Does long-term use of Gabapentin (Gabapentin) cause dementia?

From the Guidelines

There is currently no strong evidence that long-term use of gabapentin causes dementia. Gabapentin is an anticonvulsant medication commonly prescribed for epilepsy, neuropathic pain, and certain anxiety disorders. While some studies have examined potential cognitive effects of anticonvulsant medications, research specifically linking gabapentin to dementia development remains limited and inconclusive, as seen in a study published in 1. Some patients may experience temporary cognitive side effects while taking gabapentin, such as confusion, memory problems, or difficulty concentrating, but these typically resolve when the medication is reduced or discontinued. These cognitive effects are different from dementia, which involves progressive, irreversible cognitive decline.

Key Points to Consider

• The study in 1 discusses the use of gabapentin for neuropathic corneal pain, but does not mention any association with dementia.
• Gabapentin is FDA approved for the treatment of postherpetic neuralgia (PHN) and has been shown to be effective in reducing pain in patients with PHN, as demonstrated in a randomized controlled trial (RCT) of 563 patients with PHN 1.
• Common side effects of gabapentin include dizziness, somnolence, dry mouth, and constipation, but dementia is not listed as a potential side effect.
• If you're taking gabapentin and experiencing cognitive symptoms, discuss these concerns with your healthcare provider rather than stopping the medication abruptly, as sudden discontinuation can cause withdrawal symptoms.

Recommendations for Patients Taking Gabapentin

• Continue taking gabapentin as prescribed by your healthcare provider.
• Monitor your cognitive function and report any changes to your healthcare provider.
• Discuss any concerns about potential cognitive side effects with your healthcare provider.
• Do not stop taking gabapentin abruptly, as this can cause withdrawal symptoms.

Alternative Treatment Options

• Other medications, such as pregabalin, duloxetine, and venlafaxine, may be considered for the treatment of neuropathic pain.
• Lifestyle changes, such as cardio-exercise and nutritional interventions, may also be beneficial in managing neuropathic pain.
• Meditation and mindfulness may contribute positively to pain management and have a positive impact on overlapping co-morbidities, such as depression and anxiety.

From the Research

Association between Gabapentin and Dementia

• The study published in Frontiers in pharmacology in 2023 2 found that patients treated with gabapentin or pregabalin had an increased risk of dementia, with a multivariate-adjusted hazard ratio of 1.45.
• The risk of dementia increased with higher cumulative defined daily doses during the follow-up period, and was significant in all age subgroups, but higher in younger patients (age <50) than in older patients.
• Another study published in Frontiers in pharmacology in 2022 3 found that gabapentin initiation was significantly associated with deleterious neurocognitive changes among older adults with initially normal cognition.

Gabapentin and Neurocognitive Changes

• The 2022 study 3 found that gabapentin initiation was associated with cognitive decline, functional status decline, and motor function change in older adults with normal cognition.
• The study published in The Cochrane database of systematic reviews in 2017 4 found that gabapentin can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy, but did not investigate its association with dementia.

Gabapentin in Dementia Treatment

• A systematic review published in the British journal of clinical pharmacology in 2019 5 found preliminary low-grade evidence suggesting possible benefit of gabapentin and pregabalin in patients with behavioral and psychological symptoms of dementia (BPSD), but noted that well-powered randomized controlled trials are needed to confirm these findings.
• The review suggested that gabapentin and pregabalin could be considered for BPSD when medications with stronger evidence bases have been ineffective or present unacceptable risks of adverse outcomes.

Gabapentin in Epilepsy Treatment

• A Cochrane review published in 2021 6 found that gabapentin has efficacy as an add-on treatment in people with drug-resistant focal epilepsy, but did not investigate its association with dementia.
• The review noted that the trials reviewed were of relatively short duration and provide no evidence for the long-term efficacy of gabapentin beyond a three-month period.