Clinicians may miss side effects of nerve pain drugs like gabapentin, leading to a chain of additional medications that cause more harm than good.
This is called a ‘prescribing cascade’ and poses serious risks, especially for older patients.
Gabapentinoids, such as gabapentin (Neurontin) and pregabalin (Lyrica), are often used for nerve pain. One known side effect is leg swelling, which can be mistaken for signs of heart failure. In response, doctors may prescribe diuretics like Lasix. These drugs may then cause new problems like kidney damage, dizziness, or falls.
A study of 120 older veterans—mostly men on multiple medications—showed that after starting gabapentinoids, patients developed swelling in their legs or feet. Only 4 of the veterans’ doctors suspected the medication, while 69 blamed other conditions like heart failure or venous stasis.
Despite no prior evidence of heart failure, nearly all doctors prescribed loop diuretics. Within two months, 28 patients experienced side effects from the diuretics, and six needed emergency care.
“Gabapentinoids are often seen as safe, but we need to regularly reassess whether patients still benefit from them,” says Dr. Michael Steinman from UCSF. “Non-drug options should be considered.”
Dr. Matthew Growdon adds, “Doctors should use lower doses or consider avoiding these drugs altogether if the risks outweigh the benefits.”
This study highlights the importance of careful medication review—especially in older adults who are often prescribed multiple drugs. Recognizing drug side effects early can prevent a harmful cascade of unnecessary treatments.
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The study is published in JAMA Network Open.
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