Prescriptions for gabapentin have surged over the past decade, making the drug the fifth most dispensed medication nationwide in 2024, despite growing safety concerns for older adults, according to new federal data.

Researchers from the CDC found that gabapentin prescriptions increased from about 24 million in 2010 to nearly 59 million in 2024, according to a study published in the Annals of Internal Medicine. The number of patients receiving the drug more than doubled during that time, increasing from 5.7 million to over 15.5 million.

Gabapentin, approved by the FDA for partial seizures, postherpetic neuralgia, and restless legs syndrome, is widely prescribed off-label to treat other forms of chronic pain. The study found the sharpest increases in prescriptions were for older adults and women. Patients aged 65 years or older were prescribed gabapentin at more than twice the rate of younger adults in 2024.

“Gabapentin should not be routinely prescribed to older adults due to a constellation of age-related risks and adverse effects,” said Awais Alam, MD, a geriatrician at Massachusetts General Brigham in Boston, who was not involved with the study.

“Although gabapentin alone is infrequently involved in fatal overdose, serious breathing difficulties may occur in patients with respiratory conditions or those using gabapentin in combination with opioids,” the researchers wrote.

“Many clinicians still view gabapentin as ‘benign,’ underestimate fall and delirium risk, and don’t consistently apply renal dose limits or stop rules,” said Samir Tulebaev, MD.

Electronic health record systems “do not provide good safety prompts,” said Tulebaev, associate physician in geriatrics at Brigham and Women’s Hospital in Boston, who was not involved in the study.

Primary care physicians wrote most prescriptions, but nurse practitioners and physician assistants showed the fastest growth in prescribing — an increase of more than sevenfold since 2010, the study found.

Although the rate of growth overall slowed after 2016, the continued rise has prompted renewed concern about the drug’s safety profile.

Tulebaev said the rise in prescriptions reflects “a mix of substitution and convenience” and cited pressure to avoid opioids, limited nonopioid pain options, and time constraints in busy primary care settings.

“Once prescribed, there is a prescribing inertia,” he said. “I’ve had many experiences when a patient tells me gabapentin has been marginally effective or not effective, and yet they keep taking it because ‘my doctor prescribed it.’”

Gabapentin “should be prescribed to older adults only after thorough evaluation of individual risk factors, with preference for the lowest effective dose and vigilant monitoring for neurocognitive and functional decline,” Alam said. Side effects of gabapentin can include neurocognitive decline, delirium, and motor disturbances such as gait instability and falls.

Because gabapentin is cleared through the kidneys, a decline in renal function due to age can result in the drug’s accumulation and toxicity, he said.

He urged clinicians to follow a cautious approach, especially after surgery. “When starting a pain medication postoperatively, it is best to stick with the geriatric prescribing mantra of ‘start low and go slow,’” Alam said.

Alam pointed to evidence linking concurrent gabapentin and opioid use with higher risks for hospitalization and opioid-related deaths.

“Alternative therapies with more favorable safety profiles should be considered when possible for older adults,” he said.

Alam and Tulebaev reported having no disclosures.

Lara Salahi is a health reporter based in Boston.