For those living with seizures or nerve pain, effective treatment is important for health, safety and quality of life. Many people rely on a medication called gabapentin to control their conditions. Keep reading to learn more about this medication, including how it works, what to expect when taking it, and what to know before stopping treatment.
Understanding Gabapentin
Gabapentin is available as a generic or under the brand names Gralise and Neurontin, and it’s classified as an anticonvulsant. This medication is taken by mouth and comes in several forms, including capsule, tablet and liquid. It also comes in an extended-release tablet under the brand name Horizant that works over an extended period.
Interestingly, researchers aren’t entirely sure how the medication works, but they believe it sticks to certain spots on muscle and nerve cells, called voltage-gated calcium channels, helping to reduce activity.
For people with seizures, experts believe gabapentin decreases abnormal electrical activity in the brain by causing cells to produce more of a chemical called GABA. In people experiencing nerve pain from shingles, the medication is believed to change the way pain signals are carried through the body and brain.
The Food and Drug Administration also approves this medication’s use for controlling restless leg syndrome, though researchers don’t yet know why it helps with this condition.
Uses and Benefits
The FDA officially approves gabapentin to manage partial seizures (seizures that originate from a single location in the brain), persistent nerve pain related to shingles and restless leg syndrome. Along with these uses, gabapentin may be prescribed off-label to manage other conditions. Off-label use means that there’s evidence that the drug can effectively treat conditions other than what it’s officially approved for.
It’s important to note that health insurance companies differ in their coverage for off-label use, so before beginning treatment, you may want to confirm that your health insurance will pay for the medication.
Some off-label uses for gabapentin include:
- Alcohol or cannabis addiction withdrawal symptoms
- Mood disorders, such as generalized anxiety disorder
- Hot flashes that result from menopause or treatment for breast cancer
- Pain from nerve damage resulting from diabetes
- Nerve pain in the neck and back from sciatica
- Treatment of pain related to fibromyalgia
- Persistent hiccups
- Migraine prevention
Gabapentin is available as a generic as well as under several brand names. Depending on the condition you and your doctor are addressing, the generic form may not be a suitable substitute for the branded version.
Risks and Side Effects
While gabapentin is generally safe for those aged 3-60 years old, there are a few common side effects. These include:
- Drowsiness
- Nystagmus (rapid and uncontrolled eye movements)
- Behavioral changes
- Dizziness
- Headache
- Blurred vision
- Digestive upset, including nausea, vomiting, diarrhea or constipation
- Dry mouth
- Weight gain
- Swelling of the hands, feet or ankles
- Joint or back pain
- Fever
- Body aches
In rare cases, individuals may experience more serious side effects when they take gabapentin. These may include:
- Personality changes
- Memory impairment
- Difficulty concentrating
- Problems with speaking or swallowing
- Swelling in the face or throat
- Skin problems, including rashes, itching or yellowing
- Depression or thoughts of suicide, particularly in young adults
For many people, these side effects disappear after a few days as the body adapts to the medication. However, if side effects persist, you may need to talk to your doctor about adjusting your dose. Alcohol may worsen side effects such as drowsiness.
Certain side effects, including tiredness, are most likely to occur when you first start taking the medication. Although starting on a low dose and slowly ramping up can delay the benefits of the drug, it can also help reduce or prevent bothersome side effects.
It’s important to note that gabapentin may interact with some medications, including prescription opioids, antacids and other medications that may cause drowsiness or dizziness. Additionally, because those who take gabapentin may develop a dependence on it, especially if they use it alongside an opioid such as hydrocodone, those with a history of substance abuse may want to talk to their doctor about whether this medication is suitable for them.
Precautions and Considerations
Once you begin taking gabapentin, be sure to schedule regular check-ups with your doctor, especially during the first few months as your body adjusts to the medication. This lets your doctor monitor your progress and symptoms and determine whether you’re benefiting from the medication.
Because gabapentin can cause drowsiness or confusion and impact your reaction times, it’s important to be cautious about driving or operating heavy machinery until you know how the medication affects you. The medication can also cause changes in your personality, resulting in increased agitation, increased depression or suicidal thoughts. If you notice any of these changes, talk to your doctor.
Additionally, gabapentin can interact with medications that affect your central nervous system. If you’re on any antihistamines, sleep aids, prescription pain medications, muscle relaxants or other seizure medications, this drug may not be right for you. If you’re already taking gabapentin, be sure to let your doctor or dentist know before going on a prescription pain medication.
In rare cases, gabapentin causes serious allergic reactions that may be life-threatening, including difficulty breathing or swelling of the throat. If you experience any of these symptoms, it’s critical to let your doctor know right away.
Because of how the body adapts to gabapentin, slowly tapering off the drug under medical supervision is necessary. Stopping it abruptly can cause seizures or other withdrawal symptoms such as headaches, nausea, insomnia and in some cases, seizures.
Dosage and Administration
Gabapentin is taken orally, and it’s available in several forms, including capsules, tablets or liquid. Generally, individuals start out with an initial dose of 300 milligrams three times daily. They may work up to larger doses, depending on what they use the medication for.
For adults using this medication to control seizures, their maintenance dose is usually around 300-600 mg taken three times per day. Depending on the effectiveness of the medication, their doctor may prescribe doses as large as 1200 mg three times daily.
For those using the immediate-release form of gabapentin to address nerve pain, usual dosage runs around 300 mg between one and three times per day, with a maximum daily dose of 1800 mg. The extended-release dosage for the branded version Gralise differs and typically follows a schedule:
- Day 1: initial dose of 300 mg with the evening meal
- Day 2: 600 mg with the evening meal
- Day 3-6: 900 mg with the evening meal
- Day 7-10: 1200 mg with the evening meal
- Day 11-14: 1500 mg with the evening meal
- Day 15 and onward: 1800 mg with the evening meal
Those on Horizant, another extended-release version, generally take smaller doses of 600 mg once or twice per day.
In individuals using gabapentin for restless leg syndrome, the typical dose is 600 mg once per day. Research has shown that higher doses offer no additional benefit but increase the risk of side effects.
If you’re taking gabapentin and you forget a dose, take it as soon as you remember. However, if it’s within two hours of the next dose, it’s best to skip the missed dose and take the next dose as normal. Don’t double up on the medication to make up for the missed dose.
Treatment Duration and Withdrawal
How long an individual stays on gabapentin depends on the condition they’re addressing. For someone using the medication to control seizures, they may expect to stay on it for several years. On the other hand, if someone is taking the medication for nerve pain, they typically stay on the medication for several months after their pain goes away before tapering off.
It’s important to not stop taking gabapentin abruptly, even if you feel normal. For those who have epilepsy, going off the medication suddenly can cause uncontrollable seizures. Additionally, sudden withdrawal can cause you to feel nauseated and bring on anxiety, sleep problems, pain and sweating. If you need to stop taking gabapentin, your doctor will wean you off slowly, gradually decreasing your dose over time.
Conclusion
Gabapentin can effectively control certain types of seizures and nerve pain, but it’s not without several considerations. Side effects are somewhat common, and interactions with other medications may be a concern for some people. Be sure to talk to your doctor about any questions you have about starting, staying on, or weaning off of gabapentin.
