What is gabapentin?
Gabapentin is an anti-seizure drug that is also prescribed for nerve pain. It has been available in the US since 1993. I was unaware of any widespread reports concerning any safety issues with it. Indeed, my quick review of the literature indicated that the first peer-reviewed report of any gabapentin-linked death was published in 2011 in the Journal of Forensic Sciences, and that was an intentional suicide by overdose.
Well, many prescription and non-prescription drugs taken in excessive amounts may cause death, even such innocuous drugs as aspirin and acetaminophen. Further review of the literature revealed yet another report of fatality by overdose, which was published the International Journal of Legal Medicine in 2015. However, these two reports hardly constituted thousands.
“So, what’s really going on here?” I pondered. Was this just social and broadcast media hysteria or is this based on a real abuse phenomenon? As it turns out, after my initial scratch of the surface, there was a lot for me to uncover about the truth behind these gabapentin warnings.
Since its introduction, gabapentin has been very popular and widely used as an adjuvant, an add-on drug that boosts the effects of other drugs, especially to help control partial seizures in adults. However, in the quarter century since its initial approval, off-label uses have exploded. It’s been prescribed to treat multiple physical conditions with neurological origins, from restless leg syndrome to nerve pain to acute and post-herpetic pain associated with shingles. It’s also prescribed for multiple psychiatric conditions, such as anxiety disorder, bipolar disorder, attention deficit disorder, and is even prescribed, somewhat ironically, in addiction treatment to reduce cravings and withdrawal symptoms.
Like almost all FDA-approved medications, when prescribed responsibly and taken as prescribed, gabapentin can offer great relief to those with these conditions. However, we all know that we live in a world in which not every patient takes medications as prescribed.
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Gabapentin is an anti-epileptic drug, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain.
All brands of gabapentin are used in adults to treat neuropathic pain (nerve pain) caused by herpes virus or shingles (herpes zoster). The Gralise brand of gabapentin is indicated for the management of neuropathic pain only. It is not used for epilepsy. The Horizant brand of gabapentin, in addition to treating neuropathic pain, is also used to treat restless legs syndrome (RLS). The Neurontin brand of gabapentin is also used to treat seizures in adults and children who are at least 3 years old, in addition to neuropathic pain. Use only the brand and form of gabapentin your doctor has prescribed. Check your medicine each time you get a refill to make sure you receive the correct form.
Some people have thoughts about suicide while taking this medicine. Children taking gabapentin may have behavior changes. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor. Do not stop using gabapentin suddenly, even if you feel fine.
Before taking Gabapentin
You should not use gabapentin if you are allergic to it. To make sure this medicine is safe for you, tell your doctor if you have ever had:
- kidney disease (or if you are on dialysis);
- depression, a mood disorder, or suicidal thoughts or actions;
- a seizure (unless you take gabapentin to treat seizures);
- liver disease;
- heart disease; or
- are taking an anti-depressant or sedating medication; or
- (for patients with RLS) if you are a day sleeper or work a night shift.
Some people have thoughts about suicide while taking this medicine. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms. It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. Seizure control is very important during pregnancy, and having a seizure could harm both mother and baby. Do not start or stop taking gabapentin for seizures without your doctor’s advice, and tell your doctor right away if you become pregnant.
How should I take gabapentin?
Take gabapentin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended. Both Gralise and Horizant should be taken with food.
Neurontin can be taken with or without food, but should be taken with water. If you break a Neurontin tablet and take only half of it, take the other half at your next dose. Any tablet that has been broken should be used as soon as possible or within a few days.
Do not crush, chew, or break an extended-release tablet. Swallow it whole. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. If your doctor changes your brand, strength, or type of gabapentin, your dosage needs may change.Ask your pharmacist if you have any questions about the new kind of gabapentin you receive at the pharmacy.
Do not stop using gabapentin suddenly, even if you feel fine. Stopping suddenly may cause increased seizures.
Follow your doctor’s instructions about tapering your dose. Wear a medical alert tag or carry an ID card stating that you have seizures. Any medical care provider who treats you should know that you take seizure medication.
This medicine can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using this medicine. Store both tablets and capsules at room temperature away from light and moisture. Store the liquid medicine in the refrigerator. Do not freeze.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Be sure to take the medicine with food. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking gabapentin?
This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Avoid taking an antacid within 2 hours before or after you take gabapentin. Antacids can make it harder for your body to absorb gabapentin. Drinking alcohol with this medicine can cause side effects.
Gabapentin side effects
Get emergency medical help if you have signs of an allergic reaction to gabapentin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Seek medical treatment if you have a serious drug reaction that can affect many parts of your body.Symptoms may include: skin rash, fever, swollen glands, flu-like symptoms, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes. This reaction may occur several weeks after you began using gabapentin.
Call your doctor at once if you have:
- increased seizures;
- fever, rash, and/or swollen lymph nodes;
- severe weakness or tiredness;
- problems with balance or muscle movement;
- upper stomach pain;
- chest pain, new or worsening cough with fever, trouble breathing;
- severe tingling or numbness;
- rapid eye movement; or
- kidney problems – little or no urination, painful or difficult urination, swelling in your feet or ankles.
Some side effects are more likely in children taking gabapentin. Contact your doctor if the child taking this medicine has any of the following side effects:
- changes in behavior;
- memory problems;
- trouble concentrating; or
- acting restless, hostile, or aggressive.
Common gabapentin side effects may include:
- headache, dizziness, drowsiness, tiredness;
- swelling in your hands or feet;
- problems with your eyes;
- coordination problems; or
- (in children) fever, nausea, vomiting.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect gabapentin?
Taking gabapentin with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking a sleeping pill, narcotic medication, muscle relaxer, or medicine for anxiety, depression, or seizures. Other drugs may interact with gabapentin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.
How should this medicine be used?
Gabapentin comes as a capsule, a tablet, an extended-release (long-acting) tablet, and an oral solution (liquid) to take by mouth. Gabapentin capsules, tablets, and oral solution are usually taken with a full glass of water (8 ounces [240 milliliters]), with or without food, three times a day.
These medications should be taken at evenly spaced times throughout the day and night; no more than 12 hours should pass between doses. The extended-release tablet (Horizant) is taken with food once daily at about 5 PM. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take gabapentin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Gabapentin extended-release tablets cannot be substituted for another type of gabapentin product. Be sure that you receive only the type of gabapentin that was prescribed by your doctor. Ask your pharmacist if you have any questions about the type of gabapentin you were given.
Swallow the extended-release tablets whole; do not cut, chew, or crush them.
If your doctor tells you to take one-half of a regular tablet as part of your dose, carefully split the tablet along the score mark. Use the other half-tablet as part of your next dose. Properly dispose of any half-tablets that you have not used within several days of breaking them.
If you are taking gabapentin to control seizures or PHN, your doctor will probably start you on a low dose of gabapentin and gradually increase your dose as needed to treat your condition. If you are taking gabapentin to treat PHN, tell your doctor if your symptoms do not improve during your treatment.
Gabapentin may help to control your condition but will not cure it. Continue to take gabapentin even if you feel well. Do not stop taking gabapentin without talking to your doctor, even if you experience side effects such as unusual changes in behavior or mood. If you suddenly stop taking gabapentin tablets, capsules, or oral solution, you may experience withdrawal symptoms such as anxiety, difficulty falling asleep or staying asleep, nausea, pain, and sweating. If you are taking gabapentin to treat seizures and you suddenly stop taking the medication, you may experience seizures more often. Your doctor may decrease your dose gradually over at least a week.
Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with gabapentin and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs) or the manufacturer’s website to obtain the Medication Guide.
Other uses for this medicine
Gabapentin is also sometimes used to relieve the pain of diabetic neuropathy (numbness or tingling due to nerve damage in people who have diabetes), and to treat and prevent hot flashes (sudden strong feelings of heat and sweating) in women who are being treated for breast cancer or who have experienced menopause (”change of life”, the end of monthly menstrual periods). Talk to your doctor about the risks of using this medication for your condition.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use gabapentin only for the indication prescribed.
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Gabapentin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- tiredness or weakness
- uncontrollable shaking of a part of your body
- double or blurred vision
- memory problems
- strange or unusual thoughts
- unwanted eye movements
- dry mouth
- increased appetite
- weight gain
- swelling of the hands, feet, ankles, or lower legs
- back or joint pain
- runny nose, sneezing, cough, sore throat, or flu-like symptoms
- ear pain
- red, itchy eyes (sometimes with swelling or discharge)
Some side effects may be serious. If you experience any of the following symptoms, call your doctor immediately:
- swelling of the face, throat, tongue, lips, or eyes
- difficulty swallowing or breathing
- difficulty breathing; bluish-tinged skin, lips, or fingernails; confusion; or extreme sleepiness
Gabapentin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).