Risks v. Benefits of prescribed Gabapentin Use in the Elderly

What is Gabapentin?

Gabapentin is used to treat chronic neuropathic pain, but it may cause dizziness, drowsiness, and confusion in some older adults.  Making the decision on whether the benefit of gabapentin outweighs the side effects, which could lead to increased falls, may seem daunting.  Gabapentin is one of the most common drugs used for neuropathic pain and psychiatric disorders, including bipolar disorder.  Gabapentin is used in 82.6% of people who need anticonvulsants.  Dosing for gabapentin has a wide variety.  The average dose is 975 mg/day, ranging from 100 to 4800 mg/day.  Older adults should be started on a low dose of gabapentin, and then titrated to the optimum mg/day per each individual resident.

The Study

One study done revealed that residents with gabapentin prescriptions higher than 600mg/day had an increased risk of hospitalization with altered mental status than residents with a prescribed dosage less than 600mg/day, however there was not a statistically significant higher risk of mortality.

Since gabapentin is almost entirely eliminated by the kidneys, kidney function should be closely monitored, and in some cases, dose-reduction of gabapentin may be necessary if the kidneys begin to be affected, especially those with chronic kidney disease as a pre-existing condition.

Despite the risks of altered mental status and possible decreased kidney function, gabapentin has been proven to significantly improve the quality of life secondary to neuropathic pain reduction.  The study showed that residents taking 600 mg/day or less of gabapentin had decreased hyperesthesia, decreased episodes of lancinating pain, and reduced burning pain.  Residents taking 900 mg/day received moderate to excellent pain relief.

The study concluded that close monitoring of the resident and low dosing (600 mg/day or less) of gabapentin is most beneficial to the elderly resident if they are receiving the benefits of pain relief including a decreased burning sensation.

Risk v. Benefit

Despite the positive effects revealed in the study above, gabapentin has many side effects that may outweigh the benefit of gabapentin, and each individual resident should be monitored and evaluated separately.

Common Side Effects of Gabapentin:

  • Abnormal eye movements that are continuous, uncontrolled, back-and-forth, or rolling
  • Clumsiness or unsteadiness
  • Constipation
  • Diarrhea
  • Difficulty speaking
  • Drowsiness or tiredness
  • Dry mouth
  • Nausea
  • Vomiting
  • Altered mental status

Serious side effects:

  • Violent behavior, aggressiveness, anger
  • Anxiousness or restlessness
  • Anxiety that is new or worse
  • Depression that is new or worse
  • Irritability that is new or worse
  • Mania
  • Panic attacks
  • Suicidal thoughts or behavior
  • Insomnia

Gabapentin’s side effects of altered mental status, dizziness, and unsteady gait lead to increased falls in the elderly, which increases the risk of hip fractures, and other life-threatening injuries.  If your loved one is prescribed gabapentin, make sure that there are fall risk interventions in place and that they are benefiting from the drugs positive effects.  Additionally, it is important to keep an eye on renal function, to ensure your loved one is not experiencing the adverse effects of kidney failure or decreased kidney function.  Gabapentin can be a beneficial drug, but the side effects of the drug are extremely scary, and your loved one should be monitored as closely as possible to decrease the risk of falls and other injuries.  If you believe a loved one has unnecessarily suffered from the side effects of gabapentin, please contact us.

 

 

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