What Is Gabapentin Prescribed For?
Gabapentin is FDA-approved for:
- The treatment of postherpetic neuralgia in adults.
- Use as an adjunctive therapy in the treatment of partial-onset seizures, with and without secondary generalization, in pediatric and adult patients with epilepsy age 3 and older.
What is gabapentin prescribed for? In addition to its FDA-approved uses, gabapentin is often prescribed off-label (i.e., non-FDA-approved) for other purposes, such as:
- Neuropathic pain.
- Fibromyalgia.
- Bipolar disorder.
- Postmenopausal hot flashes.
- Essential tremors.
- Anxiety.
- Resistant depressant and mood disorders.
- Irritable bowel syndrome (IBS).
- Alcohol withdrawal.
- Postoperative analgesia.
- Migraine prophylaxis.
- Pruritus (itching).
- Insomnia.
- Post-traumatic stress disorder (PTSD).
Conditions treated with Gabapentin
Gabapentin is FDA-approved as Neurontin to treat partial seizures in adults and children with epilepsy. Partial seizures are convulsions that originate from a single location in the brain.
Neurontin is also approved to treat a type of nerve pain called postherpetic neuralgia, or PHN. PHN can happen after a person has had shingles, an infection from the same virus as chickenpox that causes a painful rash or blisters. Nerve pain from PHN can last for months, or even longer, after the rash has gone away.
An extended-release form of gabapentin is also FDA-approved to treat PHN.
Another extended-release form of gabapentin is FDA-approved to treat restless legs syndrome. This condition causes unpleasant or uncomfortable sensations in the legs and an irresistible urge to move them around, especially at night, which disrupts sleep.
Off-label uses for gabapentin
Doctors often prescribe gabapentin off-label to treat conditions such as:
- pain from diabetic neuropathy, which is numbness or uncomfortable tingling caused by nerve damage from diabetes
- nerve pain in the neck and back from conditions such as sciatica, a painful compression of the sciatic nerve
- hot flashes, which are sudden feelings of heat and sweating that can happen in women after menopause and in those being treated for breast cancer
- mood disorders such as anxiety
- alcohol addiction.
How Gabapentin works
In people with partial seizures, gabapentin works by decreasing abnormal activity in the brain. Experts believe gabapentin may cause brain cells to produce more of a chemical called GABA, which reduces abnormal electrical activity of brain cells.
In people experiencing nerve pain after having had shingles, gabapentin is thought to change the way pain signals are sent through the body and brain.
It’s not entirely clear how gabapentin works to treat restless legs syndrome.
Side Effects of Gabapentin
Gabapentin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- drowsiness
- tiredness or weakness
- dizziness
- headache
- uncontrollable shaking of a part of your body
- double or blurred vision
- unsteadiness
- anxiety
- memory problems
- strange or unusual thoughts
- unwanted eye movements
- nausea
- vomiting
- heartburn
- diarrhea
- dry mouth
- constipation
- increased appetite
- weight gain
- swelling of the hands, feet, ankles, or lower legs
- back or joint pain
- fever
- runny nose, sneezing, cough, sore throat, or flu-like symptoms
- ear pain
- red, itchy eyes (sometimes with swelling or discharge)
Some side effects may be serious. If you experience any of the following symptoms, call your doctor immediately:
- rash
- itching
- swelling of the face, throat, tongue, lips, or eyes
- hoarseness
- difficulty swallowing or breathing
- seizures
- difficulty breathing; bluish-tinged skin, lips, or fingernails; confusion; or extreme sleepiness
Gabapentin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What special precautions should I follow?
Before taking gabapentin,
- tell your doctor and pharmacist if you are allergic to gabapentin, any other medications, or any of the inactive ingredients in the type of gabapentin you plan to take. Ask your pharmacist for a list of the inactive ingredients.
- you should know that gabapentin is available in different forms that may be prescribed for different uses. Ask your doctor to be sure that you are not taking more than one product that contains gabapentin.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking gabapentin. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- if you are taking antacids such as Maalox or Mylanta, take them at least 2 hours before you take gabapentin tablets, capsules, or solution.
- the following nonprescription products may interact with gabapentin: nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve). Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking gabapentin. Do not start any of these medications while taking gabapentin without discussing with your healthcare provider.
- tell your doctor if you have or have ever had lung or kidney disease. If you will be taking the extended-release tablets, also tell your doctor if you need to sleep during the day and stay awake at night.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking gabapentin, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking gabapentin.
- you should know that this medication may make you drowsy or dizzy, may slow your thinking, and may cause loss of coordination. Do not drive a car or operate machinery until you know how this medication affects you, and your doctor agrees that it is safe for you to begin these activities.
- if you are giving gabapentin to your child, you should know that your child’s behavior and mental abilities may change while he or she is taking gabapentin. Your child may have sudden changes in mood, become hostile or hyperactive, have difficulty concentrating or paying attention, or be drowsy or clumsy. Have your child avoid activities that could be dangerous, such as riding a bicycle, until you know how gabapentin affects him or her.
- remember that alcohol can add to the drowsiness caused by this medication.
- you should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking gabapentin for the treatment of epilepsy, mental illness, or other conditions. A small number of adults and children 5 years of age and older (about 1 in 500 people) who took anticonvulsants such as gabapentin to treat various conditions during clinical studies became suicidal during their treatment. Some of these people developed suicidal thoughts and behavior as early as one week after they started taking the medication. There is a risk that you may experience changes in your mental health if you take an anticonvulsant medication such as gabapentin, but there may also be a risk that you will experience changes in your mental health if your condition is not treated. You and your doctor will decide whether the risks of taking an anticonvulsant medication are greater than the risks of not taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood); talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; giving away prized possessions; or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.
Is Gabapentin Addictive?
Yes, gabapentin has been shown to lead to dependence, withdrawal, and addiction in some people as well as in animal studies. Case reports have indicated that most people suffering from gabapentin addiction had a history of other substance misuse, including alcohol, cocaine, or opioid misuse, and were taking more than the recommended doses.
Gabapentin can cause dependence, which refers to a physiological adaptation that occurs due to repeated administration of a substance, resulting in withdrawal symptoms when you stop using it. People can be dependent but not addicted, although these two tendencies often occur together. Addiction refers to a pattern of compulsive substance misuse that often continues despite the harmful consequences.
Gabapentin, while not traditionally considered highly addictive like opioids or benzodiazepines, does carry a risk for misuse, dependency, and addiction, especially among individuals with a history of substance use disorders.
Due to gabapentin’s sedative effects, it has potential for recreational misuse, often in combination with other depressants, to intensify its sedative and euphoric effects. Awareness of its addiction potential is essential for safe use.
Gabapentin Addiction Risk Factors
- History of Substance Use Disorders: People with a history of alcohol, opioid, or other drug abuse are at higher risk of developing a dependence on gabapentin.
- Higher Doses: High doses of gabapentin, especially above the therapeutic range (900–3,600 mg/day), increase the risk of misuse and dependence.
- Combination with Other Drugs: Mixing gabapentin with opioids, alcohol, or other depressants heightens both the risk of addiction and potential respiratory depression.
- Chronic Pain Conditions: Patients with chronic pain may develop a psychological dependency on gabapentin due to its calming and pain-relieving effects.
Signs and Symptoms of Gabapentin Addiction
Withdrawal Symptoms From Gabapentin
People can experience Neurontin withdrawal symptoms when gabapentin use is abruptly stopped, especially if they have used higher than recommended doses. Stopping gabapentin may result in gabapentin withdrawal symptoms, such as:
- Agitation.
- Disorientation.
- Confusion.
- Pain.
- Sweating.
- Anxiety.
- Insomnia.
Gabapentin withdrawal has been reported to occur within 12 hours to 7 days of the last dose of gabapentin.
Addiction to gabapentin may present with behavioral, psychological, and physical symptoms:
- Behavioral Signs:
- Taking gabapentin in higher doses or more frequently than prescribed.
- “Doctor shopping” to get multiple prescriptions.
- Engaging in deceptive behaviors to obtain more gabapentin.
- Psychological Signs:
- Feeling anxious, irritable, or depressed when unable to take gabapentin.
- Experiencing cravings for the drug.
- Physical Signs:
- Developing tolerance (requiring higher doses to achieve the same effects).
- Experiencing withdrawal symptoms such as anxiety, nausea, sweating, or seizures when not taking the drug.
Treatment for Gabapentin Addiction
Stopping gabapentin use abruptly can have detrimental consequences. A medical detox program may be advisable to help you safely stop taking gabapentin and deal with Neurontin withdrawal symptoms; it can be especially beneficial if you also use other substances, like opioids, benzodiazepines, or alcohol. If you’re struggling with gabapentin or other substance misuse, you may also benefit from a formal treatment program, such as an inpatient or outpatient rehab.
Addiction treatment for gabapentin generally involves a multi-step approach, often within a structured addiction treatment program:
- Medical Detoxification:
- Gradual tapering of gabapentin under medical supervision helps to avoid severe withdrawal symptoms. Medical detox centers can monitor for complications such as seizures, which may occur if gabapentin is suddenly stopped.
- Therapy and Counseling:
- Cognitive Behavioral Therapy (CBT): CBT helps patients recognize and change patterns of behavior and thought that contribute to addiction.
- Group Therapy: Group settings can provide peer support and accountability.
- Family Therapy: Helps family members understand addiction and provides support to aid the patient’s recovery.
- Medication-Assisted Treatment (MAT):
- In cases where gabapentin was used alongside other substances, such as opioids, medications like methadone, buprenorphine, or naltrexone may be used as part of MAT.
- Aftercare and Support Groups:
- Programs like Narcotics Anonymous (NA) or substance-specific support groups help individuals maintain sobriety post-treatment.
- Aftercare plans, including continued therapy, support groups, and lifestyle changes, are essential for preventing relapse.
Prevention of Gabapentin Misuse and Addiction
- Strict Prescription Guidelines:
- Prescribe gabapentin only when truly necessary and at the lowest effective dose. Physicians should regularly reassess the patient’s need for continued gabapentin use, especially for off-label uses.
- Screening for Substance Use History:
- Before prescribing gabapentin, healthcare providers should screen patients for a history of substance use disorder, as this population has a higher risk of misuse.
- Education on Proper Use:
- Patients should be informed about the risks of misuse and instructed to avoid taking gabapentin in higher doses or combining it with other depressants.
- Close Monitoring:
- Regular follow-ups with patients can help detect signs of misuse early. Physicians can monitor refill requests and check for any signs of dose escalation.
- Using Alternative Therapies When Possible:
- Non-pharmacological treatments, such as physical therapy, acupuncture, or mindfulness practices, may be effective for managing pain or anxiety and should be considered when possible.
Addressing the Growing Concern of Gabapentin Misuse
Due to the increase in gabapentin misuse and addiction cases, some regions are implementing tighter control measures, such as reclassifying it as a controlled substance. Education for both healthcare providers and patients can reduce misuse by raising awareness of gabapentin’s risks and helping to promote safer use practices.
In summary, gabapentin addiction, while less common than with opioids or benzodiazepines, is still a significant risk, especially when the medication is misused. Treatment involves medical detox, therapy, and support, while prevention relies on careful prescription practices and patient education.