Yabba Dabba Gabapentin: Are Gralise and Horizant Worth the Cost?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Improve my pain and I’ll pay whatever it takes. That’s what many patients who struggle with pain in their feet from diabetic neuropathy, pain after a shingles outbreak or any other nerve pain say to their doctors. Gabapentin works, and it’s cheap and generic. But guess what, there are now two long-acting forms that aren’t so cheap. Are they better?

Let’s see:

•  Gabapentin was originally developed as a seizure medication, yet has shown to be effective in the treatment of painful neuropathies. Gabapentin (Neurontin) was approved by the FDA in December 1993 for the treatment of partial seizures and in May 2002 for the treatment of the pain after shingles, or post-herpetic neuralgia (PHN).

•  Along came Gralise. A once-daily gabapentin tablet (Gralise) was approved in January 2011 for PHN. Gralise is much more expensive than gabapentin. Much.

•  Wait wait don’t tell me. Another form of gabapentin, Horizant (gabapentin extended-release tablets) was approved by the FDA in April 2011 for the treatment of moderate to severe primary restless legs syndrome (RLS) in adults and in June 2012 for the treatment of PHN in adults. Also expensive.

•  What’s different? The duration of action and when they reach their peak concentration is much different for these three medications. What this means for you is that Gralise and Horizant may provide longer steady coverage and are only taken once a day. Gabapentin is taken three times a day.The immediate release gabapentin can be taken with or without food, whereas Horizant and Gralise should be taken with food. Horizant and Gralise are absorbed better with a fatty meal—now you’re talking.

•  Better? Whether or not one is better than the other for pain control is not known as there are no comparison studies.

Worth the cost? Those of you who have tried both, weigh in.

Dr O.

For 90 capsules of 100 mg, 300 mg, or 400 mg, you can find gabapentin at many pharmacies for under $20 per month, and it’s covered as a Tier 1 drug with a low copay by most insurance plans. In contrast, 30 tablets of Gralise comes in just under $100, and the same quantity of Horizant will run closer to $130. When covered by insurance, both Gralise and Horizant are often considered Tier 3, meaning you’ll pay your highest copay.

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