Everything you need to know about Gabapentin

The prescription drug gabapentin is used for the treatment of a range of medical conditions. This includes anxiety disorders, neuropathic pain and epilepsy. According to Drugwise, the prescribing of gabapentin has increased 150% in the last 5 years. There are similar figures around the world and the drug was actually the number 10 most prescribed drug in the United States in 2020. In this article, we’ll tell you everything you need to know about this drug, its uses and its risks.

What is gabapentin?

Gabapentin is a medication that was originally used as an anti-spasmodic medication and muscle relaxer. It was later discovered that it could be used as an anticonvulsive treatment and a medication to help neural pain.

This drug was first discovered in the 1970s but it took 20 years to be approved as a medication. It belongs to a class of medications called anticonvulsants since it helps to control epileptic seizures. It works by reducing abnormal brain excitement.

In the United Kingdom, gabapentin is used as an epilepsy treatment but it is also prescribed for other conditions including shingles, diabetes and nerve pain. Occasionally, it is used for migraines, restless leg syndrome and hot flashes (in menopause/breast cancer patients). It is prescribed under the brand name Neurontin.

Can gabapentin be addictive?

Gabapentin is not a narcotic medication but it can still be addictive. There are around 1% of people who misuse the drug, which can lead to addiction. It’s also estimated that as many as 22% of people who misuse opioid drugs also abuse gabapentin.

A gabapentin addiction is characterised by the use of gabapentin compulsively without regard for the negative effects. Like any drug, once an addiction takes hold, it is very difficult to stop without support and treatment or rehab.

Some of the signs of a gabapentin addiction include:

• Being unable to control how much gabapentin is taken.
• Continuing to take the drug despite it causing problems either psychologically, physically, occupationally or otherwise.
• Spending lots of time trying to obtain or use the drug.
• Mixing it with alcohol, benzodiazepines or opioids.
• Being unable to meet work, school or home obligations.
• Being tolerant or dependent.
• Exaggerating symptoms or lying about them to doctors to get more medication.
• Trying to get doses from multiple doctors.
• Changing doctors after a refusal to prescribe.
• Changes in social circles and habits.
• Changes in appearance, grooming and hygiene.

Physical signs of excessive use include:

• Coordination problems.
• Drowsiness.
• Tremors.
• Suicidal thoughts and behaviours.
• Depression.
• Mood changes.
• Forgetfulness.
• Dizziness.
• Anxiety.
• Problems with speech.

Lots of users report that a high dose of gabapentin (800mg+) gives a euphoric experience but it won’t show up on drug screening programmes. Many users combine gabapentin with other drugs but, unlike some drugs, there is no antidote in the case of overdose. Signs of overdose include lethargy, drooping eyelids, muscle weakness, sedation and diarrhoea.

The drug is known as “Johnnies” or “Gabbies” as a street name.

If someone is addicted to gabapentin, it needs to be dealt with carefully as the withdrawal symptoms can be quite severe. It is best for people to try to quit under medical supervision. Addiction tends to occur when people are already addicted to other drugs like opioids. The effects of gabapentin are described as being similar to marijuana in that users feel high, calm and euphoric.

What is gabapentin used for?

The main use of gabapentin is for seizure control and prevention. The drug works by calming the activity of the nerves, thus reducing seizure occurrences and their intensity when they do occur.

The drug is used in epilepsy treatments for both children and adults. Some people will just take gabapentin, while others will take a combination of medications. It also works to prevent partial seizures too.

Besides epilepsy, gabapentin is used to treat neuralgia. This is the stabbing or burning nerve pain that occurs commonly after shingles or with diabetes.

In an extended-release tablet, gabapentin is also used to treat restless leg syndrome. This is a condition in which people suffer uncomfortable sensations and an irresistible urge to move their legs.

There have also been studies to suggest that gabapentin can be used together with oxycontin, an opioid pain medication, to control cancer pain.

How is gabapentin abused?

As mentioned above, gabapentin can be addictive. As such, it’s easy to abuse the drug. People often abuse or misuse the drug to get high or mix it with other drugs that depress the central nervous system, including alcohol, benzodiazepines and opioids. When it is mixed with other substances, a person is much more likely to have life-threatening and dangerous side effects, including drug overdose.

Abusing gabapentin by taking too much or taking it without a prescription means you run the risk of becoming physiologically dependent on the drug. In turn, this means you will need to continue taking it so as not to have unpleasant symptoms through withdrawal.

Withdrawal symptoms include:

• Pain.
• Nausea.
• Anxiety.
• Excessive sweating.
• Sleep disturbances.

How does gabapentin affect the body?

When taken properly, gabapentin is a safe medication. But, there can be side effects, which might be a temporary occurrence as the body adjusts to you taking the drug.

However, there are things you should always contact your doctor about and you need to look out for signs of the following:

• An allergic reaction – This would present as hives, a rash, swellings, trouble swallowing and difficulty breathing.
• Mood or behavioural changes – This includes suicidal ideation and attempts, irritability, anxiety, worsening depression, and being restless and agitated. You might also experience impulsive behaviour, anger, aggression, poor focus and memory problems.
• Signs of problems with the liver – This includes dark urine, yellowing of the whites of the eyes and skin, pale stools, unusual bruising and bleeding, and vomiting.
• Signs of problems with the kidneys – Difficulty urinating, weight gain, blood in urine, an increase/decrease in urine output, and swollen legs and feet due to fluid retention.

What are the risks of gabapentin?

Anyone who is prescribed gabapentin needs to talk through any problems they’re having with the person who prescribed the drug, especially if they have severe or worsening side effects. Here are some of the biggest risks of the drug.

Breathing difficulties

The FDA in America issued a warning in 2019 to say that there are respiratory risks with gabapentin. If anyone already suffers from asthma or chronic obstructive pulmonary disorder (COPD) then they should speak about this with their doctor before they take gabapentin.

Suicidal ideation

There are some studies that suggest taking gabapentin increases suicidal behaviours and thoughts. For this reason, anyone taking gabapentin should contact their doctor if they experience such feelings. It’s also a good idea to inform loved ones of the possibility of this side effect so that they can monitor and support as appropriate.

Overdose risk

Like any medication, it is possible to overdose on gabapentin. Deliberate overdose is more likely among those who take other drugs or those who suffer from poor mental health. It’s important to monitor dosage to avoid accidental overdose too.

In U.S. prisons, there have been a number of intentional attempts at suicide by taking gabapentin and the figure has grown by 80% in five years.

Interactions with other substances and medications

Like all drugs, gabapentin could interact with other medications, including herbal supplements, vitamins, over-the-counter substances and other prescription medications. For this reason, you should always inform the doctor prescribing gabapentin of any other medications being taken.

Studies have shown that gabapentin can interact with:

• Phenytoin (an anticonvulsant).
• Morphine (an opioid pain relief medication).
• Mefloquine (anti-malaria medication).
• Losartan (hypertension medication).
• Ethacrynic acid (a diuretic).
• Magnesium oxide (antacid/mineral supplement).
• Caffeine.

Since gabapentin can also cause drowsiness, the following medicines can also be problematic (as they can also cause drowsiness):

• Antihistamines.
• Antianxiety medication.
• Cold/flu medicines.
• Antidepressants.
• Muscle relaxers.
• Some pain relief medicines.
• Sleeping tablets.

Other health conditions

You are also at risk of complications if you need to take gabapentin and you have or have had:

• Dialysis.
• Diabetes.
• Alcohol or drug problems.
• Kidney disease.
• Heart disease.
• Liver disease.
• Seizures (if the gabapentin isn’t prescribed for these).

Gabapentin and pregnancy/breastfeeding

Women who are pregnant or are trying to become pregnant need to inform their doctor before they take gabapentin. This is because new research has indicated that this medicine is associated with a greater risk of preterm birth, low birth weight and cardiac malformation. However, some people might need to continue taking this drug throughout pregnancy to control epileptic seizures.

As for breastfeeding, gabapentin will pass into breast milk. However, this won’t affect an infant at low levels.

Other risks and considerations

Since gabapentin is a drug that causes drowsiness, people should be careful when using machinery or driving.

Short-term and long-term effects of gabapentin

Most side effects are pretty mild and don’t need medical attention.

These include:

• Cold or flu symptoms.
• Blurred vision.
• Dementia.
• Loss or lack of strength.
• Hoarseness.
• Pain in the side or lower back.
• Swelling in the legs, feet and hands.
• Shaking or trembling.

It is also fairly common to be unsteady on your feet and have uncontrolled eye movements but these two side effects do require a visit to the doctor.

In children, the side effects of gabapentin can be different.

These include:

• Behavioural problems and aggressiveness.
• Anxiety.
• Crying.
• Poor concentration.
• Changes in performance at school.
• Distrust of other people.
• An increase in movement or hyperactivity.
• Mood swings.
• Restlessness.
• Overreacting and being quick to react.

The long-term effects of taking gabapentin

According to research, those who have an existing kidney problem could end up with fatal toxicity by taking gabapentin. Besides this, the drug can also cause other long-term side effects, which include respiratory failure, weaker muscles and memory loss.

There are rarer side effects too.

These include:

• Violent behaviour, anger and aggressiveness.
• Suicidal ideation.
• New or worsening depression.
• New or worsening anxiety.
• New or worsening irritability.
• Panic attacks.
• Mania.
• Hallucinations.

Abnormal and rare side effects

People can also be affected by gabapentin in specific areas of their bodies.

For example, a person can experience kidney abnormalities and have associated symptoms like:

• A change in urine output.
• Problems urinating.
• Blood in the urine.
• Swelling of feet or legs due to fluid retention.
• Weight gain.

Other abnormalities include weakness, tiredness and severe fatigue, muscle pain, stomach pain and cyanosis.

Gabapentin has also been known to cause severe allergic reactions, including anaphylaxis.

An allergic reaction usually shows with the following symptoms:

• Hives.
• A skin rash.
• Difficulty breathing or wheezing.
• Tightness in the throat or chest.
• Fever.
• Swollen glands.
• Swollen tongue, throat, lips or face.

What are the different forms of gabapentin?

There are different forms of gabapentin.

These include:

• Tablets (300 mg, 600 mg, 800 mg).
• Capsules (100 mg, 300 mg, 400 mg).
• Extended-release tablets (300 mg, 600 mg).
• Oral solution (250 mg/5ml).

How to take the medicine will depend on the form prescribed. Some tablets should be taken with food but not crushed or broken. Others can be taken at any time.

The dose prescribed will depend on different factors, including:

• The gabapentin brand/type.
• The strength.
• The reason for the prescribed medication.
• A person’s kidney function, general health, age and weight.

Dosing will vary greatly among individuals. If a dose is missed, it’s important to call the pharmacist or doctor for advice.

Final thoughts on gabapentin

The drug gabapentin is an anticonvulsant used to control and reduce the severity of epileptic seizures and partial seizures. It is also used for nerve pain and restless leg syndrome. There are different types of gabapentin and different forms of the drug.

Depending on the medical issue being treated, the drug will be prescribed differently both in terms of dose and in terms of the type of medicine. Patients should always inform the doctor prescribing the drug of any other medical conditions or drugs being taken so that the doctor can make appropriate decisions on their patient’s care.

Though side effects can occur, most people experience very few. Provided that advice is followed and that patients are aware of potential side effects and addiction, gabapentin is a safe and useful medicine.