Gabapentin (Generic Neurontin, Gralise, Horizant) is an anticonvulsant drug prescribed with other medications to prevent and control seizures.
It is also prescribed to relieve nerve pain after recovering from shingles (a herpes virus) or to treat restless leg syndrome.
Gabapentin is used to treat epilepsy.
It’s also taken for nerve pain, which can be caused by different conditions, including diabetes and shingles. Nerve pain can also happen after an injury.
In epilepsy, it’s thought that gabapentin stops seizures by reducing the abnormal electrical activity in the brain.
With nerve pain, it’s thought to block pain by affecting the pain messages travelling through the brain and down the spine.
Gabapentin is available on prescription. It comes as tablets, capsules and a liquid that you swallow.
What is gabapentin used for?
Gabapentin is FDA-approved as a generic for Neurontin, Gralise, or Horizant. It has the same ingredients, dosing, and efficacy as its brand-name counterparts.
Gabapentin (Generic Neurontin) is used with other medications to treat seizures in adults and children age three and older and may be prescribed for shingles-related neuropathic pain.
Gabapentin (Generic Gralise) treats nerve pain that can last for months or years in adults following a shingles infection.
Gabapentin (Generic Horizant) treats nerve pain associated with restless leg syndrome (RLS) in adults.
Check to make sure you are taking the correct form prescribed by your doctor.
Medical uses
Gabapentin is recommended for use in focal seizures and neuropathic pain. Gabapentin is widely prescribed off-label in the US and UK, for example, for the treatment of non-neuropathic pain, anxiety disorders and bipolar disorder. There is concern regarding gabapentin’s off-label use due to the lack of strong scientific evidence for its efficacy in multiple conditions and its proven side effects.
Seizures
Gabapentin is approved for the treatment of focal seizures; however, it is not effective for generalized epilepsy.
Neuropathic pain
Gabapentin is recommended as a first-line treatment for chronic neuropathic pain by various medical authorities. This is a general recommendation applicable to all neuropathic pain syndromes except for trigeminal neuralgia, where it may be used as a second- or third-line agent.
In regard to the specific diagnoses, a systematic review has found evidence for gabapentin to provide pain relief for some patients with postherpetic neuralgia and diabetic neuropathy. Gabapentin is approved for the former indication in the US. In addition to these two neuropathies, European Federation of Neurological Societies guideline notes gabapentin effectiveness for central pain. A combination of gabapentin with an opioid or nortriptyline may work better than either drug alone.
Gabapentin shows substantial benefit (at least 50% pain relief or a patient global impression of change (PGIC) “very much improved”) for neuropathic pain (postherpetic neuralgia or peripheral diabetic neuropathy) in 30–40% of subjects treated as compared to those treated with placebo.
Evidence finds little or no benefit and significant risk in those with chronic low back pain or sciatica. Gabapentin is not effective in HIV-associated sensory neuropathy and neuropathic pain due to cancer.
Anxiety
There is a small amount of research on the use of gabapentin for the treatment of anxiety disorders.
Gabapentin is effective for the long-term treatment of social anxiety disorder and in reducing preoperative anxiety.
In a controlled trial of breast cancer survivors with anxiety, and in a trial for social phobia,gabapentin significantly reduced anxiety levels.
For panic disorder, gabapentin has produced mixed results.
Sleep
Gabapentin is effective in treating sleep disorders such as insomnia and restless legs syndrome that are the result of an underlying illness. At the same time it comes with a high risk of discontinuation and withdrawal symptoms.
Gabapentin enhances slow-wave sleep in patients with primary insomnia. It also improves sleep quality by elevating sleep efficiency and decreasing spontaneous arousal.
Drug dependence
Gabapentin is moderately effective in reducing the symptoms of alcohol withdrawal and associated craving. The evidence in favor of gabapentin is weak in the treatment of alcoholism: it does not contribute to the achievement of abstinence, and the data on the relapse of heavy drinking and percent of days abstinent do not robustly favor gabapentin; it only decreases the percent days of heavy drinking.
Gabapentin is ineffective in cocaine dependence and methamphetamine use, and it does not increase the rate of smoking cessation. Gabapentin does not significantly reduce the symptoms of opiate withdrawal. There is insufficient evidence for its use in cannabis dependence.
Other
Gabapentin is recommended as a first-line treatment of the acquired pendular nystagmus, torsional nystagmus, and infantile nystagmus; however, it does not work in periodic alternating nystagmus.
Gabapentin decreases the frequency of hot flashes in both menopausal women and patients with breast cancer. However, antidepressants have similar efficacy, and treatment with estrogen more effectively prevents hot flashes.
Gabapentin reduces spasticity in multiple sclerosis and is prescribed as one of the first-line options. It is an established treatment of restless legs syndrome. Gabapentin alleviates itching in kidney failure (uremic pruritus) and itching of other causes. It may be an option in essential or orthostatic tremor. Although the efficacy of Gabapentin for insomnia has not been established, it does alleviate sleep disorder in patients with medical illness.
Gabapentin does not appear to provide benefit for bipolar disorder, complex regional pain syndrome, post-surgical pain, or tinnitus, or prevent episodic migraine in adults.
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How gabapentin works ?
Gabapentin is an anticonvulsant drug that controls electrical activity in the brain’s neurotransmitters, which send signals between nerve cells. Calming nerve activity may reduce the occurrence and intensity of seizures and reduce nerve pain related to other conditions.
Common side effects of gabapentin
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Feeling drowsy, tired, or weak
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Dizziness/unsteadiness
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Headaches
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Uncontrollable shaking
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Double vision
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Anxiety
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Memory problems
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Unwanted eye movements
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Nausea/vomiting
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Heartburn
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Diarrhea or constipation
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Dry mouth
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Increased appetite
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Weight gain
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Swelling in hands, feet, ankles, or legs
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Back pain
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Flu-like symptoms (sneezing, runny nose, coughing, sore throat, fever)
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Earache
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Red, itchy eyes
If you experience symptoms of an allergic reaction, including severe itching; swelling in the face, tongue, throat, lips, or eyes; rash; hoarseness; difficulty swallowing or breathing; seizures; or blue-tinged skin, lips, or fingernails, contact your doctor immediately.
Gabapentin dosage information
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Capsule (100 mg, 300 mg, 400 mg)
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Tablet (600 mg, 800 mg)
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Solution (250 mg/5 mL)
Always check to make sure you’re taking the correct form of gabapentin in the accurate dosage. Ask your pharmacist or doctor if you have questions.
Additional information
Adults and children may experience sudden mood or behavioral changes when taking gabapentin. Contact your doctor immediately if you or your child experience panic attacks, agitation, new or worsening irritability, aggressive or violent behavior, suicidal thoughts, or other unusual behavior or mood changes.
Gabapentin How to Use
It’s important to read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist, before you begin taking gabapentin and each time you get a refill. If you have any questions, ask your clinician or pharmacist.
Take gabapentin by mouth, either with or without food as directed by your licensed medical professional. Your dosage is based on your medical condition, as well as your response to treatment. In children, the dosage is also based on their weight.
If you are taking the tablet form of gabapentin and your licensed medical professional directs you to split the tablet in half, take the other half-tablet at your next scheduled dose. Be sure to discard remaining half-tablets if you haven’t used them within 28 days of splitting them. If you are taking the capsules, always swallow them whole with plenty of water.
It is very important to follow your licensed medical professional’s dosing instructions exactly. During the first few days taking gabapentin, your licensed medical professional may gradually increase your dose so that your body can adjust to the medication. To minimize the occurrence of side effects, take the very first dose at bedtime.
To get the most benefit, take this medication regularly. Gabapentin will work best when the amount of medication in your body is kept at a constant level. Therefore, take gabapentin at evenly spaced intervals at the same time(s) every day as prescribed. If taking this medication three times per day to control seizures, do not let more than 12 hours pass between doses, or you may increase the risk of having a seizure.
Do not increase your dose or take this medication more frequently without consulting your licensed medical professional. Your risk of serious side effects can increase, and your condition will not improve any faster.
Do not stop taking this medication without consulting your licensed medical professional. Some conditions can become worse when gabapentin is stopped suddenly. If you wish to stop taking gabapentin, your dose may need to be gradually decreased.
Antacids containing aluminum or magnesium may interfere with the absorption of this medication. Therefore, if you are also taking an antacid, it is best to take gabapentin at least 2 hours after taking the antacid.
Different forms of gabapentin (such as immediate-release, sustained-release, enacarbil sustained-release) are absorbed in the body differently. Do not switch from one form to the other without consulting your licensed medical professional.
Tell your licensed medical professional if your condition does not improve or if it worsens.
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Gabapentin Side Effects
It’s important to be aware of possible side effects before you start taking a medication. Here are the listed side effects for this drug:
Drowsiness, dizziness, loss of coordination, tiredness, blurred/double vision, unusual eye movements, or shaking (tremor) may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if any of these unlikely but serious side effects occur: swelling of the hands/ankles/feet.
A small number of people who take anticonvulsants for any condition (such as seizures, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.
Get medical help right away if you have any very serious side effects, including: slow/shallow breathing.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Gabapentin Precautions
It’s also important to be aware of precautions and warnings around taking this medication.
Before taking gabapentin, tell your doctor or pharmacist if you are allergic to it; or to gabapentin enacarbil; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, mental/mood problems (such as depression, thoughts of suicide), use/abuse of drugs/alcohol, breathing problems.
This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
Older adults may be more sensitive to the side effects of this drug, especially swelling of the hands/ankles/feet, slow/shallow breathing, dizziness, or loss of coordination. Dizziness and loss of coordination can increase the risk of falling.
Children may be more sensitive to the side effects of this drug, especially mental/mood/behavior changes (such as hostility, problems concentrating, restlessness).
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.
Gabapentin passes into breast milk. Consult your doctor before breast-feeding.
Gabapentin Pill Storage
Store gabapentin at room temperature, and away from moisture and light. Do not store gabapentin in the bathroom. Keep gabapentin, and all medications, away from pets and children.
Do not flush this or any medications down the toilet or pour them into a drain unless instructed to do so. When you no longer need your gabapentin, or when it has expired, be sure to properly discard the remaining product. Your pharmacist or local waste disposal company can tell you how.
Gabapentin Drug Interactions
Drug interactions can change how gabapentin and your other medications work, or even increase your risk for serious side effects. This document does not contain all possible drug interactions. Be sure to keep a list of all the products you use (including prescription and nonprescription drugs, as well as herbal products) and share it with your clinician and pharmacist. Do not start, stop, or change the dosage of any medicines without your licensed medical professional’s approval.
A product that may interact with gabapentin: orlistat.
Tell your clinician or pharmacist if you use other products that cause drowsiness, like drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), opioid pain or cough relievers (such as codeine, hydrocodone), antihistamines (such as cetirizine, diphenhydramine), muscle relaxants (such as carisoprodol, cyclobenzaprine), alcohol or marijuana (cannabis).
Be sure to also check the labels on all of your medications (including cough-and-cold or allergy products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those medications safely.
Do not use this medication with other medications that contain gabapentin (including gabapentin enacarbil).
Gabapentin may interfere with certain laboratory tests for urine protein. Make sure laboratory personnel and all your licensed medical professionals know you use this drug.
Gabapentin Overdose
Symptoms of gabapentin overdose may include: severe drowsiness, slurred speech, weakness. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
Missed Doses:
If you miss a dose of gabapentin, take it as soon as you remember. If it is near the time of your next dose, skip the missed dose and take your next dose at the regular time. Do not double the dose to catch up.
If you take gabapentin three times a day to control seizures, do not let more than 12 hours pass between doses, as your seizures can increase. Talk to your licensed medical professional right away if this occurs.