Balancing the Benefits and Risks of Gabapentin

As gabapentin climbs the ranks to become one of the most prescribed medications in the U.S., questions about its safety and scope of use are also rising. This episode explores recent trends in gabapentin use, highlights key patient safety concerns, and examines pharmacist-led opportunities to reduce risks through education and medication review. You will walk away with timely insights to help navigate the growing complexities and responsibilities associated with gabapentin use.

HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Clinical Editor, CEimpact
Lead Editor, Pyrls

GUEST
Nakia Duncan, PharmD BCGP, BCPS
Associate Professor/ Pain& Palliative Care Clinical Pharmacist
Texas Tech Health Science Center - School of Pharmacy

GET CE FOR THIS LISTENING!
The GameChangers Clinical Update Series for Pharmacists delivers 52 expert-led podcast episodes and 30+ hours of clinically actionable continuing education, all for a one-time purchase of just $99—that’s less than $3 per hour for high-impact learning you can apply immediately in practice. Click here to enroll. 

PRACTICE RESOURCE
Purchase the Clinical Update Series or this course individually to receive the exclusive downloadable practice resource handout to use as a reference guide to the podcast.

 
CPE REDEMPTION
This course is accredited for continuing pharmacy education! Click the link below that applies to you to take the exam and evaluation:

• If you are already enrolled in this course, click here to redeem your credit. 
• To purchase the Clinical Update Series and claim your CPE credit, click here or to purchase this course individually, click here. 

 CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Summarize recent national prescribing trends and safety concerns associated with gabapentin use.
2. Identify pharmacist-led strategies to support safe use, patient education, and medication review involving
gabapentin.

Rachel Maynard and Nakia Duncan have no relevant financial relationships with ineligible companies to disclose.

0.05 CEU/0.5 Hr
UAN: 0107-0000-26-053-H01-P
Initial release date: 2/23/2026
Expiration date: 2/23/2027
Additional CPE details can be found here.

Follow CEimpact on Social Media:
LinkedIn
Instagram

Transcript

Welcome And CE Credit

SPEAKER_00 0:00

Here on Game Changers, we're all about helping you stay ahead of pharmacy practice. But why stop for listening? You can earn CE credit for this episode and hundreds more by visiting CEimpact.com and logging into your account or creating a new one. Get credit, get inspired, and make your learning happen. Hey CE Impact subscribers, and welcome to the Game Changers Clinical Update podcast. I'm your host, Rachel Maynard, and today we'll be discussing a drug that's been around for decades but is still continuing to see a rise in use, GABAPentin. And its increasing use of GABAPentin isn't new either. We first saw headlines about this from 2002 to 2015 when gabapentinoid use more than tripled over that timeframe. Since then, some states made policy changes to address this, like including gabapentin and prescription drug monitoring programs or reclassifying it as a Schedule V controlled substance in an effort to limit inappropriate GABAPentin prescribing. But now we have some new data on dispensing rates, and that brings a fresh opportunity to continue to reevaluate appropriate use of gabapentin and the importance of balancing safety concerns with potential benefits. So to help us clarify the role of GABAPentin, I am so thrilled to welcome our guest, Dr. Nakia Duncan. So welcome, Nakia. So Nikia, can you share a little bit about yourself? So maybe your background, your current role, and why you're interested in this topic.

SPEAKER_01 1:24

Yeah, absolutely. So thank you for having me here. I appreciate it. And as far as my background, I am a pharmacist, a clinical pharmacist, as well as an associate professor for a pharmacy practice. And my practice site currently is in a pain management and palliative care role. So for the most part, I work with patients daily that are suffering with pain. And I see a lot of GABAPentin use as a lot of it on label and off-label, kind of to foreshadow some of our conversation. So that's another reason why I was so interested in this topic. And working with pain management and palliative care, I also see something common in medications that sometimes can make you know gabapentin use tricky. So yeah, just really excited to talk about this topic. Excellent.

Efficacy: FDA Uses Versus Reality

SPEAKER_00 2:13

Yeah, I am really looking forward to having your expertise on this because I think this is a challenging area, often for the reasons you said. And so learning from some of your experience, I think will be great. So thank you so much for your time. So we're gonna start out, I think, with just a little refresher on GABAPentin itself and looking, we'll be looking at efficacy and safety, but let's look at that efficacy side of the coin first. And starting out with those, you mean you sort of alluded to the FDA approved uses versus the off-label uses. So let's start with those FDA approved uses first. I think we know there's a lot of off-label uses too, but let's start with FDA approved ones first.

SPEAKER_01 2:46

Yeah, and honestly, there's only two. There's one for postarpatic neuralgia and focal seizure onset. So those are only two that are FDA indicated. I feel like a lot of times people don't even remember those because there's so many others that we use gabapentin more for in the off-label arena.

Off-Label Landscape And Evidence

SPEAKER_00 3:06

Right, absolutely. So it is surprising when you just sort of hear that narrow focus. And I don't think most people taking gabapentin are taking them for seizures. So yeah, I think that just kind of segues nicely into those off-label uses and beyond those approved uses. What are the most common off-label uses that we see in practice? And and let's also talk about the evidence for those or lack thereof, because I think that's a really important part of this discussion.

SPEAKER_01 3:33

Yeah, so whenever it's kind of just going back and looking through this, I saw like about 10, around 10 or so off-like build indications for GABAPentin. Some of the ones that are more common are going to be things like breastless leg syndrome, some of our pain syndromes like fibromyalgia, neuropathic pain syndromes. We also see things like alcohol use, alcohol use disorder, as well as we see some other things like hiccups, chronic cough disorder. We also see utilization for menopause or vasomotor symptoms, to name a few. There's probably some I'm definitely leaving out, but these are the ones that come to my mind. Um, probably because I see them a little bit more frequently, but there's some with regards to like yes, less utilization, like general anxiety disorder, insomnia, anxiety. And I think that maybe I see those a little bit less due to maybe limited evidence and with regard to utilization. Because I think your question was like, here are all these off-labels, right? So which ones have any evidence? Which ones should we kind of like start working or thinking about? Also, when I review, I kind of look through some of the ones that I use frequently, like neuropathy for neuropathy and fibromalgia. And I feel like they have a good amount of evidence for the use of gabapentin in that area over time. Um, we see that it does show to have good analgesic benefits with a mild-sided effect profile for both conditions. Another area that I see that has good data is whenever we're using it for alcohol use disorder, it's actually been incorporated into the VAD guidelines. So this is another strong area that we can use gapensin with some confidence that it's with confidence. Um areas that kind of have wax and wane. That might be because maybe a lot of people don't have intractable hiccups. It's kind of a condition that we don't see very frequently. But so it doesn't have like a lot of um evidence there. We're mainly seeing case reports with like an N of one or two, but it makes sense, right? Again, it's like we don't have a lot of people with intractable hiccups, but in those small case reports, we did see promising outcomes for GalvaPentin. Okay, some things that have limited, as I mentioned, general anxiety disorder really limits it there. We don't see strong evidence, um, not even in case reports for the utilization of galvapentin or adjunctive therapy for that. So those are the ones that kind of come to mind.

Sleep, Anxiety, And Thin Evidence

SPEAKER_00 6:14

Yeah, I mean, I as you're as you're going through those examples, which are as as I think we can hear, just sort of spanning the spectrum of various types of conditions and concerns. You know, I think of this phrase of like throwing the kitchen sink at something because it's just like this drug that may be tried for all different kinds of things with varying levels of evidence to support those off-label uses. So I think that what I heard is neuropathic pain and alcohol use disorder are some of the ones that may have, even though off-label may have more evidence to support use than maybe some of these other uses, even anxiety, and I think you mentioned sleep too. So would you call that on the sort of less, less or mixed evidence to support use for those indications?

SPEAKER_01 6:57

Yeah, yeah. And I would say probably with regard to insomnia or sleep is probably the least. And I was unable to really find much at all. I think that's really an anecdotal um kitchen throw, if you would say. With regard to gabapentin. So yeah.

Safety Basics And CNS Effects

SPEAKER_00 7:12

Okay. And I mean, that actually it it sort of transitions into the consideration of the safety profile of gabapentin because you might think of it for sleep because sedation, sleepiness, drowsiness, those are potential side effects of gabapentin. But in terms of targeted use for that reason, we may not have the evidence to support that. So let's go ahead and talk about the safety side of things now, that safety side of the coin and and thinking about, you know, we're talking about this continued increase in use. So with that comes potential safety concerns. And what are those safety concerns that we should be thinking about most commonly with gabapentin?

SPEAKER_01 7:52

I think the major side effects for gabapentin are gonna be CNS related. So they're gonna be these are the things that we predict. These are the things that when I start a patient on it, I warn them about. It's gonna be like dizziness, somnolence, drowsiness. And those are things that you know I expect could happen. But some other things that we're being careful about, in particular, if your patient has like renal insufficiency, could be those dramatic or exaggerated responses. So they may even have like a toxic as possible, but they could also have if they have like an anaphylactic reaction to it, which I haven't seen too much, but just to cover it, it can be like hypersensitivity or dress or even Stephen Johnson syndrome. Those are things that could happen with galapentin. But as I mentioned, the more common ones are the ones I mentioned. Also, with older adults, I always think about dry mouth. There is a little bit of anticholinergic activity with galapentin. So, in combination with other anticholinergics, we can get a burden which can cause GI or I'm sorry, she can cause some dry mouth.

Opioids Combo Warning And Risks

SPEAKER_00 9:00

Yeah, and so I think you you summarized that well. And the point about especially in combination with other anticholinergics that concern about dry mouth, I'm thinking about also the issue of gabapentin in combination with other CNS depressants, which you alluded to, but specifically with opioids, for example, and there is a box warning about this combination of gabapentin, gabapentinoids, and opioids, and maybe you can speak about that a little bit too. That's that's I think something that is within the last five, six years that that box warning came out, but definitely something to be thinking about, especially because you know, we've talked about gabapentin use for pain. And so thinking about it either as a substitute, substitute for an opioid or as an add-on to an opioid, where where do you start in terms of sorting out some of those challenges and concerns? What would you summarize for our listeners?

Not Benign: Older Adults And AKI

SPEAKER_01 9:50

Yeah, I think whenever I think about this and kind of even hearing this topic, I I kind of my brain went back, like you said, about thought almost 10 years, honestly. Is it a pensive thing? Yeah, honestly, I went like, whoo, went back there. And the reason for that is because about 10 years ago, we saw the opiate crisis happen and you know be labeled as the opiate crisis. And in 2016, the CDC issued this, you know, statement saying, hey, we need to really monitor opiate use. And subsequently at that time, we started seeing a gabapentinoid increase, right? And I think that what the thought was is that gabapentin was less of a concern or even a mild or non-concern, right? And over time, when we have relaxed and kind of like come a little bit out of the opioid crisis, we see that that increase in GABAPentin use had some effects where in combination with opioids and other CNS agents, we did see some marked increased CNS effects. So, a long-winded way to say that you know it's not a benign medication, which I believe that we at some point felt like even though there's a label that says CNS depression, we felt like it didn't have too much of an effect. I really think that it's a cumulative issue as well as an individualized if your patient already has sensitivities, that it could exacerbate those CNS sensitivities.

SPEAKER_00 11:30

Yeah, absolutely. So just I I to to sort of call out that point that you just said, that it's not necessarily the benign drug. I think that's just so important. Really, to me, a key takeaway from this discussion is that like with the that balance of potentially limited evidence for some of these off-label uses in particular, and the potential safety risks that you just talked about, that risk benefit balance doesn't always make sense for all patients. And like you say, it's benign. And you you work with older adults, and in particular, that's something to be aware of, especially in the context of renal impairment or polypharmacy, some of these other considerations. So yeah, anything you want to add to that thought?

SPEAKER_01 12:11

Or yeah, no, no, I I think definitely driving it home there. I mean, another thing I see sometimes in practice is that, you know, for whatever reason, maybe an older person comes in, they have an AKI, you know, and we stock Gebapentum for a bit, and then they remember they have it in their house, and then they get back on it. But in that time frame, they also got on other medications. And then there was this forgotten, like maybe just even make their providers aware of it because they had permission a while ago to use it, and now they got back on it. And now it's like, oh, I'm so tired, I'm so sleepy, mom had a fall. All these kind of things are happening, and sometimes it's not inherent, like why this is happening. And then, you know, with yeah, without having that good discussion about like, oh, oh, this is the gabapentin that could be causing this because of all those shifts and changes and fluctuations and medication utilization.

SPEAKER_00 13:02

Absolutely. Yeah. Yeah, I love how you're calling out, you know, that this was I I remember when that the box warning about opioids with gabapentinoids came out and it was challenging because many people were taking them together. And so the concern around how do I explain this to a patient, what the risk is. But I think what you're hitting on is sort of this idea of any minor other change, change in medications, change in health status, change in, you know, hydration, all of these things could sort of tip that balance into potentially increased risk for serious side effects.

Chemo Patients And Misattributed Symptoms

SPEAKER_01 13:35

Yep, that's exactly what I'm saying. Yeah, definitely. And you know, different subsets of patients are at higher risk. I mean, I've said older adults a few a few times, but as I mentioned, I work with patients that are in chemotherapeutic regimens, and that's another really high risk. A lot of times having dehydration and a risk of patients who are frequently on gapapensin, maybe they're on it for an indication I didn't talk about, but chemo-induced neuropathy, they could be on it for that. Or yeah, that's another indication. And sometimes just even moluminacy or chemo-induced. So sometimes they're on it for that, and we know that they are at risk for dehydration and and frequent rapid status changes. So, you know, it can definitely get misconstrued for chemo brain, or maybe even particularly like oh, is something going the patients are getting a little nervous? Like, is something going on with me? And you know, we look, and I think, you know, looking at the timeline, you know, when did that when did this happen? Oh, it's when I started the gabapentin. Okay, well, let's talk about that.

New Dispensing Data And Trends

SPEAKER_00 14:33

Right, right. So, yeah, keeping it top of mind, I think is one of the things that is going to be to me, the the recent data that we have now on the rates of prescribing dispensing is a reason to keep gabapentin top of mind and dig a little deeper in some of those conversations, especially if issues are cropping up. So I just think that's a that's a great point to highlight. So now let's move on to some of the data that we've been sort of dancing around and then just dive into that because I think this is a great, again, a great opportunity for us to think about why this sort of increase in use is continuing to happen and what that will mean for practice. So we had a uh paper that was published that sort of spurred this discussion in the first place. So maybe you can speak a little bit about that, Nikki, and sort of what were the takeaways from that new data.

SPEAKER_01 15:20

Yeah, so there is a like we're then talking about an article that came out. The it looked at the gabapentin trends over almost like 14 years, 2010 through 2024. And the main thing is they were looking at the dispensing trends and retail settings just to kind of see like what's been happening. And one of the strongest things I got out of that is that they found out that the dispensing trends within 2010 to 2016 doubled. They had this doubling of that amount of how many were there. I believe it was, I don't know, oh, I don't remember the exact number, but it was a double in their number on how many there were. Millions. Millions. It was millions. I knew I didn't know exactly what it was, but I knew it was a lot. And it was a lot. And also in that paper, they also found that older adults showed the largest growth in that time post-2016. Um, and again, that was almost, it wasn't exactly double, but almost in that way. So we're seeing a large increase in that. This article also highlighted that Galapentin is currently the fifth, you know, medication that's suspense, fifth most suspense medication on total, right? So that's like we've got a lot of meds. So in if it's coming up as the fifth rank, it really kind of showed that basically that we're really using this quite a bit in the retail pharmacies. One thing that I kind of invalue in evaluating this article, like in my mind, I thought through, I said, well, did we capture we captured all the pharmacies? I think this number could have been even underestimated because in this article they looked at like retail settings, but they kind of excluded long-term care facilities, excluded like uh meal order pharmacies, pharmacies that are inside of a hospital. So it could probably be even more um gablopentin dispensing that we had that that that's available. So those are some of the things I saw, just kind of brief highlights, but other, I don't know if you want to chime in a little bit or have anything that yeah.

Opioid Era Shifts And Prescriber Behavior

SPEAKER_00 17:26

Yeah, yeah. I mean, I I uh to me again, the punchline was the fact that among all of these medications in the US dispensed by community pharmacies, given those limitations that you said, you know, not it may not be counting other practice settings, but that GABAPentin was the fifth most dispensed drug in the US in 2024. I just think that is such really an astounding number, especially considering the the off-label uses that you discussed versus the approved label uses and and the fact to me that suggests that a lot of this prescribing is likely off label and potentially with limited evidence to support it in some cases. And just the fact that it the I had mentioned earlier how initially, sort of around that 2016-2015 timeframe, we had originally seen these increases in gapapentin describe prescribing, and then we had the opioid guidelines that came out and that also further impacted practice. But the fact that despite all of that, where we've come from 2016 to today is still continuing to see the rate is not as high as it was originally, but it's still continuing to go up. And that I think again really speaks to the fact that people are looking for options for managing various conditions and often reaching for gabapentin, it sounds like, based on the data we have that we just looked at. And I guess, you know, to go back to the opioid guidelines and and how that might have impacted practice, because I think that ties in really importantly with this discussion, is you know, when when you see these numbers and the fact that rates are continuing to go up, what do you think are are like the primary reasons why this is happening? Is it because people are using it primarily as an alternative to opioids? And is that appropriate? What do you think are substance for this trend?

Is Gabapentin An Opioid Alternative?

SPEAKER_01 19:18

No, absolutely. That's exactly what I thought. When I first saw this, I looked at the article and I was looking at the data between 2010 and 2016. Another thing I looked at was the types of prescribers. So in 2010, if you look at pain medicine prescribers and you look surgical prescribers, they were barely prescribing GABA pensin. But at the end of 2016, their numbers doubled and tripled with regard to prescribing of GABA pensin. So that told me something, you know, typically pain medicine prescribers and post-surgical are probably would have been using opioids, right? But then when the guidelines came out, they're like, no, you can't do that. It's attributing to the you know crisis. Granted that the 2016 guidelines may have been a little bit knee-jerky with that, but it still prompted like this shift where we need to give patients something, right? Right, but I don't want to give them an opioid. I don't want and and and who's going to follow them after to keep giving them the opioid. So then we're grabbing for something that maybe can work, but we don't know if it will work, but it's at least it's something. And I felt like that is what happened with gabapentin. It got thrown in this. Maybe there's partial evidence. There's so much other off-labeled use of it, maybe it can work here too. And I think that that's what we saw increasing and increasing. And then because of that, if it didn't work, then we just have a bunch of gabapentin being auto-refilled and sitting in people's sitting in people's houses.

SPEAKER_00 20:50

Right, right. And so how how would you address that head on if you had a pay like if you if you were talking to a prescriber, a colleague who's has a patient with pain, thinking about an opioid but wanting something safer for that patient, how would you sort of put the role of gabapentin into context for for that? I obviously there's a lot of patient-specific factors that need to be considered in the scenario, but as a as a general reaction, like you say, uh again towards something else instead of opioids, where would you sort of categorize gabapentin in in managing pain broadly?

Practical Pharmacy Interventions

SPEAKER_01 21:24

I know it's yeah, I think what's important, no, no, no, no, I think what's important in context of this conversation is to again go back to the beginning. It's not a benign drug, right? Right. It has its own effects, right? So we, you know, even though maybe it's not, you know, an opioid, it does have concerns. You know, we have patients that are continuously fluctuating. It's a with fluid renal insufficiency. We don't know what's going on with them from that standpoint. It does potentially cause in a you know, like increases in dizziness, somulence, and those things. So it's not benign. So we can't just think of it in that way, right? So I would first. Hope to educate them in that perspective. And then also let them know that by adding it in, it just increases polypharmacy for those patients. And then maybe even throwing off another cascade that we're going to have to loop around and deal with later. So it may be more appropriate to be judicious with your opiate prescribing, have rules, have boundaries, have lower doses, have shorter frequencies and time frames instead of just throwing a medication that really doesn't make sense, but also could actually increase harm in other ways that we don't intend. That's a conversation.

SPEAKER_00 22:35

Yeah, I think we automatically think of risks with opioids and maybe not as automatically think those risks similar risks that can also crop up with gabapentin too. Even misuse is a concern with gabapentin too. And again, the move towards some states making it a controlled substance speaks to that. So I think that's a great perspective to again keep in mind. So I think you know, thinking about sort of tying this all together, and we've seen these increasing rates, especially in older adults, and taking this as an opportunity to help patients navigate safe use of gabapentin. What are some of the top tips that you'd want our listeners to think about in terms of if they're reevaluating the role of the gabapentin for their patients or they're seeing new prescriptions coming in or refills you know coming through and this conversation is top of mind? What would you what would you advise them to be thinking about or looking for with these patients who are either starting or refilling gabapentin, let's say?

Spotting Prescribing Cascades

SPEAKER_01 23:34

Yeah. I think you know, with regard to thinking about I kind of try to put myself in this place and I decide, well, if I was a community pharmacist, a lot of times these prescriptions come into me, it's just gabapentin. I don't know why the person's on it, right? I think what could be helpful is including a note to them, including in your person, it's for rustless leg syndrome, it's for chronic call-ups, so that the red tail pharmacy can retail pharmacist can be equipped with an opportunity to look better for drug drug interactions, to provide more efficient counseling for the patient, because they're really the first line that in the community for those patients. So I think that's really important. I think, you know, as the ambulatory pharmacist, you know, helping to give that education that Galva Pentin can be used differently. I think as a pharmacist that is working collaboratively with providers, giving education on all of these different miscellaneouses of their off-labeled use, letting them know about the varying levels of limitations and their limited studies, which ones have better data, making sure to refresh our providers on new data that comes out on Gabapendon and its potential harms that might happen. I think that also partnering with our healthcare providers to let them know, hey, make sure to add in your indications because that helps our helps our whole team, right? Helps everybody, right? I think that these are just you know really simple things that, you know, in a way, we just don't think about it. But they're like small, soft touches that really enhance the quality of care. And from the patient perspective, like whenever we're counseling our patients, also in a way telling them the same thing. These are this medication, while it's not a controlled substance, it can still have these, you know, concerns. If you notice this, you know, if your if your you know, heart doctor says this, please communicate it with this. If your renal doctor says this, please communicate it with that, you know, this doctor to try to empower them to make sure that everybody's communicating. I think pharmacists are in a such a unique position because we see all the prescriptions coming in from all the providers. So we're able to kind of disseminate that information back out and educate patients appropriately. Um, so these are just some things I think about that could really help on all aspects of it whenever it comes to Galva Pentin use.

SPEAKER_00 26:06

Absolutely. I think I think you called out a few very great practical takeaways. And yeah, I you had alluded to earlier the idea of this prescribing cascade. And I think that's also a great opportunity for for pharmacists to be staying alert for new symptoms patients may be reporting. And like you say, having to dig a little bit deeper to see is that is that a new symptom? Is that from a new condition or existing condition, and thinking about gabapentin or any other medication the patient is taking for that matter as a possible cause? Because we were chatting before the podcast started about this report where somebody had had fluid retention, a diuretic was added, increasing the risk for falls, and that fluid retention was due to gabapentin and not identified, and that led to this prescribing cascade, as you say. So just a really good example of interventions that pharmacists are just in a great position to be able to make.

Tapering And Discontinuation

SPEAKER_01 26:58

Absolutely. Yeah, whenever I was training, you know, one of the things that my my mentor would say, you know, any symptom should be um considered a side effect until proven otherwise. Yeah. Right? I don't know if all pharmacists, I don't know if all pharmacists heard that, but I did. She was always telling me that any symptom, you know, it's kind of until proven guilty. That's until, you know, you kind of like, you know, it's a side effect, you know, and and figure it out, dig deeper.

SPEAKER_00 27:27

Yeah.

SPEAKER_01 27:27

Um, and that's I feel like that's what pharmacists are trained to do. Dig deep and figure it out. So I would encourage us to keep digging with gabapentin.

SPEAKER_00 27:37

Yeah, I love that phrase, guilty until proven proven otherwise with a side effect instead of instead of yeah, that's a that's a great, that's a great pearl. And just to think about for patients who maybe are thinking about discontinuing gabipentin or switching to something else, what are some safe and practical tips that they may need to be aware of? Do they need to taper? You know, what are again, this this news may sort of prompt some new discussions. And so if we're helping patients switch off or discontinue, what are some key things to keep in mind there?

SPEAKER_01 28:11

Yeah, it it all it does depend on this clinical situation, but generally speaking, we do want to taper down off of that uh as well, kind of the same way we got on, the same way we will get, you know, the GABA pencil, you know, maybe not identical, but you know, kind of slowly moving off of that. And and the reason for that is that, you know, it is stimulating some of our CNS receptors, our GABA pencil in our in our brain. So kind of quickly removing of that could cause some agitation, it could cause some discomfort. So it's nice to kind of move down in a slower fashion, so long as that there isn't any harm being had with the GABA pent. And then of course we would have to remove it more quickly.

The Game Changer And CE Close

SPEAKER_00 28:50

Okay, good to know. Yep. So that's about all the time we have. So I just wanted to wrap up. It is our Game Changers Clinical Updates podcast. And so we always wrap up with a game changer. So, Nikia, what would you say is the game changer that you want our listeners to walk away with about this discussion about gabapentin today?

SPEAKER_01 29:08

I want our listeners to know that gabapapen, despite the fact that it's not a control substance, it is not a benign drug. Remember that gabapapentin should be monitored, it should be educated on, and dig deep a little with gabapentin. Make sure that we're using it in a good way, we're using it in a responsible way. So that's my game changer.

SPEAKER_00 29:29

Excellent. Thank you so much. And thank you so much, Nikki, for your time and taking time out of your busy practice. We really appreciate your expertise on this and really practical examples. I loved it. Great discussion. Thank you. Thank you so much. So, listeners, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpact.com. And as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week.