A cohort study of over 52,000 adults with chronic low back pain found that gabapentin prescriptions are associated with a significantly increased risk of dementia and mild cognitive impairment (MCI), notably among non-elderly adults. Published in Regional Anesthesia & Pain Medicine, the study adds to growing concerns about the long-term neurological safety of gabapentin when prescribed for chronic pain rather than its approved indications.1
Gabapentin is FDA approved for partial seizures and postherpetic neuralgia, but has widespread off-label use for various chronic pain conditions, including back pain. The study raises red flags for clinicians and pharmacists alike, especially considering that gabapentin is often perceived as a safer option to opioids.2
correlation With Frequency and Age
Using the TriNetX national database, researchers followed patients for 10 years and matched cohorts by demographics, comorbidities, and concurrent medications through propensity score matching. Patients prescribed gabapentin 6 or more times had a 29% increased risk of dementia and an 85% increased risk of MCI compared with those who never received the drug.
The association was even stronger in patients ages 35 to 64, with more than double the risk of dementia and MCI when prescribed gabapentin. Among patients with 12 or more prescriptions,the dementia risk rose to 40% higher than those prescribed gabapentin 3 to 11 times.
Younger adults,ages 18 to 34,did not show elevated cognitive risk with gabapentin use. In contrast, both middle-aged and elderly patients demonstrated a clear increase in incidence of dementia and MCI with higher exposure levels.1-2
PharmacistS Role in Monitoring and Risk Mitigation
These findings underscore the importance of pharmacist involvement in long-term medication management for chronic pain patients. Gabapentin, although generally well tolerated, is known to cause adverse effects such as drowsiness, dizziness, blurred vision, and difficulty with coordination.3 In 2019, the FDA issued a warning about serious breathing problems when gabapentinoids are used concurrently with opioids or in patients with respiratory risk factors.4
given the rising off-label use of gabapentin and its perception as a “safe” alternative to opioids,pharmacists should proactively assess cognitive risk,especially in non-elderly patients receiving chronic prescriptions. Medication therapy management programs might potentially be especially useful in identifying patients at risk.