Talk:Gabapentin/Archive 2

Revision by Medgirl131
Thanks for the major revision to this article. I checked the sources and they all seem great to me, as does the revision. It seems really thoughtful.  Blue Rasberry  (talk)  01:25, 30 June 2014 (UTC)

Nerve pain?
You changed the section "pain" to "Neurogenic pain". What is "neurogenic pain"? How is this different from neuropathic pain? Do you know the difference between that and neuralgia or "nerve pain"? Is there such a thing as nerve pain, and if so, what might it be? I thought you might know used because you used this technical term, and some time ago I was trying to sort this out. Thanks for what you have done here.  Blue Rasberry  (talk)  01:30, 30 June 2014 (UTC)
 * Changed it back to pain. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 03:46, 30 June 2014 (UTC)

Deeply confusing section
The following section appears in the article:

"'' Franklin v. Pfizer case Main article: Franklin v. Parke-Davis

By some estimates, off-label prescriptions account for roughly 90 percent of Neurontin sales.[62]''

"While off-label prescriptions are common for a number of drugs and are legal, marketing of off-label uses of a drug is illegal.[52] In 2004, Warner-Lambert agreed to plead guilty and pay $430 million in fines to settle civil and criminal charges regarding the illegal marketing of Neurontin for off-label purposes, and further legal action is pending. The 2004 settlement was one of the largest in U.S. history, and the first off-label promotion case brought successfully under the False Claims Act. The courts of New York State, for example, have refused to certify a class of plaintiffs who took Neurontin for off-label use, finding that they had failed to state that they had any injury.[63]

"The University of California, San Francisco (UCSF) has archived[64] and studied[65] the documents made public by this case, which opens a window into the illegal promotion and marketing of pharmaceuticals. However, Pfizer maintains that the illegal activity originated in 1996, well before it acquired Parke-Davis (through its acquisition of Warner-Lambert) in 2000. Several lawsuits are underway after people who had been prescribed gabapentin for off-label treatment of bipolar disorder later attempted or committed suicide[citation needed]."

The sentence "in 2004, Warner-Lambert . . ." followed later by the sentence "However, Pfizer maintains . . ." creates utter confusion in the reader, who is never told directly why the two companies are connected. (The fact that this connection is mentioned almost parenthetically later in that second sentence does nothing to avoid the reader's intense confusion before getting to that point.)

There is no excuse for this kind of bad writing. The fact that there is a "main article" with presumably more details certainly does not excuse this.

I hope that someone who has more direct knowledge of this case than I can rewrite this section so that it is comprehensible.Daqu (talk) 00:12, 3 December 2014 (UTC)
 * ✅ (i hope - let me know if it is still unclear) Jytdog (talk) 03:19, 3 December 2014 (UTC)

"'' Titrating dose on gabapentin is tricky. Is there a way of monitoring patients that are on it? (like a blood test). If so, or if not, that should be mentioned in the article. -24.240.74.46 (talk) 05:35, 8 May 2015 (UTC)

spinning gifs
please see this discussion Jytdog (talk) 11:42, 15 May 2015 (UTC)

Stanford Dr. Barres study shows Gabapentin halts the formation of new synapses in the brain. Please discuss.
https://med.stanford.edu/news/all-news/2009/10/study-pinpoints-key-mechanism-in-brain-development-raising-questions-about-use-of-antiseizure-drug.html

The paper, published online Oct. 8 in the journal Cell, looks at the interaction between neurons — the extensively researched nerve cells that account for 10 percent of the cells in the brain — and the less-studied but much more common brain cells called astrocytes. Much work has been done on how neurons transmit electrical signals to each other through synapses — the nanoscale electrochemical contact points between neurons. It is the brain’s circuitry of some 100 trillion of these synapses that allow us to think, feel, remember and move. — Preceding unsigned comment added by 50.122.167.96 (talk) 06:20, 10 October 2015 (UTC)
 * I see that the study, http://pmid.us/19818485 (Gabapentin receptor alpha2delta-1 is a neuronal thrombospondin receptor responsible for excitatory CNS synaptogenesis. Barres et al 2008) is now included in the "Pharmacology" section, but not in the "Mechanism of action" section.
 * This mechanism appears relevant to its desired effects according to this: http://pmid.us/22745497 (Thrombospondin-4 contributes to spinal sensitization and neuropathic pain states. Barres et al 2012).
 * But it would also be related to its negative effects/controversies.--Bstard12 (talk) 02:55, 5 September 2016 (UTC)
 * We should be using recent high quality secondary sources per WP:MEDRS Doc James  (talk · contribs · email) 07:38, 5 September 2016 (UTC)

Statements regarding efficacy for neuropathic pain are not consistent with cited article.
This article twice states that gabapentin is effective for 14% of patients with neuropathic pain. The cited article for these statements states:
 * Second tier evidence, with potentially important residual biases, showed that gabapentin at doses of 1200 mg or more was effective for some people with some painful neuropathic pain conditions. The outcome of at least 50% pain intensity reduction is regarded as a useful outcome of treatment by patients, and the achievement of this degree of pain relief is associated with important beneficial effects on sleep interference, fatigue, and depression, as well as quality of life, function, and work. About 35% achieved this degree of pain relief with gabapentin, compared with 21% for placebo.

I suggest that the statements regarding efficacy for neuropathic pain be changed to say 35% instead of 14%. I am willing to make these edits if they will be accepted.

Aocole (talk) 18:57, 8 October 2016 (UTC)
 * ✅ - thanks. Jytdog (talk) 22:50, 8 October 2016 (UTC)

Effectiveness of Gabapentin for Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy
http://rsds.org/pregabalin-and-gabapentin-for-neuropathic-pain-crps-by-brett-r-stacey-md-and-pamela-campbell-md/

The page on gabapentin mentioning Complex Regional Pain Syndrome is wrong. The above link and others from rsdsa.org and several sites that chronicle the treatment of CRPS/RSD prove that it is a very great relief to RSD warriors. I was on it for 2 years in the 90s before getting remission and have been on it for 7 years since coming out of remission. If it were not for this medicine, I could not get out of bed. I hope no one looking for answers came across your post...it could keep them from the help they need. Gabapentin is the goto rx and first line choice for doctors helping people with this disease.

Dulcecantante (talk) 07:42, 5 December 2016 (UTC)
 * Please read WP:MEDRS Best  Doc James  (talk · contribs · email) 11:45, 5 December 2016 (UTC)

Blurred vision?
From personal experience, low-dose gabapentin can cause blurred vision, making it harder to read or to see potential dangers. Some sources reference blurred vision, if not its day-to-day implications. For example, Alberto Verotti et al. "Antiepileptic Drugs and Visual Function." 173.66.5.216 (talk) 22:32, 3 June 2017 (UTC)

no mention of withdrawal, dependence, or tolerance development for daily gabapentin use
At least not when I search the article for these terms. Might be an important addition? Givethemahug (talk) 23:33, 28 July 2017 (UTC)

First sentence
The first sentence typically starts with the generic name in bold followed by either the first or most common brand name.

Often it is in the format "Gabapentin, sold under the brand name Neurontin among others," Not sure the justification for the change?here

User:Medgirl131 restored it to the prior. Doc James (talk · contribs · email) 15:26, 22 June 2018 (UTC)

does grabapentin thin the blood. thank you MR. Leach  — Preceding unsigned comment added by 24.45.126.88 (talk) 17:25, 21 October 2018 (UTC)

WikiProject Medical Student Edit
Hello everyone, I am a 4th year medical student pursuing a career in psychiatry. I am currently enrolled in a course called WikiMedicine that allows medical students to learn about and contribute to the efforts to make Wikipedia a thorough and reliable source. Over the course of the next month I will be editing and adding to this page to enhance the sections regarding uses, side effects, overdose, and the role gabapentin prescription and use plays in society. Particularly, I would like to find more information regarding the addictive properties of gabapentin and what drives its misuse in both neurologic and psychiatric patients.

This article is currently rated as B-class and of mid-importance; I hope to improve its quality scale by the following goals: (1) Verify the quality and appropriate use of citations and sources within the current text (2) Provide additional evidence-based information regarding the use of gabapentin, particularly in the "Anxiety disorders" and "other uses" section. I hope to clarify the current evidence regarding its use in anxiety, and update any other psychiatric indications for its use. (3) Enhance the "Side Effects" section, particularly the "Abuse and addiction" subsection. I will expand upon why gabapentin has addictive qualities, what are the current trends regarding its misuse, and any other updated literature regarding its abuse potential. ( 4) Verify and continue to enhance the "Society and culture" section, particularly the "Off-label promotion" subsection. I will evaluate the laws and regulation behind its prescription, as well as expand upon the impact these laws are having on patient-care. (5) Expand upon "Recreational Use" subsection of "Society and culture" with more information regarding which populations it typically impacts and why its abuse has become more popular.

I look forward to editing this article and receiving feedback from my peers and the community! If anyone has any suggestions, comments, or questions regarding this plan, please feel free to reach out. Thank you! Smangal06 (talk) 13:28, 1 February 2019 (UTC) — Preceding unsigned comment added by Smangal06 (talk • contribs) 03:26, 10 January 2019 (UTC)

Feedback
Overall great job on the article! It reads well and encompasses all the important points about Gabapentin. The article serves as a good source of information about Gabapentin. The pharmacodynamic and kinetics section may be a little detailed for the lay person. however given that is in the manual of style for drugs on the wikiproject medicine page I think the information should stay in the article. The sections you edited are well structured and clear to read. Specifically, per section you edited:

Uses: Great information on anxiety disorders and other uses. The sources were strong and all citation links worked.

Side effects: Very comprehensive. For source 68, however the page was not found. Please find a different source or link for this citation. Under "Cancer", citation 70 goes to drugs.com just verify this is official FDA information. The abuse and addiction section is interesting and provides good information. Some grammar issues: change "affects" to "effects" and in the last sentence "user" to "users". Also maybe add a link to benzodiazepine withdrawal if possible. No corrections to the overdose section.

Society and culture: Add a citation to first and second sentence. Under "off-label promotion" at the end of the first paragraph a citation is needed. At the end of the paragraph under "Franklin v. Pfizer" a citation is needed.

Other than the small additions/corrections above the article was great and very helpful, good job!

— Preceding unsigned comment added by Ucfmed2019 (talk • contribs) 20:11, 27 January 2019 (UTC)


 * Thank you for the feedback! I will go ahead and make the changes you have suggested, and am currently looking to fix the citation links that you found to be problematic. I will also try to find citations for the information that is lacking them. Smangal06 (talk) 13:28, 1 February 2019 (UTC)

Internal Article Condradictions
Article Text (pharmacology): " There are two drug-binding α2δ subunits, α2δ-1 and α2δ-2, and gabapentin shows similar affinity for (and hence lack of selectivity between) these two sites.[10] Gabapentin is selective in its binding to the α2δ VDCC subunit.[80][81]"

I believe this is intended to mean that gabapentin acts as an antagonist of the α2δ-1 subunit but obtains most of its clinical effects due it acting as an agonist of the α2δ-2 subunit. This section needs to be edited to explain that is has similar affinity for these subunits but works differently on them, as the current text appears to directly contradict itself. If I have misinterpreted this information (I did not research the source text) it still needs to be edited to clarify this contradiction.

20 Feb. 2019 - please delete this section once corrections have been made — Preceding unsigned comment added by 107.2.190.142 (talk) 07:35, 20 February 2019 (UTC)

Topical route
If I understand Efficacy of a topical gabapentin gel in a cisplatin paradigm of chemotherapy-induced peripheral neuropathy the route of gabapentin is not only oral but also topical. I leave it to experts to judge. --Error (talk) 19:11, 17 March 2020 (UTC)

One sentence sections
We do not need one sentence sections for minor uses of this medication. They can go under "other". Doc James (talk · contribs · email) 01:16, 4 April 2020 (UTC)

Interaction with antacids
I note that patient instructions generally include a warning not to take Mg/Al antacids within 2 hr of gabapentin. One source also notes an unrelated interaction with cimetidine. From what I've read so far, it seems the antacids interfere with the absorption of gabapentin while cimetidine decreases its clearance rate. This seems important enough to include under pharmacodynamics. However, I haven't so far found good sources for the details of these interactions. I have found these NIH papers:


 * Impact of Concomitant Antacid Administration on Gabapentin Plasma Exposure and Oral Bioavailability — primary source
 * Review about gabapentin misuse, interactions, contraindications and side effects — review paper but very brief mention

Can anyone help? --D Anthony Patriarche, BSc (talk) 07:38, 10 June 2020 (UTC)

Redundant text
The repeated sentence re 1% / 22 % history of abuse under Side effects - Abuse and addiction has now been removed by three separate editors and reverted by two other editors. The redundant text is complete with inline cites and is clearly duplication. Here are the 2 sentences:

(1) Surveys suggest that approximately 1.1 percent of the general population and 22 percent of those attending addiction facilities have a history of abuse of gabapentin.

(2) About 1 percent of the general population and 22 percent of those attending addiction facilities have a history of abuse of gabapentin.

I have once again removed (1). Please leave this alone or discuss here. --D Anthony Patriarche, BSc (talk) 07:06, 1 July 2020 (UTC)

Sources about the toxicity
There are some medical sources on the adverse effect of Gabapentin which aren't yet cited in the English WP article. From the Spanish version of the project: The first two were linked to the website black****-**nergy.com which is blacklisted on en:WP. For both of them there exists a more WP:reliable source to be used. As for what concerns the the third study, the related copy can be verified by an university library.
 * Gabapentin-induced neurologic toxicities (DOI 10.1592/phco.2005.25.12.1817]
 * Gabapentin-induced coma in a patient with renal failure (, OCLC 5156414207, )
 * Gabapentin-associated hepatotoxicity (DOI 10.1111/j.1542-4758.2006.00089.x?journalCode=hdi, )

I don't know the reason why the Spanish article links a website which seems to sell illegal anabolyc steroids. It is a disruptive use of WP and a payed contribution.

Some more specialized expert users of WP who will want to verify if cited sources are compliant with the related originals and how to cite them on WP.

Some years ago, such a drug was used by the Canadian press to create a mediatic case- with a basis personal truth- which was used to extent the euthanasia law even to not mortal states of illness such as wide and plenty variety of psychiatric disorders. The same successful format risks to be repeat in Europe. I hope it won't be so.Philosopher81sp (talk) 13:49, 10 October 2020 (UTC)
 * P.S.:

Problem with this statistics: About 90% of usage is for off-label conditions.
About 90% of usage is for off-label conditions. The problem with this statistics is that it is about the US in 2000-2001. At that point, gabapentin was approved only for seizures, so all prescriptions for neuropathic pain were counted as off-label. I will remove this sentence.

The more recent data from the UK indicates that off-label use was 52% in 2017. I am going to replace About 90% of usage is for off-label conditions. with Gabapentin is widely prescribed off-label in the US and UK

The Sceptical Chymist (talk) 16:44, 14 December 2020 (UTC)

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 7 January 2019 and 1 February 2019. Further details are available on the course page. Student editor(s): Smangal06. Peer reviewers: Ucfmed2019.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 21:59, 16 January 2022 (UTC)

Is gabapentin Chemo
is gabapentin Chemo 2603:7000:C00:F1D8:84D:A42E:ACA2:9F04 (talk) 23:34, 26 August 2022 (UTC)

Does this work for Covid-19 headaches?
https://www.nationalgeographic.co.uk/science-and-technology/2022/09/how-covid-19-headaches-are-different-from-others-and-how-to-manage-them

23 Sept 2022: Experts say 3 types of headaches can occur with coronavirus infection.

* Headache specialists often treat tension-type headaches or Daily headaches with Gabapentin.

* Post-COVID headaches tend to respond well to the Migraine medications AmiTriptyline and NorTriptyline.

ee1518 (talk) 20:36, 26 September 2022 (UTC)

Effects on GABA transaminase or 4-aminobutyrate aminotransferase, or GABA
Why is this article not mentioned? https://www.sciencedirect.com/science/article/abs/pii/0920 The page on gabapentin actively avoids discussion of how gabapentin increases gaba levels in the brain and decreases glutamate levels. 2603:9001:1A06:6EB5:FD6C:3B44:6A4B:317D (talk) 00:19, 20 February 2023 (UTC)

Neuropathy as possible side-effect
I recently heard mention of a new study that found that gabapentin and pregabalin can actually cause (I presume meaning worsen?) periphpheral neuropathy, in long-term use in patients with diabetic neuropathy. It was published within the last six months or so (i.e. late 2022 to early 2023) and I believe NIH-sponsored; unfortunately, I didn't get a reference. A quick Google didn't find the paper in question, and the new Bing AI (!) couldn't help either. It's a primary source, so would be deprecated for inclusion here, especially being very recent. However, since this discovery would be somewhat shocking (although not unique)—a condition caused by its principal remedy—I would lean toward at least mentioning the finding in the article, if the source can be confirmed (and obviously if reliable in itself).

My searching was hampered by the fact that the obvious key-words (neuropathy, side-effect &c) are commonly found in association with these drugs regardless, and I've had little success lately doing Boolean searches with current search engines, which favour popularity over precision. I will do some more digging to try and get the cite, but meanwhile has anyone else found this information? D Anthony Patriarche (talk) 05:40, 16 April 2023 (UTC)