Barbiturates may be Habit-forming

Tolerance, psychological dependence, and physical dependence may occur especially following prolonged use of high doses of barbiturates. The average daily dose for the barbiturate addict is usually about 1500 mg. As tolerance to barbiturates develops, the amount needed to maintain the same level of intoxication increases; tolerance to a fatal dosage, however, does not increase more than two-fold.

As this occurs, the margin between an intoxication dosage and fatal dosage becomes smaller. The lethal dose of a barbiturate is far less if alcohol is also ingested. Major withdrawal symptoms (convulsions and delirium) may occur within 16 hours and last up to 5 days after abrupt cessation of these drugs. Intensity of withdrawal symptoms gradually declines over a period of approximately 15 days. Treatment of barbiturate dependence consists of cautious and gradual withdrawal of the drug.

Barbiturate-dependent patients can be withdrawn by using a number of different withdrawal regimens. One method involves initiating treatment at the patient’s regular dosage level and gradually decreasing the daily dosage as tolerated by the patient.

What Happens When you Suddenly Stop Taking Gabapentin?

Case reports have shown that gabapentin withdrawal can last for up to 5 days or longer, but the duration has not been well established in human studies.

Gabapentin is a prescription medicine. It’s important to take it as advised by your doctor.

Dosage and strength

Each capsule of gabapentin contains 100mg, 300mg or 400mg of gabapentin. Each tablet contains 600mg or 800mg of gabapentin.

If you’re taking gabapentin as a liquid, 2ml is usually the same as taking a 100mg tablet or capsule. Always check the label.

Dosage for epilepsy

The usual dose for:

  • adults and older children (aged 12 and over) is 900mg to 3,600mg a day, split into 3 doses
  • younger children (aged 6 to 12) – varies depending on their weight

Dosage for nerve pain

The usual dose to treat nerve pain in adults is 900mg to 3,600mg a day, split into 3 doses.

Changes to your dose

To prevent side effects, your doctor will prescribe a low dose to start with and then increase it over a few days. Once you find a dose that suits you, it will usually stay the same.

How to take it

Swallow gabapentin capsules and tablets whole with a drink of water or juice. Do not chew them.

You can take gabapentin with or without food, but it’s best to do the same each day.

Try to space your doses evenly through the day. For example, you could take it first thing in the morning, early afternoon and at bedtime.

If you or your child are taking a liquid, it will come with a plastic syringe or spoon to measure your dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen spoon, as it will not measure the right amount.

The symptoms and how long they last depend on how much of the drug you are taking and for how long you’ve been taking it.

Gabapentin withdrawal is not a common problem unless you are abusing the drug.

Abuse means taking gabapentin in higher than prescribed amounts and taking it for reasons not intended by your doctor.

A study on gabapentin abuse from 1993 through 2015 showed that people who experienced withdrawal were taking an average of 3,000 mg (600 to 8,000 mg) of gabapentin per day, but some case reports mention withdrawal symptoms at 400 mg per day.

What happens when you suddenly stop taking gabapentin?

If you are taking gabapentin at a normal dose prescribed by your doctor and you don’t have a history of substance abuse, you are less likely to have withdrawal symptoms when you stop taking it.

Higher doses and a history of substance problems pose more risk for abuse. You can start to build up a tolerance to the drug, and you may need to take even more of it to get the desired effect. This is called physical dependence.

Your brain cells (neurons) become dependent on a high dose of the drug for normal functioning. When the drug is stopped, your brain becomes temporarily disorganized. If you start to feel that you need more of the drug to function, stopping suddenly is more likely to lead to withdrawal symptoms.

Withdrawal symptoms may start within 12 hours or take up to 7 days to begin after stopping suddenly. Symptoms commonly include:

      • Restlessness (agitation)
      • Disorientation
      • Confusion

Various case reports describe these other symptoms of gabapentin withdrawal:

  • Headache
  • Body/stomach pain
  • Anxiety
  • Heart palpitations
  • Sweating
  • Muscle twitching
  • Light sensitivity
  • Restless limb movements
  • Nervousness

What is the treatment for gabapentin withdrawal?

There are no approved medications to treat gabapentin withdrawal. The only reliable treatment is to slowly taper the drug under the supervision of your doctor, usually a substance abuse specialist. Sometimes gabapentin is restarted to ease withdrawal symptoms before tapering off.

There is no evidence to show that other drugs or supplements — such as magnesium or CBD oil — are helpful in treating withdrawal symptoms.

Most case reports show that withdrawal patients went back onto gabapentin to relieve their symptoms. But there may be unreported cases of gabapentin withdrawal, as not everyone seeks treatment.

How can I avoid gabapentin withdrawal?

The best way to avoid gabapentin withdrawal is to only take the drug in the dose prescribed by your doctor for its approved uses.

Gabapentin is a prescription medication approved to treat certain types of seizures and nerve pain that follows a herpes infection (postherpetic neuralgia). A long-acting form is used to treat restless legs syndrome. The most common brand name is Neurontin.

Gabapentin is also prescribed and used for unapproved reasons. These are called off-label uses. Off-label uses for gabapentin include:

  • Substance abuse treatment
  • Migraine headaches
  • Fibromyalgia
  • Mental health disorders
  • Insomnia

People with a history of drug or alcohol abuse may be at increased risk for:

  • Tolerance
  • Self-dose escalation
  • Drug-seeking behavior
  • Withdrawal symptoms

Withdrawal Symptoms From Gabapentin

It is rare to experience withdrawal symptoms from Gabapentin, but it does happen. A review of medical journals published between 1993, when Gabapentin was approved, and 2015, found 18 case reports of Gabapentin addiction, dependence, or withdrawal.

Doctors publish case reports when they encounter a patient with a rare disorder or with a condition that they want to make their colleagues aware of. Case reports are significant because they help further knowledge and identify subjects worthy of future research.

It’s worth noting that just because there are so few reports of gabapentin withdrawal, doesn’t necessarily mean it’s as rare as people once thought. It’s possible that many people simply don’t seek treatment for gabapentin withdrawal.

According to the Drug Enforcement Administration (DEA), gabapentin use is on the rise. Doctors wrote more than double the amount of gabapentin prescriptions in 2017 as they did in 2011.

The illicit use of gabapentin also appears to be increasing.

In a small survey of prescription drug abusers in Appalachian Kentucky, 15 percent reported using gabapentin to get high. That number is a 165 percent increase from the year prior and a 2,950 percent increase from 2008.

It appears as though gabapentin dependence and withdrawal are most common among people who use at least one other substance, such as opioids or alcohol. In the case reports, all patients had past drug or alcohol addiction issues.

Opioid users have reported using gabapentin to intensify their high. Cocaine users have reported the same, as well as attempts to use gabapentin to help alleviate cocaine withdrawal.

Signs and Symptoms

Among the documented cases, gabapentin withdrawal began between 12 hours and 7 days after the last dose.

The majority saw withdrawal symptoms within 24 to 48 hours.

Common Symptoms

The most common symptom was agitation, occurring in about half of the recorded cases. Confusion and disorientation were the next most common symptoms, followed by:

      • Sweating
      • Gastrointestinal symptoms
      • Tremors
      • Fast heart rate
      • High blood pressure
      • Insomnia

In many of the cases reported in the medical journals, individuals entered gabapentin withdrawal without the intention to do so.

This was typically a result of running out of gabapentin or leaving it at home during a trip out of town.

This sample of cases is unlikely to be reflective of most people’s experiences with gabapentin withdrawal. The reason for this is that only people with severe or alarming symptoms seek emergency medical treatment.

Among the cases reported, gabapentin withdrawal symptoms typically peaked three days after someone’s last dose. In almost all cases, doctors eventually treated the symptoms by resuming the previous gabapentin dose. Once people resumed their dose, their symptoms disappeared within hours.