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Gabapentin for Adults with Neuropathic Pain: A Review of the Clinical Efficacy and Safety

Rapid Response Report: Summary with Critical Appraisal

Pharmacological management of neuropathic pain (NP) includes medications such as anticonvulsants, antidepressants, serotonin noradrenaline reuptake inhibitors, opioid analgesics, cannabinoids and methadone. Gabapentin is an anticonvulsant and has been used to manage neuropathic pain. Gabapentin is not without side effects and there is also potential for misuse. Side effects associated with gabapentin include somnolence, dizziness, peripheral edema and gait disturbances. Gabapentinoids (including gabapentin) in high doses may result in sedative and psychedelic effects. Gabapentin is structurally related to the neurotransmitter gamma aminobutyric acid (GABA) but does not bind to the GABA receptors. Its mechanism of action is through binding to calcium channels and modulating the influx of calcium and thereby bestowing antiepileptic, analgesic and sedative effects. Recent research also suggests that gabapentin acts by blocking new synapse formation. Gabapentin is available in various dosages and formulations. Besides the immediate release gabapentin there is an extended release, gastro-retentive formulation and an extended release gabapentin prodrug (enacarbil) that rapidly hydrolyses to gabapentin.

The purpose of this report is to review the clinical efficacy and safety of gabapentin compared with placebo in adults with neuropathic pain.

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.

Copyright © 2015 Canadian Agency for Drugs and Technologies in Health.

Copyright: This report contains CADTH copyright material and may contain material in which a third party owns copyright. This report may be used for the purposes of research or private study only. It may not be copied, posted on a web site, redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner.

Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at

Bookshelf ID: NBK304850PMID: 26180879


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