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Gabapentin (Neurontin) is a pharmaceutical drug, specifically a GABA analog. It was originally developed to treat epilepsy, and currently is also used to relieve neuropathic pain. There are, however, concerns regarding the quality of the trials conducted for a number of conditions
Gabapentin capsules, tablets, and oral solution are used to help control certain types of seizures in people who have epilepsy. Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles).
Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down). Gabapentin is in a class of medications called anticonvulsants.
Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.
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Gabapentin (Neurontin) is a pharmaceutical drug, specifically a GABA analog. It was originally developed to treat epilepsy, and currently is also used to relieve neuropathic pain. NEURONTIN is a prescription medicine used to treat: Pain from damaged nerves (postherpetic pain) that follows healing ofshingles (a painful rash that comes after a herpes zoster infection) in adults. Partial seizures when taken together with other medicines in adults and children 3 years of age and older with seizures.
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Neurontin is FDA-approved for partial seizure (adjunct) in children age 3 to 12 and in adults. It is also FDA-approved for postherpetic neuralgia in adults. Neurontin is used primarily to treat epilepsy. More specifically it treats elementary partial seizures (brief, without loss of consciousness) and complex partial seizures (consciousness impaired), with and without secondary generalization (grand mal epilepsy with loss of consciousness). Usually it must be taken for two to three weeks to determine if it decreases the frequency or severity of seizures. Neurontin can only treat epilepsy; it is not a cure. Neurontin is also used to treat: Anxiety, Insomnia, and Chronic pain (not FDA approved for this use)
Neurontin has been used as a mood stabilizer, but some studies show that it is no more effective than a placebo in treating bipolar disorder.
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Gabapentin Warnings and Precautions
Neurontin has been tested in children and adolescents from 3 to 18 years old, and its effects have been found to be the same as those in adults, when dosage is appropriately adjusted. Neurontin may impair the ability to drive or operate heavy machinery.
Neurontin should not be discontinued suddenly – sudden withdrawal may cause seizures to return or occur more frequently. Dosage should be gradually tapered over at least 7 days when Neurontin is discontinued. For Pregnant or Nursing Mothers: Neurontin has not been studied in pregnant women, but other antiepileptic drugs have been known to cause birth defects. Studies in animals indicate that very high doses of Neurontin can cause bone and kidney problems. It is not known whether Neurontin passes into breast milk, and nursing mothers should be cautious about using Neurontin.
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Gabapentin, or Neurontin, is an anticonvulsant with analgesic properties that is available in capsule, tablet and oral solution. It has a wide range of intended uses, including controlling specific types of seizures in patients with epilepsy, treating postherpetic neuralgia (PHN) and restless leg syndrome.
In the treatment of seizures, gabapentin decreases abnormal activity in the brain, specifically excitement. When treating PHN, which is the lingering pain after suffering shingles, gabapentin changes the way the body senses pain, lowering the burning, aching and stabbing pain that can last up to years after a diagnosis. However, it is unknown exactly how it works in the treatment of restless legs syndrome.
Gabapentin can also be used to as a pain reliever for those suffering from diabetic neuropathy, which is numbness or pain due to diabetes and subsequent nerve damage. For menopausal women or women being treated for breast cancer, gabapentin can relieve hot flashes. It has also proven as an effective treatment for those suffering from alcohol dependency. In a recent study, patients who received high doses of gabapentin were four times more likely to stop drinking altogether, and twice as likely to refrain from heavy drinking. It is the only medication to have shown to help the alcohol dependent sleep better and improve their moods.
How Gabapentin is typically packaged?
Capsule: 100, 300, 400mg
Tablet: 100, 300, 400, 600, 800mg
Oral solution (brand-name only): 250mg/5mL
Normal Dosage Of Gabapentin
USAGE FOR EPILEPSY: The usual starting dose is 300mg for adults and children over 12 years of age. This dose is taken on the evening of the first day. Your doctor may then increase the dose on the second day to 300mg in the morning, and 300mg in the evening. On the third day you may be increased to 300mg three times per day. The maximum dosage is 3600mg per day. Gabapentin is not recommended for children under 12 years.
USAGE FOR DIABETIC NERVE PAIN: The dosage follows the rules for epilepsy, and may be continued for up to 5 months. If you suffer from any kidney problems, the doctor may issue a lower dosage.
USAGE AS A NERVE BLOCK: Gabapentin is not marketed for use as a nerve block, but is commonly used as such following successful applications. The dosage follows the same rules as for epilepsy patients, with a maximum dosage of 3600mg.
10 Most Common Questions About Gabapentin
- Is there a generic version of gabapentin available?
Since its manufacturer no longer has patent protection on the drug, there are generic versions on the market. They include Neurontin, Gralise, Gabarone, and Fanatrex.
- How much does gabapentin cost?
According to online Gabapentin pharmacy, generic Gabapentin can cost between $7-$27 for ninety 100mg or 300mg capsules and between $14-$53 for ninety 400mg capsules.
- What is the difference between gabapentin and other mood-stabilizing medications?
This is kind of a trick question. Technically, even though we hear the term “mood stabilizer” quite often, especially in the context of bipolar disorder, the FDA doesn’t officially recognize the term. Not only that, but even researchers and psychiatrists can’t come with a definition everyone agrees on. That said, lithium (which is probably the drug anyone with bipolar disorder is most familiar with) has significant differences from gabapentin. Lithium is in a class called bipolar disorder agents. Gabapentin is in a class called anticonvulsants. Their chemical structures are not the same and they work differently in the body. In addition to being used for bipolar, both have also been used for epilepsy.
- How is gabapentin different from valproate and carbamazepine?
There are claims that gabapentin was successful in helping with rapid cycling and mixed bipolar states in people who have not received relief from valproate or carbamazepine. It appeared that gabapentin helped more with anxiety and agitation than the other two drugs. Likewise, it has been shown to be beneficial with certain types of tardive dyskinesia.
- Are there potential interaction issues for people taking carbamazepine, valproate or lithium?
No interactions between gabapentin and valproate, carbamazepine or lithium have been reported.
- Does gabapentin interact with any other prescriptions or over-the-counter medications, such as MAO inhibitors?
There are only a few interaction issues that are known. Antacids have been known to decrease absorption of the drug. Gabapentin could also increase the level of concentration of some oral contraceptives by up to 13 percent. As far as MAO’s, this particular combination doesn’t present any special issues, but you should always let your doctor and pharmacist know all the medications you are taking.
- Are there any interaction issues between gabapentin and alcohol?
Alcohol has been known to increase the discomfort of Gabapentin’s side effects.
- Is it safe for a woman who is pregnant, about to become pregnant, or nursing to take gabapentin?
The FDA placed gabapentin in pregnancy category C. According to studies done on animals, there has been evidence of fetal loss. However, there have been no studies done on humans. Despite all this, experts believe that the benefits gained from taking gabapentin may outweigh its risks.
- Can children and adolescents safely take gabapentin? What about the elderly?
Gabapentin may be used to treat seizures in children as young as 3 years old. The dosages will be different from what you’d give an adult, and the doctor may specify a particular brand name, such as Neurontin. Similar to children, the elderly may start on a lower dose.
- Why do doctors prescribe gabapentin when there are other mood stabilizing medications that have been around for many years? True, there are medications that have been shown to be more effective in double-blind studies that are placebo controlled. But there are two reasons why physicians prescribe gabapentin over more established drugs. One: not everyone improves with the older, more established medications. Two: some people can’t deal with the side effects of the other drugs.
- Is there a generic version of gabapentin available?
Gabapentin Mechanism of action
The mechanism of the anticonvulsant action of gabapentin has not been fully described. Several possible mechanisms for pain improvement have been discussed. Though similar in structure to the endogenous neurotransmitter GABA, gabapentin has not been shown to bind to GABA receptors at concentrations at or below 1 mM. Gabapentin modulates the action of glutamate decarboxylase (GAD) and branched chain aminotransferase (BCAT), two enzymes involved in GABA biosynthesis. In human and rat studies, gabapentin was found to increase GABA biosynthesis, and to increase non-synaptic GABA neurotransmission in vitro.
Gabapentin prevents seizures in a wide variety of models in animals, including generalized tonic-clonic and partial seizures. Gabapentin has no activity at GABAA or GABAB receptors of GABA uptake carriers of brain. Gabapentin interacts with a high-affinity binding site in brain membranes, which has recently been identified as an auxiliary subunit of voltage-sensitive Ca2+ channels.
Gabapentin has been shown to bind to the α2δ-1 subunit of voltage gated calcium ion channels, which contributes to its pain attenuation effects in diabetic neuropathy and post-herpetic neuralgia. Other neurophysiological findings indicate that gabapentin also interacts with NMDA receptors, protein kinase C, and inflammatory cytokines.
Gabapentin prevents pain responses in several animal models of hyperalgesia and prevents neuronal death in vitro and in vivo with models of the neurodegenerative disease amyotrophic lateral sclerosis (ALS). Gabapentin is also active in models that detect anxiolytic activity.
Although gabapentin may have several different pharmacological actions, it appears that modulation of GABA synthesis and glutamate synthesis may be important.
Gabapentin interacts with cortical neurons at auxillary subunits of voltage-sensitive calcium channels. Gabapentin increases the synaptic concentration of GABA, enhances GABA responses at non-synaptic sites in neuronal tissues, and reduces the release of mono-amine neurotransmitters.
One of the mechanisms implicated in this effect of gabapentin is the reduction of the axon excitability measured as an amplitude change of the presynaptic fibre volley (FV) in the CA1 area of the hippocampus. This is mediated through its binding to presynaptic NMDA receptors.
Other studies have shown that the antihyperalgesic and antiallodynic effects of gabapentin are mediated by the descending noradrenergic system, resulting in the activation of spinal alpha2-adrenergic receptors. Gabapentin has also been shown to bind and activate the adenosine A1 receptor.
Side effects reported in children age 3 to 12 include: Aggressive behaviors / behavior problems,Anxiety, fidgeting or restlessness, Difficulty concentrating or change in school performance, Crying, False sense of well-being, Hyperactivity, Depression, Emotionally overreacting, mood swings.
Side effects in adults: Drowsiness, Dizziness, Fatigue, Clumsiness, Tremor, Nystagmus (rapid involuntary movements of the eyes), Ataxia (shaky movements and unsteady gait), Rhinitis (excessively runny nose and eyes), Nausea, Weight gain, Skin rash, Changes in vision, Vomiting, Low blood pressure, Constipation, Impotence, Lowered white blood cell count, Sleepiness, Mood swings, Hostile behavior, Disordered thinking, Hyperactive behavior
Rarely Gabapentin Side Effects: Severe skin rash (Stevens-Johnson syndrome, rare), Seizure
Gabapentin Interactions with Drugs and Other Substances
Drugs or substances that may interact with Neurontin include:
- Antacids (within 2 hours) – taking Neurontin with antacids may reduce Neurontin’s effects.
- Alcohol – frequent use of alcohol may seriously reduce the effectiveness of Neurontin.
- Tagamet (cimetidine) – may increase blood levels of Neurontin.
- Dilantin (phenytoin) – taking Neurontin with Dilantin may lead to phenytoin toxicity.
- Central nervous system (CNS) depressants, including cold medicines – these medications may add to the sedative effects of Neurontin.
Gabapentin for Central Nervous System Depression
Gabapentin has been associated with central nervous system (CNS) depression including sedation, somnolence, loss of consciousness as well as serious cases of respiratory depression. Patients with compromised respiratory function, respiratory or neurological disease, renal impairment and the elderly are at higher risk of experiencing these severe adverse effects. Concomitant use of CNS depressants with gabapentin is also a contributing factor.
Concomitant Use With Opioids
Concomitant use of opioids with NEURONTIN potentiates the risk of respiratory depression, profound sedation, syncope, and death. Gabapentin concentrations may also increase in patients receiving concomitant opioid (See DRUG INTERACTIONS).
Patients who require concurrent treatment with opioids or other CNS depressants should be observed carefully for signs and symptoms of CNS depression, and the dose of gabapentin or opioid should be reduced accordingly. See also DOSAGE AND ADMINISTRATION, Dosing Considerations.
Carcinogenesis and Mutagenesis
Gabapentin produced an increased incidence of acinar cell adenomas and carcinomas in the pancreas of male rats, but not female rats or in mice, in oncogenic studies with doses of 2000 mg/kg which resulted in plasma concentrations 14 times higher than those occurring in humans at a dose of 2400 mg/day. The relevance of these pancreatic acinar cell tumours in male rats to humans is unknown, particularly since tumours of ductal rather than acinar cell origin are the predominant form of human pancreatic cancer. (See TOXICOLOGY, Carcinogenicity Studies).
The abuse and dependence potential of gabapentin has not been evaluated in human studies. Cases of abuse and dependence have been reported in the post-marketing database. These individuals were taking higher than recommended doses of gabapentin for unapproved uses. Most of the individuals described in these reports had a history of polysubstance abuse or used gabapentin to relieve symptoms of withdrawal from other substances. As with any CNS active drug, physicians should carefully evaluate patients for a history of drug abuse and follow such patients closely, observing them for signs of abuse or misuse of Neurontin (e.g. development of tolerance, self-dose escalation, and drug-seeking behavior).
There are rare post-marketing reports of individuals experiencing withdrawal symptoms shortly after discontinuing higher than recommended doses of gabapentin used to treat illnesses for which the drug is not indicated. Such symptoms included agitation, disorientation and confusion after suddenly discontinuing gabapentin that resolved after restarting gabapentin. Most of these individuals had a history of poly-substance abuse or used gabapentin to relieve symptoms of withdrawal from other substances.
Serious Dermatological Reactions
There have been post-marketing reports of Stevens-Johnson syndrome (SJS) and Erythema multiforme (EM) in patients during treatment with gabapentin. Should signs and symptoms suggest SJS or ER, gabapentin should be discontinued immediately. (see Post-Marketing Adverse Drug Reactions)
There have been reports in the post-marketing experience of hypersensitivity including systemic reactions and cases of urticaria and angioedema. (see Post-Marketing Adverse Drug Reactions)
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
Severe, life-threatening, systemic hypersensitivity reactions such as Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome have been reported in patients taking antiepileptic drugs including gabapentin.
It is important to note that early manifestations of hypersensitivity, such as fever or lymphadenopathy, may be present even though rash is not evident. If such signs or symptoms are present, the patient should be evaluated immediately. Gabapentin should be discontinued if an alternative etiology for the signs or symptoms cannot be established.
Prior to initiation of treatment with gabapentin, the patient should be instructed that a rash or other signs or symptoms of hypersensitivity such as fever or lymphadenopathy may herald a serious medical event and that the patient should report any such occurrence to a physician immediately.
Gabapentin can cause anaphylaxis. Signs and symptoms in reported cases have included difficulty breathing, swelling of the lips, throat and tongue and hypotension requiring emergency treatment. Patients should be instructed to discontinue gabapentin and seek immediate medical care should they experience signs or symptoms of anaphylaxis.
Gabapentin treatment has been associated with dizziness and somnolence, which could increase the occurrence of accidental injury (fall). There have also been postmarketing reports of agitation, confusion, loss of consciousness and mental impairment. Therefore, patients should be advised to exercise caution until they are familiar with the potential effects of the medication. (See DOSAGE AND ADMINISTRATION, Dosing Considerations and Special Patient Populations).
Suicidal ideation and behaviour
Suicidal ideation and behaviour have been reported in patients treated with antiepileptic agents in several indications.
All patients treated with antiepileptic drugs, irrespective of indication, should be monitored for signs of suicidal ideation and behaviour and appropriate treatment should be considered. Patients (and caregivers of patients) should be advised to seek medical advice should signs of suicidal ideation or behaviour emerge.
An FDA meta-analysis of randomized placebo controlled trials, in which antiepileptic drugs were used for various indications, has shown a small increased risk of suicidal ideation and behaviour in patients treated with these drugs. The mechanism of this risk is not known.
There were 43,892 patients treated in the placebo controlled clinical trials that were included in the meta-analysis. Approximately 75% of patients in these clinical trials were treated for indications other than epilepsy and, for the majority of non-epilepsy indications the treatment (antiepileptic drug or placebo) was administered as monotherapy. Patients with epilepsy represented approximately 25% of the total number of patients treated in the placebo controlled clinical trials and, for the majority of epilepsy patients, treatment (antiepileptic drug or placebo) was administered as adjunct to other antiepileptic agents (i.e., patients in both treatment arms were being treated with one or more antiepileptic drug). Therefore, the small increased risk of suicidal ideation and behaviour reported from the meta-analysis (0.43% for patients on antiepileptic drugs compared to 0.24% for patients on placebo) is based largely on patients that received monotherapy treatment (antiepileptic drug or placebo) for non-epilepsy indications. The study design does not allow an estimation of the risk of suicidal ideation and behaviour for patients with epilepsy that are taking antiepileptic drugs, due both to this population being the minority in the study, and the drug-placebo comparison in this population being confounded by the presence of adjunct antiepileptic drug treatment in both arms.
Pregnant Women: Based on animal data, gabapentin may cause fetal harm (see TOXICOLOGY – Reproduction Studies). In non-clinical studies in mice, rats and rabbits, gabapentin was developmentally toxic (e.g., increased fetal skeletal and visceral abnormalities, and increased embryofetal mortality) when administered to pregnant animals at doses lower than the maximum recommended human dose (MRHD) of 3600 mg/day on a body surface area (mg/m2) basis.
Teratogenic Potential: Gabapentin crosses the human placental barrier. Although there are no adequate and well-controlled studies in pregnant women, congenital malformations and adverse pregnancy outcomes have been reported with gabapentin use, both from literature and Pregnancy Registries. Since the potential risk for humans is uncertain, gabapentin should only be used during pregnancy if the potential benefit to the mother outweighs the potential risk to the fetus. If women decide to become pregnant while taking NEURONTIN, the use of this product should be carefully re-evaluated.
Pregnancy Registry: Physicians are advised to recommend that pregnant patients taking NEURONTIN enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry. This can be done by calling the toll free number 1-888-233-2334, and must be done by patients themselves. Information on the registry can also be found at the following website: http://www.aedpregnancyregistry.org/.
Nursing Women: Gabapentin is excreted in human milk. There are no controlled studies on the effects of gabapentin on breast-fed infants. Because of the potential for serious adverse reactions in nursing infants, a decision should be made as to whether to discontinue nursing or to discontinue NEURONTIN, taking into account the benefit of the drug to the mother.
Pediatrics: The safety and efficacy in patients under the age of 18 have not been established.
Safety data in 39 patients between the ages of 12 and 18 years included in the double-blind, placebo-controlled trials showed that, at doses of 900 to 1200 mg/day, the incidence of adverse events in this group of patients was similar to that observed in older individuals.
In controlled clinical trials involving patients, 3 to 12 years of age (N=323), psychiatric adverse events such as emotional lability, hostility, hyperkinesia and thought disorder were reported at a higher frequency in patients treated with gabapentin compared to placebo.
Geriatrics: Systematic studies in geriatric patients have not been conducted. Adverse clinical events reported among 59 patients over the age of 65 years treated with Neurontin did not differ from those reported for younger individuals. The small number of individuals evaluated and the limited duration of exposure limits the strength of any conclusions reached about the influence of age, if any, on the kind and incidence of adverse events associated with the use of Neurontin.
As Neurontin is eliminated primarily by renal excretion, dosage adjustment may be required in elderly patients because of declining renal function. (See DOSAGE AND ADMINISTRATION, Dosing Considerations; ACTION AND CLINICAL PHARMACOLOGY, Special Populations and Conditions).
Monitoring and Laboratory Tests
Clinical trials data do not indicate that routine monitoring of clinical laboratory parameters is necessary for the safe use of Neurontin. Neurontin may be used in combination with other commonly used antiepileptic drugs without concern for alteration of the blood concentrations of gabapentin or other antiepileptic drugs.
How should Gabapentin be used?
Gabapentin comes as a capsule, a tablet, an extended-release (long-acting) tablet, and an oral solution (liquid) to take by mouth. Gabapentin capsules, tablets, and oral solution are usually taken with a full glass of water (8 ounces [240 milliliters]), with or without food, three times a day.
These medications should be taken at evenly spaced times throughout the day and night; no more than 12 hours should pass between doses. The extended-release tablet (Horizant) is taken with food once daily at about 5 PM. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take gabapentin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Gabapentin extended-release tablets cannot be substituted for another type of gabapentin product. Be sure that you receive only the type of gabapentin that was prescribed by your doctor. Ask your pharmacist if you have any questions about the type of gabapentin you were given.
Swallow the extended-release tablets whole; do not cut, chew, or crush them.
If your doctor tells you to take one-half of a regular tablet as part of your dose, carefully split the tablet along the score mark. Use the other half-tablet as part of your next dose. Properly throw away any half-tablets that you have not used within several days of breaking them.
If you are taking gabapentin to control seizures or PHN, your doctor will probably start you on a low dose of gabapentin and gradually increase your dose as needed to treat your condition. If you are taking gabapentin to treat PHN, tell your doctor if your symptoms do not improve during your treatment.
Gabapentin may help to control your condition but will not cure it. Continue to take gabapentin even if you feel well. Do not stop taking gabapentin without talking to your doctor, even if you experience side effects such as unusual changes in behavior or mood. If you suddenly stop taking gabapentin tablets, capsules, or oral solution, you may experience withdrawal symptoms such as anxiety, difficulty falling asleep or staying asleep, nausea, pain, and sweating. If you are taking gabapentin to treat seizures and you suddenly stop taking the medication, you may experience seizures more often. Your doctor may decrease your dose gradually over at least a week.
Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with gabapentin and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs) or the manufacturer’s website to obtain the Medication Guide.
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Other uses for this medicine
Gabapentin is also sometimes used to relieve the pain of diabetic neuropathy (numbness or tingling due to nerve damage in people who have diabetes), and to treat and prevent hot flashes (sudden strong feelings of heat and sweating) in women who are being treated for breast cancer or who have experienced menopause (”change of life”, the end of monthly menstrual periods). Talk to your doctor about the risks of using this medication for your condition. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
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. Be sure to mention any of the following: hydrocodone (in Hydrocet, in Vicodin, others), medications that make you feel dizzy or drowsy, morphine (Avinza, Kadian, MSIR, others), and naproxen (Aleve, Anaprox, Naprosyn, others). 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.
- tell your doctor if you have or have ever had 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.
What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
What should I do if I forget a dose?
If you forget to take gabapentin capsules, tablets, or oral solution, take the missed dose as soon as you remember it. However, if it is almost time for the next dose or if you forget to take gabapentin extended-release tablets, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Gabapentin abuse tends to occur in people who already have an addiction to opioids or other drugs. The effects of Gabapentin intoxication have been described as a sense of calm, euphoria, and a high similar to marijuana.
A 2013 study in Kentucky found that of the 503 participants reporting illegal drug use, 15% reported using Gabapentin in addition to other drugs to get high in the previous six months. Another study, working with a sample of participants meant to represent the national population, found almost a quarter of patients with co-prescriptions of opioids and Gabapentin were getting more than three times their prescribed amount to supply their addiction. People using the drug without a prescription is a growing problem in many areas. Due to the drug’s legal status, this is difficult to address from a policing standpoint. States where Gabapentin abuse is becoming more common are beginning to classify the drug as a more strictly controlled substance.
Gabapentin’s unique ability to address multiple ailments has made it one of the most popular prescription medications in the U.S. In May of 2019, GoodRx reported that it was the fifth-most prescribed drug in the nation. Despite its low abuse potential, its ability to be used in conjunction with other drugs causes widespread harm and addiction.
Signs of a Gabapentin Addiction
Effects of excessive Gabapentin use include:
- Coordination problems
- Suicidal thoughts/behaviors
- Changes in mood
- Poor coordination
- Difficulty speaking
- Inability to feel pleasure
It is important to try to recognize these symptoms and to be wary of other red flags, such as the presence or abundance of pill bottles. These effects can be detrimental to one’s health, livelihood, and overall safety.
Many Gabapentin users in early recovery abuse Gabapentin because at high doses (800mg or more), they may experience a euphoric-like high that does not show up on drug screens. Gabapentin abusers typically take the drug in addition to opioids to produce their desired high, a dangerous and potentially deadly combination. It is possible to fatally overdose on Gabapentin, both on its own or in conjunction with other drugs. However, there is currently no antidote that can be administered to someone in the case of a Gabapentin overdose as there is with opioid overdoses. If you find a loved one showing signs of an overdose–drowsiness, muscle weakness, lethargy and drooping eyelids, diarrhea, and sedation—seek medical attention immediately.
Signs of Gabapentin Addiction
- Lying about or exaggerating symptoms to doctors
- Seeking out multiple doctors to get extra doses
- Switching doctors after the original doctor refuses to continue prescribing the medication
- Changes in social habits and/or circles
- Changes in personal hygiene and grooming habits
- Constant preoccupation with the drug
- Unease at the thought of the drug being unavailable
- Refusal to quit despite social, financial, or legal consequences
- Failed attempts to quit
Prescription drug overdose deaths have been on the rise for many years. According to the National Institute on Drug Abuse, the number in the US alone rose above 25,000 in the year 2014 alone.
Gabapentin overdose is rather similar in nature to an overdose of an opioid like heroin or Vicodin. The key difference is that, unlike with opioids, there is no antidote to gabapentin that can instantly block the substance from affecting the brain. Doctors will do what they can to treat the immediately life-threatening symptoms, but permanent damage to the brain or body is possible even if intervention occurs early.
Overdose is most likely to occur when mixing gabapentin with other intoxicants, especially opioids and/or alcohol. The fact that gabapentin can be and is being mixed with heroin by illegal distributors is alarming for this reason. Heroin users typically have no way of knowing what is in the substance they purchase on the streets, which is one of the reasons that heroin overdose deaths are so common.
Common signs of gabapentin overdose include:
- Slurred speech
- Ataxia (loss of control of body movements)
- Double vision
- Rapid heartbeat
- High or low blood pressure
- Depression of the respiratory system
- Abnormally slow heart rate
Especially with ingestion with opioids, the biggest threat to a gabapentin overdose victim is a lack of oxygen to the brain. The depression of the central nervous system results in slowed breathing, or even a cessation of breathing altogether. If the brain isn’t getting enough oxygen, rapid cell death will soon occur, which can quickly lead to brain damage. The first treatment for this kind of overdose will be to make sure the airway is clear and that the patient is breathing.
Additionally, to help the body get rid of the excessive level of the drug, the individual may be treated with activated charcoal. This substance absorbs intoxicants like gabapentin and opioids, and the charcoal then passes out of the body naturally. Stomach pumping is not usually required for gabapentin alone. High or low blood pressure will then need to be treated until it reverts back to a normal level.
Once the overdose symptoms are under control, the afflicted individual should consider substance addiction treatment. Taking so much prescribed Neurontin can be a sign of addiction, as it indicates that more is being taken than is recommended. At the same time, mixing substances to increase the high of one or more drugs is a sign that substance abuse is present, and treatment is needed.