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Gabapentin is an anticonvulsive medication that received approval from the US Food and Drug Administration (FDA) in 1993 and has been available in generic form in the USA since 2004. Gabapentin was originally used as a muscle relaxant and an anti-spasmodic. However, it was later discovered that gabapentin has the potential of an anticonvulsive medication and can be used as an adjunct to more potent anticonvulsants. The medication also proves beneficial in managing certain types of neural pain and psychiatric disorders. As its applications have broadened, there is a growing demand for interprofessional collaboration among primary care, neurology, anesthesiology, and other pertinent specialties. This activity outlines the indications, mechanisms of action, administration, significant adverse effects, contraindications, monitoring, and characteristics of gabapentin toxicity. This activity also provides clinicians with the necessary skills and tools to treat various types of muscular, neurological, and psychiatric medical conditions, both acute and chronic, thereby improving patients' quality of life. Objectives: Identify the appropriate indications for gabapentin therapy, including neuropathic pain, partial onset seizures, restless legs syndrome, and other relevant neurological and psychiatric conditions. Screen patients for risk factors and contraindications before initiating gabapentin therapy, such as renal impairment, history of substance misuse, or concurrent medication interactions. Apply patient-centered approaches to gabapentin prescribing, tailoring dosage adjustments and treatment plans based on individual needs and preferences. Collaborate with interprofessional healthcare team members to optimize gabapentin therapy by coordinating comprehensive patient care and addressing emerging clinical concerns or treatment adjustments. Access free multiple choice questions on this topic.

At the federal level, gabapentin is not classified as a controlled substance, is regarded as a non-addictive medication, and is recognized by the Centers for Disease Control and Prevention (CDC) as a potential substitute for opioids in managing chronic pain. However, growing concerns about the potential for misuse are increasing.[52] Several US states have moved gabapentin to the Schedule V controlled substance category. Gabapentin does not have a high risk of an overdose but can increase the euphoria caused by opioids and reduce drug withdrawals. An Australian study examined fatal gabapentinoid-related poisoning and discovered that concomitant other drug use is almost universal in such cases.[53] Furthermore, gabapentin can bypass the blocking effects of addiction treatment medications and, unfortunately, does not appear in urine drug tests.[54] Gabapentin toxicity is seen in those with chronic kidney disease or undergoing hemodialysis, showing symptoms like tremors, altered mental states, and respiratory depression requiring intubation. Reports of rhabdomyolysis due to gabapentin have been described.[55][56] No antidote for gabapentin poisoning currently exists. Gabapentin can be removed through dialysis. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup recommends refraining from utilizing extracorporeal treatments (ECTR) and standard care for gabapentin poisoning in patients with normal kidney function. However, if reduced kidney function and coma necessitating mechanical ventilation are evident, the EXTRIP suggests incorporating ECTR and standard care.[57]

Gabapentin is widely prescribed by various healthcare providers, including primary care providers, nurse practitioners, physician assistants, neurologists, internists, and orthopedic surgeons, to address various medical conditions. Apart from its anticonvulsant properties, the drug serves multiple purposes. While gabapentin is generally considered safe, pharmacists play a crucial role in assisting the healthcare team and monitoring patients' medication regimens to prevent potential drug interactions. In a documented case, a patient with diabetes, diabetic neuropathy, and hypertension was prescribed both gabapentin and pregabalin, resulting in adverse effects. Upon intervention by the pharmacist, the physician was contacted, leading to the successful discontinuation of pregabalin. This scenario underscores the importance of effective communication among healthcare professionals in safeguarding patient well-being and achieving favorable treatment outcomes.[41] Nursing staff can address patient inquiries, review dosing information, and act as a liaison for clinicians. Notably, all members of the interprofessional team must recognize the potential for gabapentin misuse. Severe RLS cases may necessitate referral to a movement disorder specialist for gabapentin use. The role of psychiatrists is crucial in effectively managing the conditions that patients experience during alcohol withdrawal. Referral to an epileptologist may be warranted for gabapentin usage in refractory seizure cases. In instances of severe overdose, consultation with a critical care physician and admission to the medical intensive care unit (MICU) may be imperative. Adopting an interprofessional team approach with transparent communication among clinicians, specialists, pharmacists, and nurses is vital for enhancing patient outcomes associated with gabapentin therapy while mitigating potential adverse effects.