and a fourth-year medical student at Case Western Reserve University School of Medicine , told Medical News Today . “There is a lack of strong understanding of how gabapentin affects cognitive function and whether it may contribute to neurodegenerative processes. Previous studies have shown conflicting results. So we decided to fill that gap.”
The results showed that participants with six or more gabapentin prescriptions had a 29 percent higher risk of dementia and an 85 percent higher risk of MCI . “The significance of this finding is that it establishes an association between gabapentin prescriptions and dementia at a national level,” Eghrari said. “This does not prove a cause-and-effect relationship, but it warrants further studies on the long-term effects of the drug.”
Moreover, the team found that the risk was highest for the 35-49 age group: they had a double risk of dementia and a triple risk of MCI. Eghrari explains that they were surprised that the greatest increase in risk was in the non-elderly population, since people over 65 are generally at higher risk of neurodegeneration.
Limitations and criticisms of the study
This observational study has some limitations. One of them is the lack of information about other diagnoses or concomitant medications of the participants. There are also many factors that influence the risk of dementia, so it is impossible to determine the exact cause, especially in studies with large databases.
“One very important factor that hasn’t been looked at is physical activity levels,” Professor Tara Spiers-Jones, director of the Brain Sciences Research Centre at the University of Edinburgh, told Medscape . “People with chronic pain who take gabapentin may have been less physically active — and that’s a known risk factor for dementia.”
Ian Maidmont, professor of clinical pharmacy at Aston University , Birmingham, also notes that the analysis did not control for duration of treatment and dosage. He stresses that other similar studies have not found a link. “So it is still not clear whether gabapentin causes dementia,” he adds.
Dr. Neil Anand, a board-certified orthopedic surgeon who was not involved in the study, notes that the only way to prove causality is to compare patients taking only the drug with a similar group not taking it, ensuring that they were taking it correctly. Still, he concludes, “At least we can be aware of the potential side effects of long-term gabapentin use.”
Main conclusions
see the next page
