From the Guidelines
Gabapentin is associated with confusion in older adults according to the Beers Criteria, and its use should be approached with caution due to the risk of central nervous system effects, including confusion, sedation, and dizziness. The American Geriatrics Society's Beers Criteria specifically identifies gabapentin as a medication that should be used with caution in elderly patients because it can cause these adverse effects, which are more pronounced in older adults due to age-related changes in pharmacokinetics and pharmacodynamics 1. The risk of confusion is particularly concerning in patients who already have cognitive impairment or dementia. When gabapentin is necessary for pain management or seizure control in older adults, it's recommended to start with lower doses, titrate slowly, and monitor closely for adverse effects, as suggested by the principles of deprescribing and managing polypharmacy in older patients 1. Key considerations include:
- Starting with lower doses, such as 100mg daily or 100mg three times weekly in those with renal impairment
- Titration should be slow and cautious
- Close monitoring for adverse effects, including confusion, sedation, and dizziness
- Regular reassessment of the need for continued therapy and consideration of dose reduction or discontinuation if adverse effects occur, in line with the recommendations for managing high-risk medications in older adults 1.
From the Research
Gabapentin and Confusion
- Gabapentin is associated with adverse outcomes such as dizziness, drowsiness, and confusion in older adults, as reported in a retrospective population-based study 2.
- The study found that high-dose gabapentin (>600 mg/day) was associated with a higher risk of hospitalization with altered mental status compared to low-dose gabapentin (≤600 mg/day) 2.
- Another study found that gabapentin initiation was significantly associated with cognitive and functional status decline, including worsening cognitive function and increased falls, in older adults with normal cognition 3.
Beers Criteria
- The American Geriatrics Society (AGS) Beers Criteria provide lists of potentially inappropriate medications to be avoided in older adults, including those that may cause confusion 4, 5.
- The criteria are updated regularly to reflect new evidence and include medications that should be avoided or have their dose adjusted based on kidney function and drug-drug interactions 4, 5.
- The Beers Criteria are an important tool for clinicians to identify potentially inappropriate medications and improve patient outcomes in older adults 6.
Association with Confusion
- While the Beers Criteria do not specifically mention gabapentin as a medication to avoid in older adults due to confusion, the evidence suggests that gabapentin may be associated with confusion and other adverse cognitive effects in this population 2, 3.
- Clinicians should exercise caution when prescribing gabapentin to older adults and monitor for signs of confusion and other adverse effects 2, 3.