Risks and uncertainties about gabapentinoids

The use of gabapentinoids has increased in the recent years. Approvedindications include epilepsy, peripheral neuropathic pain, diabetic neuropathy,postherpetic neuralgia and anxiety disorder. However, these drugs are widely prescribedoff-label for indications such as low back pain, fibromyalgia, migraine or restless legssyndrome. Side effects associated with these drugs are common, highlighting the risk ofrespiratory depression when combined with other drugs that depress the central nervoussystem, suicidal ideation, abuse and addiction. OBJETIVE To review the evidenceavailable on the uses of gabapentinoids (epilepsy excluded) and its associated risks.METHODS A search in Tripdatabase and Dynamed was conducted for clinical practiceguidelines. In addition, a PubMed search was performed including systematic reviews,clinical trials and observational studies in order to analyze the evidence available onthese drugs for their different indications. Data about the use of gabapentinoids inNavarre were obtained from the electronic prescription database of the public healthsystem of Navarre -Osasunbidea (SNS-O). CONCLUSIONS Off-label use of gabapentinoids isnot recommended due to the lack of consistent evidence available and its potential risks(sedation, dizziness or respiratory depression). Some recommendations are provided for asafe prescription of gabapentinoids.