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New uses for older drugs: the tales of aspirin, thalidomide, and gabapentin.

In this issue of Mayo Clinic Proceedings, 2 articles describe original research in which gabapentin therapy produced novel, beneficial effects in patients with chronic neurologic conditions. Bogan et al1 report that gabapentin enacarbil, a gabapentin prodrug, may be useful for maintenance treatment of restless legs syndrome. Pistoia et al2 document a case series that suggests efficacy of gabapentin for treating opsoclonus-myoclonus syndrome in paralyzed patients with locked-in syndrome. The benefit from gabapentin treatment included opening a window of communication with the otherwise noncommunicative patients. These descriptions of novel uses for established drugs represent a growing trend in medicine: (1) gabapentin (developed as an antiseizure medication) currently being used to treat chronic pain conditions and the aforementioned conditions; (2) thalidomide (developed as a sedative and once removed from the market because of its propensity to produce birth defects) and its congeners currently being used to treat neoplastic diseases; and (3) aspirin, introduced as an analgesic, currently being used to treat a host of ills. As a corollary, when the modern pharmacopoeia is viewed in aggregate, the number of off-label uses of medicines is growing at an impressive rate. The prototype drug for such expansion of uses is aspirin; however, newly introduced drugs are accomplishing in years and decades what aspirin took millennia to achieve.