Tapering Gabapentin

RE: Tapering Gabapentin

Martin Hamilton — Mon, 11 Mar 2024 14:51:01 GMT

Echoing the above, I also feel gabapentin is the next tramadol. The only solid evidence we have for its use is in neurology and to relax fractious dogs and cats (to my knowledge). Here in Ontario (Canada) almost all veterinary anaesthesia specialists have stopped using it. Since completing residency (dentistry), I've also stopped using it - dogs >10kg get an NSAID and paracetamol post-op, and smaller animals get an NSAID and transmucosal (or compounded transdermal) buprenorphine. At least we actually have solid evidence behind these medications, with more and more evidence emerging about the safety and efficacy of paracetamol.

RE: Tapering Gabapentin

Michael Woodhouse — Sat, 09 Mar 2024 22:19:56 GMT

[quote userid="24356" url="~/f/clinical-questions/30911/tapering-gabapentin/243976#243976"]I rarely use it alone or as sole therapy, but if the animal needs something extra to metacam and can’t afford librela then I will add it in.[/quote]

Paracetamol or ketamine will do much more. Also cheap and cheerful.

RE: Tapering Gabapentin

Michael Woodhouse — Sat, 09 Mar 2024 22:16:16 GMT

[quote userid="12930" url="~/f/clinical-questions/30911/tapering-gabapentin/243966#243966"]You posted 6 months ago that you found it very useful, has your opinion altered or do you still consider it very useful, but just with minimal evidence and you are keeping an open mind? i.e. has your own experience and observation led you to prescribe less gabapentin than you used to?[/quote]

I regularly see an arthritic dog started on (usually) an NSAID with gabapentin thrown in as a 2nd drug and I don't think it does very much in these dogs. I've seen dogs from other practices where they were on it as a sole therapy! These are the dogs I will often stop and use paracetamol (33mg/kg dose) and discuss Librela.

Where I find it useful - as a pre procedure sedative. I will try it if I believe actual nerve pain, rather than typical OA. Sometimes useful for some senile behaviour issues - a good dose each evening can help settle dogs pacing/messing/not settling at night. I actually have wondered in the cases of OA that 'respond' whether we are sedating them and the dog is resting better, rather than reducing nerve pain? It is something I occasionally throw into the mix "try this for 2 weeks and we will see you back and see if it made a difference" but I don't have any dogs on it at the moment, in this way or with OA.

I have similar feelings with tramadol - some people very spaced out by the drug.

So a useful drug that I wouldn't want to be without, keeping an open mind. Don't prescribe much myself (5 vet practice and less than 5% will go out under me).

RE: Tapering Gabapentin

David Mills — Fri, 08 Mar 2024 23:36:02 GMT

Not convinced in any way.

As above, the new tramadol. It did amuse me when tramadol was licensed just as it was plummeting. Hopefully same happens for gaba.

Only real use I see effects is 50/100mg to a fractious cat, quite nice sedation for scanning etc.

It only deals with neuro pain. Which in our patients is hard to assess and possibly has much less significance than MSK pain.

RE: Tapering Gabapentin

Elizabeth — Fri, 08 Mar 2024 18:08:22 GMT

I rarely use it alone or as sole therapy, but if the animal needs something extra to metacam and can’t afford librela then I will add it in. Currently following a TPLO support page where, from what I can tell, most of the animals have been prescribed Gabapentin afterwards, although whether this is for pain relief or to keep them drowsy, I don’t know.

RE: Tapering Gabapentin

Beats — Fri, 08 Mar 2024 04:29:05 GMT

[quote userid="3169" url="~/f/clinical-questions/30911/tapering-gabapentin/243961#243961"]I tend to feel like gabapentin is like tramadol 10 years ago - massively overused with minimal evidence or actual efficacy. Come back to this post in 2034 and lets see if I'm right and what we are reaching for then........[/quote]

You posted 6 months ago that you found it very useful, has your opinion altered or do you still consider it very useful, but just with minimal evidence and you are keeping an open mind? i.e. has your own experience and observation led you to prescribe less gabapentin than you used to?

I remain unconvinced and rarely prescribe it (and the shift to complex "Under care" prescribing rules makes me all the more hesitant), but that means that I don't have much experience to go off. I do use it for instance in cases of syringomyelia and have found it useful in those cases. I know there seem to be an increasing number of vets who prescribe gabapentin for routine osteoarthritis cases, and I keep wondering if I am missing a trick by not doing so, but equally as you say there were a lot of vets prescribing tramadol for these same cases 20 years ago and if you suggest why not try tramadol to those same vets now they tend to say they don';t think it does much. I had a dog in recently belonging to a spinal surgeon. I'm not sure I should take his view strongly into mind, as he had been treating the dog for a few days with amoxicillin without any clear indication before bringing it to me, and on presentation it ironically had neck pain, most likely due to a disc... but amongst other meandering considerations, the option of gabapentin was offered at one point as a potential adjunctive analgesic for at home care in addition to NSAIDs - he was dismissive of this and couldn't see how that would help with pain from a disc - in the end he requested an injection of dexamethasone. I'm not sure how much the views of a single surgeon should colour my prescribing habits, but it did make me curious as to in what circumstances the drug is prescribed in people as a pain-killer and in what circumstnaces it is not? I haven't looked into this in more depth presently.

My prediction for the last 10 years has been palmitoylethanolamide is just a catchy abbreviation away from being the next big thing. Perhaps PEM rather than PEA would be all it would take?

RE: Tapering Gabapentin

Michael Woodhouse — Thu, 07 Mar 2024 22:36:06 GMT

My understanding was, unless used for epilepsy or in epileptic animals, that you can stop abruptly in animals. I have done so many times and never noted any unusual signs.

I tend to feel like gabapentin is like tramadol 10 years ago - massively overused with minimal evidence or actual efficacy. Come back to this post in 2034 and lets see if I'm right and what we are reaching for then........