This study at Howard University College of Pharmacy assessed student knowledge and opinions on off-label gabapentin use for treating pruritus—a persistent, distressing itch where gabapentin is commonly prescribed despite lack of FDA approval. Focused on its primary use for seizures and neuropathic pain, concerns arise over potential misuse when extended to pruritus treatment. Surveying 39 students, findings indicated only 27% recognized its approval for seizures, and a mere 10.8% were aware of its use for hemodialysis-related pruritus. Furthermore, just 32.4% acknowledged its broad safety in dosing. Many students expressed caution against off-label use due to potential adverse effects outweighing benefits, with 40.5% hesitant about using non-approved medications for pruritus, and 37.8% advising against promoting its off-label application. Conversely, 48.6% supported the use of established treatments instead. The study highlights the need for targeted educational interventions to correct misconceptions and improve understanding of off-label drug use, though its findings are limited by reliance on self-reported data and a sample restricted to one institution—potentially impacting wider applicability. These results lay the groundwork for further research into off-label drug implications in varied medical settings.