Pivagabine is primarily used in the field of neurology and psychiatry due to its anxiolytic and neuroprotective properties. It is employed in the management of anxiety disorders, helping to reduce symptoms such as tension, irritability, and nervousness without causing significant sedation, making it suitable for daytime use. Its mechanism involves modulating neurotransmitter activity in the central nervous system, contributing to a calming effect.

It has also been explored for improving cognitive function in patients with mild cognitive impairments, particularly those associated with aging or neurodegenerative conditions. Pivagabine may support mental clarity and concentration, and has been used as an adjunct in the treatment of asthenic conditions—those characterized by weakness and lack of energy—of psychological or neurological origin.

Additionally, it is sometimes prescribed to help manage symptoms related to alcohol withdrawal, due to its calming effect on the nervous system. Because of its favorable safety profile and low potential for dependency, pivagabine offers an alternative to traditional benzodiazepines in long-term anxiolytic therapy.