Gabapentin (Neurontin) is approved by the US Food and Drug Administration for treatment of epilepsy and post-herpetic neuralgia. Despite lack of strong evidence, gabapentin is also often prescribed off-label for psychiatric conditions. The case described here involved a 38-year-old male physician with substance intoxication delirium and psychoactive substance dependence due to high self-administered doses of gabapentin, which had been prescribed at lower doses in combination with buspirone and bupropion for depression and anxiety. This unusual case of gabapentin dependence and abuse involved toxic delirium, intense cravings, and a prolonged post-withdrawal confusional state reminiscent of ben-zodiazepine withdrawal. Gabapentin is a central nervous system inhibitory agent with likely gamma-aminobutyric acid (GABA)-ergic and non-GABAergic mechanisms of action. The similarity between benzodiazepine withdrawal and what this patient experienced with gabapentin suggests a common role for GABA-related effects. The case reported here suggests the need for heightened concern regarding the off-label prescription of this drug to vulnerable individuals with psychiatric conditions. (Journal of Psychiatric Practice 2009;15:314-319).
*Stefan P. Kruszewski, MD & Associates, Harrisburg, PA
†Clinical Professor and Vice Chair for Clinical Affairs, Columbia University, Department of Psychiatry
Disclosure: Dr. Kruszewski does not have any current business or financial arrangements with any pharmaceutical company. Prior to 2001, Dr Kruszewski participated on the speaker's bureaus of the following companies: Pfizer, Inc. GlaxoSmithKline, Janssen (Johnson and Johnson), Astra Zeneca, Wallace Labs, Eli Lilly, GE-Amersham Biosciences; and previously served on an Eli Lilly Northeast Advisory Panel (1998). Dr Kruszewski has been, and continues to be, directly involved as an expert in olanzapine, gabapentin, sertraline and OxyContin state and federal, individual plaintiff, and class action litigation. Dr Kruszewski currently owns less than $25,000.00 in Celgene common stock.
Dr Paczynski does not have any current business or financial arrangements with any pharmaceutical company. He had brief experience as a speaker for Astra-Zeneca on two occasions in 2002 and 2003.