Although the drug is not currently approved for this indication, the findings suggest that extended-release gabapentin might have potential as a treatment option for hot flashes and sleep disturbances in postmenopausal women who are reluctant to use hormonal therapies, the researchers said.
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A Reasonable Agent
Gabapentin is a very reasonable agent to study for hot flashes and sleep problems in postmenopausal women. Both of these problems are common concerns for midlife women. For women who cannot – or choose not to – take hormone therapy, a Food and Drug Administration–approved alternative is needed.
Small, randomized trials of non–extended-release gabapentin showed efficacy, compared with placebo. Side effects include drowsiness and sedation, so its use at bedtime often kills two birds with one stone. It's interesting that in these studies, daytime fatigue was not a side effect of this new extended-release formulation.
Gabapentin already is being used off label for night sweats and sleep problems in postmenopausal women. I discuss both gabapentin and SSRIs/SNRIs with my symptomatic patients who cannot – or choose not to – use hormone therapy, and they often elect a trial of gabapentin. If they're not depressed, many women do not like the idea of being on an antidepressant, and these agents have side effects as well. If daytime hot flashes are manageable, but night sweats and sleep disruption are a woman's principal concerns, then gabapentin is a very good off-label option.
JAN L. SHIFREN, M.D., is associate professor of ob.gyn. and reproductive biology at Harvard Medical School, Boston. She reported having no relevant conflicts of interest.