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Gabapentin in Myeloma? The article linked below highlights serious problems with this commonlly prescribed pain medication for MM side effects.
Here’s a focused look at gabapentin’s side effects in cancer survivors or patients using it for chemotherapy-induced peripheral neuropathy (CIPN). The context matters because these patients often have other concurrent treatments (chemotherapy, corticosteroids, opioids, etc.) that can amplify or mimic gabapentin’s effects.
⚕️ Most Common Side Effects in Cancer Survivors or Neuropathy Patients
1. Fatigue and Sedation
Prevalence: 30–60% in studies of gabapentin for CIPN or post-chemo pain.
Mechanism: Central nervous system (CNS) depression.
Notes: Often worse in the first 1–2 weeks or after dose escalation; may limit daytime use.
Tip: Taking larger doses at bedtime or gradual titration helps.
2. Dizziness and Balance Problems
Prevalence: Up to 40%.
Impact: Heightens fall risk—especially in older or frail cancer survivors.
Tip: Slow positional changes (standing up slowly), hydration, and physiotherapy can help compensate.
Cause: Additive effect of gabapentin on top of chemotherapy-related cognitive changes.
Tip: Lower evening-only dosing or switching to pregabalin (shorter onset, sometimes fewer cognitive effects) may help.
4. Peripheral Edema
Prevalence: 10–15%.
Mechanism: Gabapentin can cause sodium and water retention.
Relevance: May worsen leg swelling from steroids or inactivity during recovery.
Tip: Light exercise, leg elevation, compression, and dose review if significant.
5. Weight Gain
Prevalence: 5–15% over several months.
Contributors: Increased appetite + reduced activity due to fatigue.
Tip: Monitor weight and adjust caloric intake if persistent.
6. Mood or Sleep Effects
Positive: Many patients report improved sleep and reduced anxiety.
Negative: A minority develop low mood, irritability, or vivid dreams.
Tip: Report any mood changes promptly—especially if there’s a history of depression.
⚠️ Less Common but Clinically Important in Cancer Patients
Respiratory suppression if combined with opioids, benzodiazepines, or sleep meds.
Confusion/delirium in those with renal impairment or dehydration.
Withdrawal symptoms (agitation, anxiety, pain flare) if stopped abruptly.
Poor tolerance in advanced disease—some palliative teams substitute with duloxetine for neuropathic pain.
Is Gabapentin Dangerous? Here’s a Guide to Gabapentin and its Effects
In my experience as a long-term MM survivor,oncologists focus on treating our cancer, which is great, but are less focused on treating side effects. Gabapentin aka Neurontin, is a prime example of this.
Prescriptions for gabapentin have surged over the past decade, making the drug the fifth most dispensed medication nationwide in 2024, despite growing safety concerns for older adults, according to new federal data.
Researchers from the CDC found that gabapentin prescriptions increased from about 24 million in 2010 to nearly 59 million in 2024, according to a study published in the Annals of Internal Medicine. The number of patients receiving the drug more than doubled during that time, increasing from 5.7 million to over 15.5 million.
Gabapentin, approved by the FDA for partial seizures, postherpetic neuralgia, and restless legs syndrome, is widely prescribed off-label to treat other forms of chronic pain. The study found the sharpest increases in prescriptions were for older adults and women. Patients aged 65 years or older were prescribed gabapentin at more than twice the rate of younger adults in 2024.
“Gabapentin should not be routinely prescribed to older adults due to a constellation of age-related risks and adverse effects…”
“Many clinicians still view gabapentin as ‘benign,’ underestimate fall and delirium risk, and don’t consistently apply renal dose limits or stop rules,” said Samir Tulebaev, MD…
Primary care physicians wrote most prescriptions, but nurse practitioners and physician assistants showed the fastest growth in prescribing — an increase of more than sevenfold since 2010, the study found.
Although the rate of growth overall slowed after 2016, the continued rise has prompted renewed concern about the drug’s safety profile.
Tulebaev said the rise in prescriptions reflects “a mix of substitution and convenience” and cited pressure to avoid opioids, limited nonopioid pain options, and time constraints in busy primary care settings.
“Once prescribed, there is a prescribing inertia,” he said. “I’ve had many experiences when a patient tells me gabapentin has been marginally effective or not effective, and yet they keep taking it because ‘my doctor prescribed it.’”
Gabapentin “should be prescribed to older adults only after thorough evaluation of individual risk factors, with preference for the lowest effective dose and vigilant monitoring for neurocognitive and functional decline,” Alam said. Side effects of gabapentin can include neurocognitive decline, delirium, and motor disturbances such as gait instability and falls.
Because gabapentin is cleared through the kidneys, a decline in renal function due to age can result in the drug’s accumulation and toxicity, he said…
“Alternative therapies with more favorable safety profiles should be considered when possible for older adults,” he said.
Gabapentin in Myeloma Gabapentin in Myeloma Gabapentin in Myeloma
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2 comments
Ken friesen says
a couple of weeks ago
I was prescribed gabapentin after my diagnosis when I was experiencing quite a bit of pain. I can’t comment on side effects as much as it didn’t seem to be effective. The Dr switched me to Percocets, which have been very effective. The pain has dissipated with therapy so now I only use them on it as need basis, which is very seldom.
