Utah's 4th Most Prescribed Drug Is One Most People Haven't Heard Of

Most people can name the common medications older adults take. Statins for cholesterol. Metformin for diabetes. Lisinopril for blood pressure. Maybe Levothyroxine for thyroid.

Gabapentin rarely comes up. And yet in Utah's Medicare data, it's the fourth most prescribed drug in the state, with 226,789 claims in 2023. More claims than Lisinopril. More than Metformin. More than Amlodipine, Losartan, or Hydrocodone.

If you're turning 65 or helping a parent navigate Medicare, it's worth understanding what Gabapentin is, why it's prescribed so often, and why some doctors and researchers are paying closer attention to it.

What is Gabapentin?

Gabapentin was originally approved by the FDA for epilepsy, and later for a specific type of nerve pain called postherpetic neuralgia, the lingering pain after a shingles outbreak. Those are still its official approved uses.

But in practice, it's prescribed for a much wider range of things. Restless leg syndrome. Fibromyalgia. Back pain. Anxiety. Alcohol withdrawal. Off-label use (prescribing a drug for something other than its FDA-approved indication) is legal and common in medicine. For Gabapentin, off-label prescribing is the norm rather than the exception.

For some of these uses, the evidence is solid. For others, it's thinner than patients often assume.

Why it's showing up in Utah's rural communities at the highest rates

Richfield, a small city in Sevier County with about 8,000 residents, has Gabapentin as its single most prescribed Medicare drug, ahead of Atorvastatin, Levothyroxine, and everything else. That's notable because Richfield is also in the higher opioid prescribing cluster, with Hydrocodone and Oxycodone both appearing in its top five drugs.

This pattern, Gabapentin and opioids appearing together in rural communities, is something public health researchers have started tracking nationally. Gabapentin is not classified as a federally controlled substance, which means it's easier to prescribe and refill than a traditional opioid. Some people take it alongside opioids, which can amplify the sedating effects of both drugs.

What this means for older adults specifically

Gabapentin causes dizziness and sedation in a meaningful percentage of people who take it. For older adults, that's a fall risk. Falls are one of the leading causes of serious injury and death in people over 65, and medications that affect balance and coordination are a known contributor.

The drug also builds up in the body more slowly in older adults because kidney function typically declines with age. A dose that feels manageable at first can accumulate over weeks and months, leading to increased drowsiness or confusion that can be mistaken for dementia or simply "getting older."

None of this means Gabapentin is the wrong drug for everyone who's on it. For genuine nerve pain, particularly post-shingles nerve pain, which can be severe, it's genuinely effective. The question is whether the dose is right, whether it's still necessary, and whether anyone is monitoring for side effects that might look like aging rather than medication effects.

Questions to ask at your next appointment

If you or a parent is on Gabapentin, a few things are worth checking. First, what's it being prescribed for? If the answer is something vague like "nerve pain" or "just in case," it might be worth asking for more specifics. Second, when was the dose last reviewed? Third, has anyone assessed whether the current dose is appropriate given current kidney function?

A medication review, where a pharmacist or doctor goes through every drug on your list and evaluates whether each one is still warranted, is a covered service under Medicare. It's called a Comprehensive Medication Review (CMR), and if you've never had one, it's worth asking your Part D plan about.

The fact that Gabapentin is Utah's fourth most prescribed Medicare drug isn't alarming on its own. A lot of those prescriptions are for legitimate, well-managed conditions. But it's the kind of thing worth knowing about, especially if it's on someone's medication list and nobody's had a recent conversation about why.

Source: CMS Medicare Part D Prescribers by Geography and Drug, 2023. Utah state-level data. City-level data from CMS Medicare Part D Prescribers by Provider and Drug, 2023.