Highlights
- Gabapentin is an anticonvulsant doctors prescribe for epilepsy, nerve pain after shingles, and restless leg syndrome.
- Gabapentin name brands are not interchangeable.
- Doctors still don’t fully understand how gabapentin works.
If you suffer from epilepsy, nerve pain, or bipolar disorder, your doctor may prescribe gabapentin. The off-label uses of this drug include hormonal hot flashes, alcohol withdrawal symptoms, and anxiety. Interestingly, gabapentin name brands aren’t equivalent. If your doctor prescribes a specific brand, you should take only that brand.
What is Gabapentin and What Is It Used For?
Gabapentin belongs to a class of medications called anticonvulsants. It works on the chemical messengers in the brain and nerves, modulating their activity.
Gabapentin was designed in the early ‘70s and first used to control partial seizures. In 1993, the FDA approved gabapentin under the brand name Neurontin for epilepsy and postherpetic neuralgia, a painful condition that often follows shingles.
Since its initial approval, the FDA has expanded its approval of gabapentin to include treatment of post-shingles nerve pain and restless leg syndrome.
Gabapentin Brands
The gabapentin brand your doctor prescribes depends on the condition you have. Don’t use a different brand of the same drug unless your doctor allows it.
- Neurontin. Doctors prescribe this gabapentin brand to patients suffering from nerve pain after shingles and partial seizures.
- Generic gabapentin capsules. This medication works for post-shingles nerve pain and seizures.
- Gralise. Doctors use this brand of gabapentin exclusively for the treatment of post-shingles pain.
- Horizant. This brand is gabapentin enacarbil. It is suitable for the treatment of shingles pain and restless leg syndrome.
Generic Versions
The Neurontin patent expired in the U.S. in 2004, making cheaper generic versions of the drug available to the masses. The medication is now available under several brand names, which are not interchangeable.
With generic medication widely available, gabapentin-related research gained momentum. In 2012, doctors developed gabapentin enacarbil, an extended-release version of gabapentin specialized for the treatment of moderate to severe restless leg syndrome and post-herpetic nerve pain. Gabapentin enacarbil is now available as a generic and under the brand name Horizant.
Off-Label Uses
Soon, doctors realized they could use the drug for other purposes. Though they lacked a scientific basis for using the drug for other purposes, they relied on anecdotal and clinical observations to deem it useful for anxiety and depression, alcohol withdrawal, and migraines.
The off-label use of gabapentin culminated in a scandal in the late ‘90s. Pfizer was accused of promoting the use of the drug for off-label purposes while making unsupported claims about how effective it would be for those purposes. The pharmaceutical giant paid a substantial settlement in 2004 to put the issue to rest.
How Does Gabapentin Work?
Gabapentin works on the nervous system by interacting with a particular neurotransmitter called glutamate. Glutamate is involved in sending signals that might cause over-excitement or over-activity in the nerves. Excitable neurons are responsible for transmitting pain signals and causing seizures.
By affecting the action of glutamate, gabapentin helps to calm down overactive nerves. Think of it like turning down the volume on a stereo that’s playing too loudly. This can help control seizures or reduce nerve pain.
The exact way gabapentin works is not entirely understood. Scientists have some theories, but they don’t yet know all the details.
What Formulas Are Available for Gabapentin?
Gabapentin is available in tablet, capsule, and liquid solution forms. Gabapentin tablets are available in 100 milligram, 300 milligram, 400 milligram, 600 milligram, and 800 milligram strengths.
The capsule formulations are available in 100 milligram, 300 milligram, and 400 milligram versions.
250 milligrams/5 milliliter and 300 milligrams/6 milliliter gabapentin solutions are also available.
Gabapentin Dosage and Administration
Gabapentin dosage depends on the condition the doctor wants to treat and whether the patient is an adult or a child.
Adult Dosage
If you are an adult patient whose doctor might prescribe gabapentin for epilepsy, a typical starting dose might be 300 milligrams on the first day. On the second day, the general guideline could be to take two 300 milligram doses. On the third day, you may take three 300 milligram doses. From there, you might go into maintenance mode to keep gabapentin levels in your blood relatively constant. To achieve that goal, you could typically take three 300-600 milligram doses of gabapentin per day, as directed by your healthcare provider.
If you suffer from post-shingles nerve pain, your first three days on gabapentin might look similar to the above. From there, you could generally take progressively higher doses to work towards optimal pain relief. A common guideline might be not to exceed three 600 milligram doses per day. If at a typical daily dose of 1,800 milligrams, gabapentin does not relieve your pain, consult your doctor.
If you take the Gralise brand of gabapentin for nerve pain, your doctor may gradually raise your daily dose from 300 milligrams to a typical maximum of 1,800 milligrams taken with the evening meal. Gralise is normally taken once per day with the evening meal.
If your doctor prescribes Horizant, a usual starting dose might be a 600 milligram dose once per day, in the morning, for three days. Starting with the fourth day, you might take two 600 milligram doses. This could be your maintenance dose as well.
For restless leg syndrome, adults typically take one daily dose of 600 milligrams of gabapentin with food.
These are general recommendations and might not apply to every individual. Always follow the specific instructions provided by your healthcare provider, as they will tailor the treatment to your particular situation.
Potential Dosing Adjustments
The dosage of gabapentin may need to be adjusted if you have kidney problems. Also, gabapentin can interact with other medications, so be sure to tell your doctor about all of the medications you are taking.
Children’s Dosage
Doctors generally don’t prescribe gabapentin for children younger than three. Generally, for children under 12, dosing is based on the specific condition being treated and is closely monitored by healthcare providers. The dosage of gabapentin may need to be adjusted depending on the child’s weight and response to the medication.
It is important to follow the instructions provided by the child’s doctor.
How Should I Take Gabapentin?
Only take gabapentin according to your doctor’s prescription. To avoid complications, take only the brand your doctor prescribes. Don’t make any changes to your gabapentin dose. Stick to the label instructions and ensure that you understand exactly how much gabapentin you must take and when.
Your doctor may change your dose now and then, depending on various factors. In children, doctors determine the correct dosage based on body weight. As a child gains or loses weight, the dose will change.
Under no circumstances should you take more gabapentin than prescribed, nor should you take it longer than needed.
Here are some further precautions to take when on gabapentin.
- Do not expose your gabapentin tablets or capsules to moisture or heat.
- Keep liquid gabapentin in a refrigerator but do not freeze.
- Only measure liquid medication with the provided measuring device.
- Never crush, dissolve, or chew a tablet.
- You may take Neurontin with or without food.
- Always take Gralise and Horizant with food.
- Splitting Gralise or Horizant tablets is not recommended unless directed by your doctor. These are extended-release formulations that won’t work the same if they’re split in half.
- If you take half a tablet of Neurontin as part of your prescribed regimen, always take the second half as your next dose. Never leave a broken pill unused for more than a couple of days. Whole pills in their original packaging will remain stable for months.
Never crush or chew gabapentin
Gabapentin Precautions
Gabapentin has profound effects on your body. Here are further precautions to keep in mind if you’re taking any form of this medication:
- Gabapentin may affect your kidney function, so your doctor may order frequent kidney function tests and tweak your gabapentin dosage depending on the results.
- Tell your doctors that you’re taking gabapentin when they order any test. The drug can alter your results and mislead medical professionals who aren’t aware that you’re on this medication.
- Continue taking your medication unless your doctor tells you otherwise.
- Never stop taking gabapentin suddenly, even if you think it’s a good idea or someone convinces you not to take the drug. Discontinuing this medication suddenly may cause seizures.
- If you must stop taking gabapentin, your doctor will tell you how to taper your dose until you can quit.
What Are the Potential Side Effects of Gabapentin?
Like all medications, gabapentin can cause side effects ranging from severe to mild. The most important potential effects to be aware of are allergic reactions, psychological changes, and nervous system problems.
Potentially Serious Gabapentin Side Effects
Allergic Reactions
You may have an allergic reaction to the drug or a severe drug reaction affecting different body parts.
Seek medical help immediately if you exhibit any of the following symptoms:
- Hives
- Swelling of your face, throat, or tongue
- Difficult breathing
- Jaundice
- Muscle aches
- Swollen glands
- Inexplicable bruising
- Rash
- Fever
Mood Swings and Personality Changes
Gabapentin can also cause mood and personality swings. These may range from anxiety and panic attacks to suicidal thoughts and aggression. Some patients may become more talkative than usual, restless, irritable, hostile, or impulsive. These side effects warrant medical attention as well.
Serious Effects When Combined With Alcohol or Painkillers
Gabapentin can have life-threatening side effects when combined with alcohol or opioid medications. It can lead to slow breathing, eventually stopping breathing altogether. People who suffer from this side effect may exhibit bluish lips or may be difficult to wake up. If you notice these side effects in someone taking gabapentin, seek urgent medical help.
Other Severe Side Effects
Other severe side effects of this medication can include:
- A higher number of seizures
- Weakness
- Loss of balance
- Sleepiness
- Dizziness
- Muscle problems
Possible side effect lists are never complete. You may experience as yet unreported side effects. Children are more likely to experience some gabapentin side effects than adults.
Behavioral changes like hostility, aggression, restlessness, and trouble concentrating are more frequent in children. Such side effects in children also call for medical attention.
Common Gabapentin Side Effects
Some of the more common and less-severe gabapentin side effects are:
- Nausea
- Vomiting
- Trouble formulating words and sentences
- Chills
- Fever
- Sleepiness
- Headaches
- Loss of balance
- Swelling in the extremities
- Body aches
Again, this list is not complete, as it’s impossible to account for all potential allergies and interactions in all individuals. If you experience any new or unusual symptoms after beginning any form of gabapentin, let your provider know right away.
What Should I Avoid When Taking Gabapentin?
Don’t take gabapentin and drive.
Like most medications, there are precautions you should take when taking gabapentin. Here are a few things to be aware of:
- Alcohol, marijuana, and opioid medications can make the dizziness and loss of balance side effects worse. Avoid driving or precarious situations and places that may lead to accidents and falls until you know how gabapentin affects you.
- Caffeine can counteract the effects of gabapentin. Reduce your coffee consumption while taking the drug.
- Antacids can interfere with the absorption of the drug.
- Older adults should be especially careful when taking this medication, as they can be more sensitive to the side effects. They may experience more pronounced dizziness and loss of coordination, which puts them at increased risk of falling. Older adults are also at an increased risk for breathing problems from gabapentin.
- Children can be especially susceptible to mood and behavior changes.
What Should I Do If I Miss a Dose of Gabapentin?
It is dangerous to overdose on gabapentin. If you miss a dose, take it as soon as you remember it. Skip it if it’s almost time for your next dose. You don’t want a double dose in your system at any time.
If you’re on Horizant, skip the missed dose and take your next one at your regular time.
What Should I Do If I Overdose on Gabapentin?
Overdosing on this drug can be life-threatening. Take immediate action if you notice any of the following symptoms.
- Slow breathing
- Purple lips
- Diarrhea
- Tiredness
- Slurred speech
- Sleepiness or difficulty waking up
- Double vision
Seek immediate medical attention. Call Poison Control at 1-800-222-1222.
Who Should Not Take Gabapentin?
You should avoid taking gabapentin if you suffer from breathing problems. Since the drug may slow breathing as a side effect, it can create a life-threatening situation.
Other categories of patients who should not take gabapentin are:
- Diabetics
- Those suffering from mood disorders and/or depression
- Drug addicts
- Alcoholics
- Dialysis patients
- Those with kidney problems not requiring dialysis
Tell your doctor if you belong to any of these patient categories before starting gabapentin.
Are There Any Potential Drug Interactions With Gabapentin?
Major Drug Interactions
Drugs.com lists 27 major drug interactions with gabapentin that can lead to life-threatening effects. They include:
- Opioids and analgesics. Taken with drugs in these classes, gabapentin can slow breathing depriving the brain and other organs of oxygen. These medications include:
- alfentanil
- buprenorphine
- butorphanol
- codeine
- dezocine
- fentanyl
- hydrocodone
- hydromorphone
- ketamine
- levomethadyl acetate
- levorphanol
- meperidine
- morphine
- methadone
- morphine liposomal
- nalbuphine
- oliceridine
- oxymorphone
- oxycodone
- pentazocine
- propoxyphene
- remifentanil
- sufentanil
- tapentadol
- tramadol
- Sodium oxybate. This medication is used to treat daytime sleepiness and narcolepsy. When combined with gabapentin, it can exacerbate the side effects of drowsiness and dizziness. It can also cause low blood pressure, loss of coordination, and even coma or death.
Please see the entire list of major gabapentin drug interactions at Drugs.com.
Moderate and Mild Drug Interactions
The complete interaction list for gabapentin includes 229 moderate interactions and 10 minor ones. It’s a good idea to check this list before beginning this medication.
In addition to these drugs, gabapentin may also interact with vitamins, herbal supplements, and over-the-counter drugs. Make sure your providers know all of the medications and supplements you take.
Conclusion
Gabapentin is a powerful medication that can have serious side effects, so it’s important to be well informed about its uses, side effects, and potential interactions. Now that you’ve taken the time to educate yourself, whether you’re taking it for epilepsy, nerve pain, or any of its off-label uses, the next step is to find out how to get it at the most affordable price.
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