Gabapentin is approved to prevent and control partial seizures, relieve postherpetic neuralgia after shingles and moderate-to-severe restless legs syndrome. Learn what side effects to watch for, drugs to avoid while taking gabapentin, how to take gabapentin and other important questions and answers. Gabapentin is available in both branded and generic forms.
What do people use gabapentin for?
Gabapentin’s primary use is to prevent or control seizures. It works by calming nerve activity to reduce seizure intensity or occurrence.
Children and adults can take this drug. The brand-name drug Neurontin can treat one form of epilepsy in children as young as 3 years old. Some people take other medications with gabapentin to control epilepsy symptoms.
Gabapentin can also help reduce post-herpetic neuralgia, which refers to a burning or stabbing nerve pain that is a common complication of shingles.
According to one 2017 review, oral gabapentin can reduce moderate or severe nerve pain that results from shingles or diabetes at a minimum daily dosage of 1,200 milligrams.
Extended-release gabapentin (Horizant) tablets can treat RLS, which is a condition characterized by uncomfortable sensations in the legs and a strong or irresistible urge to move the lower limbs.
A 2016 studyTrusted Source also suggests that gabapentin combined with oxycontin, which is an opioid pain reliever, can help control pain and increase the quality of life for people with severe cancer pain. However, doctors do not typically prescribe gabapentin for this purpose.
What is gabapentin?
Gabapentin is a prescription medication known as a gamma aminobutyric acid (GABA) analogue. GABA reduces the excitability of nerve cells (neurons) in the brain, which play a role in seizures and the transmission of pain signals. Gabapentin mirrors the effects of GABA calming excited neurons.
Gabapentin is in a class of medications called anticonvulsants.
Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.
Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles.
Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.
This medicine is available only with your doctor’s prescription.
This product is available in the following dosage forms:
- Tablet, Extended Release, 24 HR
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What are the brand names of gabapentin?
Gabapentin is available as both a brand name product and a generic product (chemically the same, usually lower cost than the brand name product). Brand names of gabapentin include Horizant®, Gralise® and Neurontin®.
Gabapentin is an anticonvulsive medication that originally saw use as a muscle relaxer and anti-spasmodic medication, but later it was discovered it had the potential of the medication as anticonvulsive medication and as an adjunct to more potent anticonvulsants. It is also useful in certain types of neural pain control. This activity outlines the indications, mechanism of action, dosing, significant adverse effects, contraindications, monitoring, and toxicity of gabapentin and increases practitioners’ knowledge about how to approach this medication and all health professionals in how to monitor it to drive better patient outcomes.
Mechanism of Action of Gabapentin
The exact mechanism of action with the GABA receptors is unknown; however, researchers know that gabapentin freely passes the blood-brain barrier and acts on neurotransmitters. Gabapentin has a cyclohexyl group to the structure of neurotransmitter GABA as a chemical structure. Even though it has a similar structure to GABA, it does not bind to GABA receptors and does not influence the synthesis or uptake of GABA. Gabapentin works by showing a high affinity for binding sites throughout the brain correspondent to the presence of the voltage-gated calcium channels, especially alpha-2-delta-1, which seems to inhibit the release of excitatory neurotransmitters in the presynaptic area which participate in epileptogenesis. Even though there is no evidence for direct action at the serotonin, dopamine, benzodiazepine, or histamine receptors, research has shown gabapentin to increase total-blood levels of serotonin in healthy control subjects.
The elimination half-life of gabapentin is 5 to 7 hours, and it takes two days for the body to eliminate gabapentin from its system.
One benefit of gabapentin use is its mild side-effect profile. The most common side effects are fatigue, dizziness, and headache.
What is gabapentin approved for?
Gabapentin is used to:
- Prevent and control partial seizures. Gabapentin can be used in adults and children age 3 and older who have partial seizures.
- Relieve nerve pain following shingles in adults. Shingles is a painful rash that develops many years after you’ve had chickenpox. The virus that causes chickenpox stays dormant in a portion of your spinal nerve root called the dorsal root ganglion. For whatever reason, this otherwise dormant virus gets reactivated — usually by stress — causing a shingles rash. Nerve pain following a case of shingles is called postherpetic neuralgia (PHN).
- Treat moderate-too-severe primary restless legs syndrome.
Safety and risks
Individuals taking gabapentin should talk with a doctor about any problems they experience while doing so, especially if they are severe, ongoing, or getting worse.
People taking gabapentin should be aware of the following serious safety concerns.
In 2019, the Food and Drug Administration (FDA) issued a warning that people with respiratory risk factors who take the different brands of gabapentin may experience serious breathing difficulties.
People who have conditions such as chronic obstructive pulmonary disease or asthma should speak with a doctor before taking gabapentin.
Risk of suicidal thoughts or behaviors
Studies suggest that some people may experience thoughts of suicide or exhibit suicidal behaviors when taking gabapentin or other anticonvulsants.
If a person or their loved one notices any changes in their mood or behavior, they should contact a doctor immediately.
Risk of overdose
Despite research in this area, it is not always clear whether suicidal behaviors in people who take gabapentin are a result of the drug itself or related to an existing mental health condition.
It is clear, however, that the risk of overdose from the drug is higherTrusted Source if a person also has a mental health condition such as depression.
In addition, when taking gabapentin, a person should monitor themselves carefully to make sure that they are not accidentally taking the wrong dosage.
People should also check on loved ones and minors taking this medication and seek help if there is any concern that they may have suicidal thoughts or behaviors.
Data from U.S. poison centers show that between 2012 and 2017, the number of suspected intentional suicide attempts from a gabapentin overdose grew by 80.5%.
According to the FDA, there have been reports of oral overdoses from taking up to 49 grams of the drug.
Symptoms of an overdose may include:
- double vision
- slurred speech
- coma, in cases when someone has chronic renal failure and has received treatment with Neurontin
Interactions with other medications and substances
Gabapentin can interact with other prescription and over-the-counter medications, vitamins, and herbal supplements.
People should be sure to give a doctor a full list of their current medications and supplements before taking gabapentin.
The results of another 2017 revieq. suggest that the following are some of the main substances that interact with the drug:
- caffeine, which is present in tea, coffee, and cola
- ethacrynic acid, which is a diuretic
- losartan, which is a medication for high blood pressure
- magnesium oxide, which is a mineral supplement and antacid
- mefloquine, which is an antimalarial drug
- morphine, which is an opioid pain medication
- phenytoin, which is an anti-seizure medication
If gabapentin causes sleepiness, a person should speak with a doctor before taking other medications that can also cause drowsiness, including:
- antianxiety medications
- cold and flu medications
- muscle relaxers
- narcotics, which are pain medications
- sleeping pills
Presence of other health conditions
To ensure that gabapentin is safe to take, a person should tell a doctor if they also currently have or have ever had:
- dialysis treatment
- drug or alcohol misuse issues
- heart disease
- kidney disease
- liver disease
- seizures (if taking gabapentin for conditions unrelated to seizures)
What dosage strengths and forms does gabapentin come in?
Gabapentin is available as:
- Gabapentin tablets. It’s available as 300- and 600-milligram tablets (Gralise) and 600- and 800-milligram tablets (Neurontin or generic gabapentin).
- Gabapentin oral solution. The oral solution contains 250 millgrams of gabapentin per 5 milliliter (50 mg per mL) Neurontin or generic gabapentin.
- Gabapentin capsules. It’s available as 100-, 300- or 400-milligram gelatin capsules (Neurontin or generic gabapentin).
- Gabapentin enacarbil, 300- and 600-milligram extended-release tablets (Horizant).
Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.
This medicine comes with a Medication Guide. Read and follow the instructions carefully. Ask your doctor if you have any questions.
If you are using Gralise® tablets:
- These should be taken with the evening meal.
- Swallow the tablet whole. Do not crush, break, or chew it.
For patients with epilepsy who take gabapentin three times per day, do not allow more than 12 hours to pass between any 2 doses. The medicine works best if a constant amount is in the blood.
Neurontin® capsules, tablets, and solution may be taken with or without food.
You may break the scored Neurontin® tablets into two pieces, but make sure you use the second half of the tablet as the next dose. Do not use the half-tablet if the whole tablet has been cut or broken after 28 days. Ask your doctor or pharmacist if you have any questions.
Swallow the capsule whole with plenty of water. Do not open, crush, or chew it.
Measure the oral liquid using a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.
If you take an antacid that contains aluminum or magnesium, wait at least 2 hours before taking gabapentin. Some examples of these antacids are Di-Gel®, Gaviscon®, Gelusil®, Maalox® and Mylanta®.
Only use the brand of this medicine that your doctor prescribed. Different brands may not work the same way.
The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage forms (capsules, liquid, and tablets):
- For epilepsy:
- Adults and children 12 years of age and older—At first, 300 milligrams (mg) three times per day. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 1800 mg per day (600 mg three times per day).
- Children 3 to 11 years of age—Dose is based on body weight and must be determined by your doctor. The starting dose is 10 to 15 milligrams (mg) per kilogram (kg) of body weight per day and divided in 3 doses. Your doctor may adjust your dose as needed and tolerated.
- Children younger than 3 years of age—Use and dose must be determined by your doctor.
- For postherpetic neuralgia:
- Adults— At first, 300 milligrams (mg) as a single dose in the evening. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 1800 mg per day.
- Children—Use and dose must be determined by your doctor.
- For epilepsy:
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
You should store the Neurontin® oral liquid in the refrigerator. Do not freeze.
How should I take gabapentin?
- Take Gralise tablets with your evening meal. Swallow tablets whole with a full glass of water. Don’t chew, break or crush.
- Take Horizant tablets with food. Swallow tablets whole with a full glass of water. Don’t chew, break or crush.
- Take other forms of gabapentin with or without food.
- Neurontin and generic forms of Neurontin tablets may be broken into two pieces. You can take the second half for your next dose. Don’t use the half-tablet beyond 28 days after the whole tablet was cut or broken.
- Carefully measure the liquid formulation of gabapentin using the measuring device that comes with the drug. If you did not receive a measuring device, please ask your pharmacist for a medication-measuring device.
- If you take an aluminum or magnesium-containing antacid, such as Maalox®, Mylanta®, Gelusil®, Gaviscon®, or Di-Gel®, wait at least two hours before taking your next dose of gabapentin.
- Take gabapentin exactly as prescribed by your healthcare provider.
What are the serious side effects of gabapentin?
If you have any of these symptoms, call your healthcare provider right away:
- Signs of an allergic reaction: If you have a skin rash, hives, itching or swollen, blistered or peeling skin with or without fever contact your healthcare provider. You should also contact your provider if you have trouble breathing or swallowing, wheezing or swelling of your face, lips, throat, eyes, mouth or tongue
- Changes in mood or behavior: Call your provider for any suicidal thoughts or thoughts about dying, suicide attempts, new or worsening depression, anxiety, irritability or feelings of agitation or restlessness. You should also call your provider for trouble sleeping, panic attacks, feelings of aggression or anger, impulsive behavior, extreme increase in activity or talking and other changes in mood or behavior, confusion, inability to focus or memory problems as these can be side effects of your medication.
- Signs of liver abnormalities: Yellowing of your skin or whites of your eyes, dark urine, light-colored stools, vomiting, unusual bleeding or bruising.
- Signs of kidney abnormalities: Trouble urinating, a change in how much urine is passed, blood in your urine, or weight gain and swelling of legs and feet from retaining fluid.
- Other concerning abnormalities: Change in color of your skin to a bluish color on your lips, nail beds, fingers, or toes along with severe fatigue or weakness and unexpected muscle pain.
Side Effects of Gabapentin
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
- Clumsiness or unsteadiness
- continuous, uncontrolled, back-and-forth, or rolling eye movements
More common in children
- Aggressive behavior or other behavior problems
- concentration problems and change in school performance
- false sense of well-being
- hyperactivity or increase in body movements
- rapidly changing moods
- reacting too quickly, too emotional, or overreacting
- suspiciousness or distrust
- Black, tarry stools
- chest pain
- depression, irritability, or other mood or mental changes
- loss of memory
- pain or swelling in the arms or legs
- painful or difficult urination
- sore throat
- sores, ulcers, or white spots on the lips or in the mouth
- swollen glands
- unusual bleeding or bruising
- unusual tiredness or weakness
Incidence not known
- Abdominal or stomach pain
- blistering, peeling, or loosening of the skin
- clay-colored stools
- dark urine
- decreased urine output
- difficult or troubled breathing
- fast or irregular heartbeat
- increased thirst
- irregular, fast or slow, or shallow breathing
- itching or skin rash
- joint pain
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- loss of appetite
- muscle ache or pain
- pale or blue lips, fingernails, or skin
- red skin lesions, often with a purple center
- red, irritated eyes
- unpleasant breath odor
- vomiting of blood
- yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Blurred vision
- cold or flu-like symptoms
- lack or loss of strength
- lower back or side pain
- swelling of the hands, feet, or lower legs
- trembling or shaking
Less common or rare
- Accidental injury
- appetite increased
- back pain
- bloated or full feeling
- body aches or pain
- burning, dry, or itching eyes
- change in vision
- change in walking and balance
- clumsiness or unsteadiness
- cough producing mucus
- decrease in sexual desire or ability
- dryness of the mouth or throat
- excess air or gas in the stomach or intestines
- excessive tearing
- eye discharge
- feeling faint, dizzy, or lightheadedness
- feeling of warmth or heat
- flushed, dry skin
- flushing or redness of the skin, especially on the face and neck
- frequent urination
- fruit-like breath odor
- impaired vision
- increased hunger
- increased sensitivity to pain
- increased sensitivity to touch
- increased thirst
- noise in the ears
- pain, redness, rash, swelling, or bleeding where the skin is rubbed off
- passing gas
- redness or swelling in the ear
- redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
- runny nose
- tender, swollen glands in the neck
- tightness in the chest
- tingling in the hands and feet
- trouble sleeping
- trouble swallowing
- trouble thinking
- unexplained weight loss
- voice changes
- weakness or loss of strength
- weight gain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
What are the more common side effects of gabapentin?
Common side effects of gabapentin include:
- Feeling tired.
- Nausea and vomiting.
- Difficulty speaking.
- Recurring infections.
- Memory loss.
- Weight gain.
- Movement problems: coordination problems, being unsteady, tremors, jerky movements.
- Eye problems: unusual eye movements, double vision.
Talk to your healthcare provider if any side effects do not go away.
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Are there any serious interactions with gabapentin and other medications?
Serious breathing problems can happen if you take gabapentin with drugs that cause severe sleepiness or decreased awareness. Some examples include narcotic opioids, anti-anxiety medicines, antidepressants, and antihistamines. If you are 65 years of age or older and/or have a condition that affects your lungs, such as chronic obstructive pulmonary disease (COPD), there is an increased risk for breathing problems. Watch for increased sleepiness or decreased breathing when you start taking gabapentin or when the dose is increased. Get help right away if you develop breathing problems.
Seek immediate medical attention if these symptoms develop:
- Unusual dizziness or lightheadedness.
- Slowed, shallow or trouble breathing.
- Unresponsiveness (can’t wake up).
- Bluish-colored or tinted skin, especially on lips, fingers or toes.
What other medications and products can interact with gabapentin?
Products that interact with gabapentin include:
- Antihistamine-containing cold, cough and allergy products.
- Certain medicines for anxiety or sleep.
- Certain medicines for depression, such as amitriptyline, fluoxetine and sertraline.
- Certain medicines for seizures, such as phenobarbital and primidone.
- Certain medicines for stomach problems. (Wait two hours after taking aluminum and magnesium-containing antacids before taking gabapentin.)
- General anesthetics, local anesthetics, or muscle relaxants given before surgery.
- Narcotic pain medicines.
Can I drink alcohol while taking gabapentin?
Avoid drinking alcohol while taking gabapentin. Drinking alcohol with gabapentin could increase sleepiness or dizziness.
What else do I need to know about gabapentin?
Never stop taking gabapentin without talking to your healthcare provider first. Stopping gabapentin suddenly can cause serious problems, including increasing your risk of seizures (if you are taking gabapentin to control seizures) or not improving your symptoms (if taking gabapentin for other indications). Also, never change your dose without talking to your provider first. Always take gabapentin exactly as prescribed.
Don’t drive, operate heavy machinery or do other dangerous activities after taking gabapentin until you know how it affects you.
Read the full prescription information leaflet that comes with your medication. Never hesitate to ask your healthcare provider or pharmacist if you have any questions about gabapentin.
What should I tell my healthcare provider before starting gabapentin?
Tell your healthcare provider if you:
- Have lung or breathing problems.
- Have diabetes.
- Have kidney problems or are on dialysis.
- Have or had mood problems, depression, suicidal thoughts or behavior.
- Have a history of drug abuse or alcohol abuse problems.
- Are pregnant, trying to become pregnant or are breastfeeding.
Inform your providers of all medications you take, including prescription and over-the-counter, as well as supplements, vitamins and herbal products.
Can I take gabapentin if I’m pregnant or thinking of becoming pregnant?
It’s unknown if gabapentin can harm your unborn baby. For this reason, talk to your healthcare provider as soon as you know you are pregnant. You and your healthcare provider will determine if you should take gabapentin during your pregnancy or change to a different medication.
Does gabapentin pass into breast milk?
Yes, gabapentin does pass into breast milk. If you are breastfeeding or planning to breastfeed, talk with your healthcare provider about breastfeeding or medication options.
Is gabapentin a narcotic or controlled substance?
Gabapentin is not a narcotic. It’s not classified as a controlled substance in most states. (Kentucky, West Virginia, Michigan, Tennessee, and Virginia have reclassified gabapentin as a Schedule V controlled substance). Gabapentin is not an opioid.
Is gabapentin addictive?
Gabapentin is not addictive, but this doesn’t mean that gabapentin can’t be abused. A small number of studies have reported misuse and abuse of gabapentin.
Does gabapentin cause withdrawal symptoms?
Gabapentin withdrawal symptoms have been reported since the drug was approved. However, the individuals in these reports experienced symptoms after discontinuing higher-than-recommended doses of gabapentin and for uses for which the drug was not approved.
What’s known about gabapentin and overdose?
Overdoses on gabapentin have been reported. Individuals experienced double vision, slurred speech, drowsiness, diarrhea and sluggishness.
What should I do if I miss a dose of gabapentin?
If you forget to take a dose of gabapentin, take it as soon as you remember. If it’s just a few hours before it’s time to take your next dose, take only one dose. Never take more than one dose in an attempt to catch up. If you have any concerns or questions, be sure to call your healthcare provider or pharmacist right away.