Gabapentin is an FDA-approved drug for the treatment of partial seizures and post-shingles neuralgia, but it is often prescribed off-label for the treatment of chronic pain, including back pain[1]. A new study based on the national TriNetX database followed patients for 10 years and found that patients who received gabapentin six times or more had a 29% higher risk of dementia and an 85% higher risk of mild cognitive impairment compared to patients who never took the drug[1]. The risk was even higher in patients aged 35 to 64, who had more than twice the risk of dementia and cognitive impairment[1]. Patients with 12 or more prescriptions had a 40% increased risk of dementia compared to those who received gabapentin three to eleven times[1]. Young adults aged 18 to 34 years did not show an increased cognitive risk with gabapentin[1]. Given the widespread off-label use of gabapentin and its perception as a safer alternative to opioids, pharmacists should actively assess cognitive risk, especially in middle-aged patients with long-term prescriptions[1].