Is Gabapentin on the Beers Criteria?
Gabapentin itself is not listed as a medication to avoid in the Beers Criteria, but it is specifically mentioned in the context of dangerous drug-drug interactions that must be avoided in older adults. 1
Key Distinction: Not a PIM, But a High-Risk Interaction
Gabapentin (and other gabapentinoids) does not appear on the primary list of potentially inappropriate medications (PIMs) to avoid in older adults. 1, 2 However, the 2019 American Geriatrics Society Beers Criteria update added a critical new recommendation regarding gabapentinoids:
- The concurrent use of opioids and gabapentinoids must be avoided (except when transitioning from opioids to gabapentinoids as an alternative). 1, 2
- This combination significantly increases the risk of respiratory depression, overdose, and death. 2
Clinical Implications for Prescribing
When prescribing gabapentin to older adults, you must:
- Screen for concurrent opioid use before initiating gabapentin therapy. 1
- Avoid combining gabapentin with benzodiazepines and opioids, as the 2019 update specifically warns against using three or more CNS agents concurrently due to increased fall risk. 1
- Consider gabapentin as part of the total CNS medication burden, which includes antidepressants, antipsychotics, benzodiazepines, nonbenzodiazepine hypnotics, antiepileptics, and opioids—all of which collectively increase fall risk when used together. 1
Common Pitfall to Avoid
The most critical error is assuming gabapentin is "safe" in older adults simply because it's not on the primary avoidance list. While gabapentin monotherapy is not classified as a PIM, its interaction profile makes it dangerous when combined with other CNS depressants, particularly opioids. 1, 2 Always conduct a comprehensive medication review before adding gabapentin to an older adult's regimen, specifically looking for opioids, benzodiazepines, and other CNS-active medications. 2
Monitoring Requirements
- Assess for polypharmacy (≥5 medications), as this increases the likelihood of problematic drug-drug interactions. 2
- Evaluate fall history, as gabapentin contributes to CNS depression and should be used cautiously in patients with prior falls or fractures. 2
- Review kidney function, as gabapentin requires dose adjustment in renal impairment, though this specific adjustment is not detailed in the Beers Criteria tables. 1