Gabapentin is commonly prescribed for neuropathic pain, epilepsy, and off-label conditions like anxiety and chronic back pain. Its perceived safety and tolerability have led to widespread long-term use. However, emerging observational studies suggest a potential association between prolonged gabapentin exposure and increased risk of cognitive impairment or dementia, particularly in vulnerable populations. ¹
Gabapentin acts by modulating voltage-gated calcium channels and reducing excitatory neurotransmitter release. While this mechanism helps control neuropathic pain, chronic CNS modulation may also influence cognition, alertness, and neuroplasticity over time. Additionally, sedation, dizziness, and slowed cognitive processing are already recognized adverse effects. ²
For clinicians and Pharm.D professionals, this reinforces the importance of rational prescribing, especially in elderly patients or those on multiple CNS-active medications. Regular medication review, dose adjustment, and deprescribing when appropriate are essential to minimize unnecessary long-term exposure.
Gabapentin remains an effective drug but like any CNS-active therapy, its long-term use should always be periodically reassessed based on risk–benefit balance.
MBH/AB