Efficacy and Safety of Different Dose Regimens of Gabapentin for Treating Erythema/Flushing in Rosacea: A Randomized Controlled Trial

Background: The management of rosacea-related flushing and erythema remains challenging. In routine practice, tetracyclines are commonly utilized as the initial treatment, recent research had suggested gabapentin as another potential treatment option. However, its optimal dosage, comparative efficacy relative to tetracyclines, and the factors influencing treatment response remain to be elucidated.
Objective: To evaluating the efficacy of medium (600mg/d) and high(900mg/d) dose gabapentin versus tetracyclines for rosacea-associated flushing and erythema and identified baseline predictors of response.
Methods: In this prospective, randomized, open-label, controlled trial, 195 rosacea patients were randomly assigned 1:1:1 to either a minocycline (100 mg/day), a medium-dose gabapentin group, or a high-dose gabapentin group for an 8-week treatment period. Effectiveness, safety and Prognostic factors were assessed.
Results: While final success rates were similar, high-dose gabapentin provided significantly faster improvement in flushing and erythema (by week 2). Baseline itch, migraine, and emotion-triggered flares predicted better gabapentin response. Safety profiles were comparable.
Limitations: Open-label design may introduce bias; follow-up period post-treatment was limited.
Conclusion: High-dose gabapentin offers superior early control with favorable safety, particularly for patients with specific neurosensory features.