Reversible Thrombocytopenia after Gabapentin inan HIV-Positive Patient

Gabapentin has become increasingly used in psychiatric practice specifically for anxiety disorders. Even though gabapentin is notapproved by the US Food and Drug Administration to treat anxiety, physicians sometimes use it as an alternative to benzodiazepinesin patients with a history of substance abuse. Gabapentin is also prescribed when individuals are at risk of thrombocytopenia whichis not considered a side effect. Among patients at risk of thrombocytopenia are those positive for human immunodeficiency virus(HIV). Here we present a case of an HIV-positive man who presented for inpatient psychiatric care with severe anxiety and ahistory of alcohol and benzodiazepine abuse. In this patient, gabapentin worsened thrombocytopenia after repeated exposure tothis medication. We suggest caution when considering gabapentin for patients with preexisting low platelet counts, as there seemsto be a risk for worsening thrombocytopenia with this antiepileptic in the presence of HIV infection.