Efficacy and Tolerability of Gabapentin in Adults with Sleep Disturbance in Medical Illness: A Systematic Review and Meta-analysis

Abstract

Background and purposeThe aim of this study was to systematically review the efficacy and tolerability of gabapentin in the treatment of sleep disturbance in patients with medical illness.MethodsPubMed was searched for randomized, double-blinded, placebo-controlled trials that reported sleep changes during gabapentin treatment up to November 2015.FindingsThis review included 26 studies involving 4,684 participants. Except for Composite Endpoint 3 [standardized mean difference (SMD) = 0.09, 95% confidence interval (CI): −0.05–0.22] compared with the placebo group, the gabapentin group showed superior outcomes on our endpoints: Composite Endpoint 1 (SMD = 0.50, 95% CI: 0.28–0.71), Composite Endpoint 2 (SMD = −0.53, 95% CI: −0.77 to −0.30), Composite Endpoint 4 (SMD = −0.38, 95% CI: −0.58 to −0.19), Composite Endpoint 5 [risk ratio (RR) = 1.79, 95% CI: 1.24–2.58], and Composite Endpoint 6 (RR = 0.48, 95% CI: 0.32–0.72). However, the patients in the gabapentin group showed worse tolerance than those in the placebo group (RR = 1.38, 95% CI: 1.08–1.76).ImplicationsThis study is the first to systematically assess the clinical value of gabapentin for the treatment of sleep disorders. We found that regardless the type of sleep outcomes, gabapentin displayed stable treatment efficacy for sleep disturbance in patients with medical illness. However, when an average dose of approximately 1,800 mg/day was used, the risk of treatment discontinuation or drug withdrawal was relatively high. We recommend that further studies confirm these findings in patients with primary sleep disorders.

Gabapentin for Off-Label Use: Evidence-Based or Cause for Concern?

“…Again, these findings were not consistent. In a large meta-analysis of adults with sleep disturbances by Liu et al, 25 gabapentin demonstrated efficacy over placebo in 5 out of 7 composite end points. However, tolerability was comparatively lower than placebo and included studies only assessed sleep changes secondary to other indications (such as neuropathic pain and RLS).…”

Gabapentinoid Prescribing Practices at a Large Academic Medical Center

“…Table 3 summarizes the level of evidence supporting (or not supporting) the indications for gabapentinoid prescriptions in the overall cohort. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 Gabapentinoid prescriptions for pain-related indications, such as neuropathic pain, headaches, and musculoskeletal pain, were the most common (82.1%). Although neuropathic pain and fibromyalgia indications had substantial evidence for treatment with gabapentinoids, evidence supporting their use for pain indications such as headache, osteoarthritis, and chronic abdominal pain was insufficient.…”

Presence of Night Pain, Neuropathic Pain, or Depressive Disorder Does Not Adversely Affect Outcomes After Total Knee Arthroplasty: A Prospective Cohort Study

“…Gong et al 15 reported that postoperative administration of zolpidem reduced postoperative night pain and increased postoperative satisfaction; however, this study showed results only up to 2 weeks after surgery, so further studies are needed. Other studies have reported that gabapentin was effective in the treatment of insomnia in various medical conditions, 37 38 but further studies are needed to determine whether gabapentin is effective in relieving pain after orthopaedic surgery.…”