The Hidden Risks of America's Most Popular Prescription Painkiller (gabapentin)
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Approved by the Food and Drug Administration decades ago for seizures and nerve pain from shingles, gabapentin is now the seventh-most widely prescribed drug in the U.S., according to the Iqvia Institute for Human Data Science. About 15.5 million people were prescribed gabapentin in 2024, according to an analysis by Centers for Disease Control and Prevention researchers. Studies show that most of the prescriptions are written to treat conditions that it wasn’t approved for—a practice that is legal and common, but means the FDA hasn’t vetted its risks and benefits for those purposes.
Some doctors say gabapentin can be helpful for certain types of neuropathic pain, a condition resulting from nerve damage. But doctors also give it to patients with other types of chronic pain, anxiety, migraines, insomnia, distorted sense of smell and hot flashes in menopause. Veterinarians dispense it to calm or treat pain in cats and dogs.
A growing body of research shows it isn’t as safe or effective as doctors have long thought. Gabapentin has been associated in studies with greater risk of dementia, suicidal behavior, severe breathing problems for people who have lung disease, and edema, in addition to well-known side effects like dizziness.
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People sometimes take opioids and gabapentin at the same time—either prescribed by a doctor, or on their own. The CDC warns the combination is potentially deadly. At least 5,000 people have died from gabapentin-involved overdoses in each of the past five years, according to federal and state data.
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Gabapentin quiets nerve firing in the spinal cord and brain. It works in about 12 separate chemical pathways in the body, making it a complex drug that can act differently in different people, said Dr. Marc Russo, a pain specialist and researcher in Newcastle, Australia, who wrote a 2022 research article titled “Gabapentin—Friend or foe?” He called the drug a two-headed Janus, useful when prescribed for the right condition but harmful when it’s prescribed for other conditions, produces side effects or has no benefit. “The trouble is that this two-headed nature is appreciated by about 5% of doctors in my opinion,” he said.
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