Off-label use exposes patients to adverse effects and generally is not supported by evidence. The only conditions for which gabapentinoid drugs are FDA-approved to manage pain are postherpetic neuralgia (both gabapentin and pregabalin [Lyrica]) and diabetic neuropathy, spinal cord injury, and fibromyalgia (pregabalin only).
Nevertheless, use of these drugs has tripled during the past 15 years. This increase likely reflects gabapentinoid use for managing non–FDA-approved pain conditions, in part to avoid opioid use.
The markedly increased off-label use of gabapentinoids to manage pain has no or limited evidence of benefit. This practice is worrisome, especially given known high rates of side effects, including dizziness, somnolence, and unsteadiness. In addition, patients often are prescribed gabapentinoids to avoid opioid use, but such patients sometimes still use opioids, either prescribed or illicit. The combination of gabapentinoids and opioids is associated with excess risk for opioid overdose.
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