Gabapentin Commonly Continued Long-Term After Stroke Despite Limited Guidance, Risk Assessment: Study
USA: A Medicare claims analysis has found that most older adults prescribed gabapentin within 30 days after an acute ischemic stroke continued using the medication for at least a year.
The study published in medRxiv highlights the widespread off-label use of gabapentin for post-stroke pain and emphasizes the urgent need for clearer prescribing guidelines and further research on long-term safety and effectiveness.
The research, led by Shuo Sun from the Department of Population Health Sciences, Weill Cornell Medicine, New York, analyzed treatment patterns among Medicare beneficiaries aged 65 and older who were hospitalized for their first acute ischemic stroke between 2013 and 2021. Using a national 20% random sample of US Medicare data, the team sought to understand how older stroke survivors are prescribed gabapentin and how long they remain on the medication following hospital discharge.
Gabapentin, though widely prescribed for post-stroke neuropathic pain, is often used off-label, and there is limited guidance on optimal duration or dosing in this population. The study focused on patients who initiated gabapentin within 30 days of hospital discharge, analyzing prescription coverage over 12 months using a time-varying proportion of days covered combined with a latent class mixed model. This method accounted for overlapping prescriptions and hospitalizations, while an 80% threshold for days covered was used to differentiate high versus low medication adherence.
Key Findings:
- The final cohort included 1,628 patients with a mean age of 76.4 years.
- 60% of the patients were female, and 76.5% were non-Hispanic White.
- Three gabapentin treatment patterns were identified:
- 42.5% experienced rapid low medication coverage within two months of initiation.
- 5.9% showed gradually declining coverage over eight months.
- 51.6% maintained high and stable coverage for at least one year after discharge.
These findings indicate that more than half of older stroke survivors remain on gabapentin for a year or longer, reflecting both the persistence of post-stroke pain and the routine continuation of off-label prescriptions in clinical practice. The researchers emphasized that while gabapentin can be effective for neuropathic pain, long-term use in older adults warrants careful monitoring due to potential side effects, drug interactions, and the vulnerability of this population.
The study calls attention to gaps in current clinical guidance for gabapentinoid use among older adults, particularly after ischemic stroke. Future research is needed to evaluate long-term safety, effectiveness, and adverse effects, and to explore how these patterns impact outcomes in patients with comorbidities such as Alzheimer’s disease, cardiovascular conditions, and cancer. Additionally, research into optimal pain management strategies, care quality, and functional recovery among this group could inform safer prescribing practices.
The analysis stresses that gabapentin is frequently continued for at least 12 months among older adults following an ischemic stroke, highlighting the importance of developing clear prescription guidelines and conducting rigorous studies on long-term outcomes. These steps could help ensure safer, more effective management of post-stroke pain while minimizing potential risks for older patients.
Reference:
Shuo Sun, Maria A. Donahue, Rebeka Bustamante Rocha, Madhav Sankaranarayanan, Joseph P. Newhouse, Sonia Hernandez-Diaz, Alexander C. Tsai, Sebastien Haneuse, Lidia M.V.R. Moura. medRxiv 2025.09.23.25336477; doi: https://doi.org/10.1101/2025.09.23.25336477
Next Story