Gabapentin, which belongs to the class of medications called anticonvulsants, treats seizures by decreasing excitement in the brain. Gabapentin has been studied for its effect in patients with cancer who have neuropathic pain or symptoms of peripheral neuropathy. The drug changes the way the body senses pain. It has also been studied for its effect on anxiety, chemotherapy-induced nausea and vomiting, and hot flashes.
The U.S. Food and Drug Administration (FDA) has issued a warning regarding the use of gabapentin or pregabalin and serious breathing difficulties in people with respiratory risk factors, including older adults, those having conditions that reduce lung function such as chronic obstructive pulmonary disease (COPD), and those using drugs that depress the central nervous system including opioids, anti-anxiety medication, antidepressants, and antihistamines.
Barton, D.L., Thanarajasingam, G., Sloan, J.A., Diekmann, B., Fuloria, J., Kottschade, L.A., . . . Loprinzi, C.L. (2014). Phase III double-blind, placebo-controlled study of gabapentin for the prevention of delayed chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy, NCCTG N08C3 (Alliance). Cancer, 120, 3575–3583.
To compare gabapentin to a placebo on three factors: efficacy in decreasing CINV, tolerability to the medication, and impact on quality of life.
This phase 3 study was a placebo-controlled trial that was randomized and double-blinded.
This study did not support the effectiveness of gabapentin as prophylaxis for delayed chemotherapy-induced nausea and vomiting when used in conjunction with dexamethasone and a 5HT3 receptor antagonist.
Based on this study, gabapentin is not recommended as prophylaxis for delayed chemotherapy-induced nausea and vomiting.
Cruz, F.M., de Iracema Gomes Cubero, D., Taranto, P., Lerner, T., Lera, A. T., da Costa Miranda, M., … del Giglio, A. (2012). Gabapentin for the prevention of chemotherapy-induced nausea and vomiting: A pilot study. Supportive Care in Cancer, 20, 601–606.
To evaluate the efficacy and safety of gabapentin for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV) during the first cycle of moderately or highly emetogenic chemotherapy
Chemotherapy naïve patients with cancer who were scheduled to begin moderately or highly emetogenic chemotherapy were randomized to either receive 300 mg gabapentin or a placebo, in addition to a standard regimen of antiemetic prophylaxis (8 mg IV ondansetron, 10 mg IV dexamethasone, and 50 mg IV ranitidine before chemotherapy on day 1 and 4 mg oral dexamethasone twice a day on days 2 and 3).
Patients received either the gabapentin or the placebo five and four days before chemotherapy, once per day; three and two days before chemotherapy, twice per day; and one day before through five days after chemotherapy, three times per day. After chemotherapy was administered until the morning of day 5, patients kept diaries to record episodes of emesis or retching and severity of nausea over the previous 24 hours.
The primary outcome of this study was an evaluation of the number of patients reporting a complete response (CR), defined as the absence of nausea and vomiting and no use of rescue medications, during three timeframes.
The study was conducted at a single site at a large medical institution in Brazil.
All patients were in active treatment.
This was a randomized, double-blind, placebo-controlled trial.
Gabapentin may be a low-cost, nausea prophylaxis medication that can be used as an alternative to more expensive antiemetic medications. Although the authors described gabapentin as a low-risk medication, recent reports have linked gabapentin to increased rates of depression and suicide. It also has been commonly associated with the side-effects of drowsiness and dizziness.
For patients who are uninsured or underinsured and those living in developing countries where obtaining high-cost medications may be difficult, gabapentin may prove useful as a less-expensive alternative antiemetic prophylactic medication. Research should attempt to compare less expensive alternatives with current best practices.