Gabapentin is prescribed for certain seizures and nerve pain. It can help when used appropriately, but side effects, physical dependence and misuse are possible. Side effects during prescribed use do not by themselves mean addiction.
Gabapentin acts on calcium-channel-related signaling, not in the same way as benzodiazepines. Dizziness, sleepiness and impaired coordination may affect driving or other activities. Possible side effects include:
- diarrhea
- vomiting and nausea
- constipation
- tremors
- swelling of the legs or feet
- flatulence
- weight gain
- blurred vision
A prescriber or pharmacist should check all medicines and supplements. Important interaction risks include:
- Opioids such as morphine: increased sedation and breathing risk
- Benzodiazepines and sleeping medicines: additive sedation
- Other medicines causing drowsiness: individual review is needed
- Alcohol: increased sleepiness and impairment
- Some antidepressants and antipsychotics: check combined effects
- Sedating supplements: safety may be uncertain
- Aluminum- or magnesium-containing antacids: reduced absorption
Long-term treatment may be appropriate with regular review. The following concerns can arise during treatment and are not limited to long-term use:
Mood or Behavioral Changes
Report new or worsening mood changes, unusual behavior or suicidal thoughts promptly. Antiseizure medicines carry a suicidality warning, but this is not one of the most common effects. Immediate danger requires emergency care.
Liver Abnormalities
Liver injury is rare and is not an expected consequence of long-term use. Seek prompt advice for yellow skin or eyes, dark urine or other concerning symptoms. A rash with fever, swollen glands or organ symptoms may signal a serious hypersensitivity reaction.
Kidney Abnormalities
The kidneys remove gabapentin. Reduced kidney function can cause accumulation, so the dose or schedule may need adjustment. This differs from saying routine use damages the kidneys. New swelling or urinary changes need assessment.
Abuse and Dependence
Gabapentin can be misused, especially with other sedating substances. Physical dependence can develop during prescribed use and is distinct from addiction. Tolerance or withdrawal alone does not establish a substance use disorder.
A clinician can plan gradual reduction if stopping is appropriate. Abrupt stopping can cause withdrawal and worsen seizure control. Treatment is available for people struggling with compulsive use.
Overdose
Taking more than prescribed can cause overdose. No single dose is safe for everyone or defines toxicity: kidney function, formulation, age and other drugs affect risk. Possible symptoms include:
- Sleepiness
- Tremors
- Slurred speech
- Diarrhea
- Altered mental status
- Double vision
- Lethargy
- Dizziness
Serious breathing problems can occur, especially with opioids or other sedatives, in older adults or with breathing disorders. Call emergency services for slow or difficult breathing, blue lips, collapse or inability to wake. Obtain urgent poison-center or medical advice for any suspected overdose without waiting for symptoms.
Dizziness and drowsiness are common, but do not affect everyone. These measures may reduce risk; they cannot guarantee side effects will be avoided:
Take gabapentin as instructed
Follow your own prescription. Dose and schedule depend on indication, formulation and kidney function. Do not increase the dose or double up after a missed dose; ask a pharmacist if unsure.
Inform the doctor of your past medical history
Tell your prescriber about your medical history to help assess risks and monitoring needs, including:
- Kidney disease
- Depression or other mood problems
- Diabetes
- Pregnancy or any plans for conception
- Suicidal thoughts or behaviors
- Lung problems
- Breastfeeding
- Active seizures or a history of seizures
- Any history of drug or alcohol use
Inform the doctor of all medicines you are taking
This is an important thing to do as many drugs may potentially worsen the gabapentin side effects. So make sure that the doctor who is prescribing you gabapentin knows about all over-the-counter and prescription drugs along with supplements you are regularly taking, such as opioids, anxiety drugs, sedatives, or any other drug capable of causing drowsiness.
Take gabapentin with food
If gabapentin is triggering digestive issues, such as vomiting, nausea, and stomach problems, try combining it with food.
Avoid taking gabapentin with antacids
Aluminum- or magnesium-containing antacids reduce absorption. Standard gabapentin product information advises taking gabapentin at least two hours after such an antacid. Check your specific product instructions with a pharmacist.
Be mindful of all risky activities
Some common side effects of gabapentin include vision changes, dizziness, and sedation. These impairments can make it risky for you to involve in certain activities, such as operating heavy machinery, driving, or engaging in a presumably hazardous activity that requires full attention,
Say no to alcohol
Alcohol can increase gabapentin-related drowsiness, dizziness and impairment. Ask your prescriber or pharmacist for individual advice, particularly if you also use opioids, sedatives or have breathing problems.
Avoid combining it with other sedatives
Check with a clinician or pharmacist before adding sedating medicines or supplements. Some combinations are prescribed when needed, with benefit-risk assessment and monitoring.
Keep close tabs on your breathing pattern
Seek emergency help for slow, shallow or difficult breathing, blue lips, severe confusion or inability to wake. These risks are not confined to deliberate overdose.
Do not skip gabapentin
If you have been using gabapentin for a long time, skipping its dose can lead to withdrawal symptoms, especially if you do it suddenly. If you feel like this medication is not working or causing too many side effects, try seeking medical advice before stopping gabapentin. An expert can help you avoid these withdrawal effects by progressively tapering the dose.
Because of the potential hazards associated with gabapentin, it may not be the right medication for people in certain circumstances. For example, anyone allergic to gabapentin may not be able to tolerate it even once. Other people might be able to use it for some time but may end up developing side effects or other issues secondary to their pre-existing issues. In such cases, a doctor will prescribe them gabapentin very cautiously and monitor them closely and regularly.
Some people who require additional monitoring and special care while using gabapentin include the following:
- People with depression, previous self-harm or new mood symptoms need appropriate monitoring. Seek help for suicidal thoughts; previous depression does not automatically rule out gabapentin.
- Reduced kidney function often requires dose adjustment to prevent accumulation. The formulation and schedule must follow product information and individual assessment.
- Because gabapentin can slow down the breathing rate, people with pre-existing lung issues may require frequent monitoring while taking gabapentin.
- Human pregnancy studies exist, but uncertainties remain. Discuss benefits and risks if pregnant or planning pregnancy. Do not stop suddenly, especially when treating epilepsy.
- Gabapentin passes into breast milk. It may be used during breastfeeding after clinical assessment. Monitor the baby for unusual sleepiness, poor feeding or poor weight gain and seek advice if concerned.
- In the US, immediate-release gabapentin is approved as an add-on treatment for partial-onset seizures from age three. Age limits and indications differ by product and country; do not self-treat a child.
- Older adults can benefit, but are more vulnerable to sedation, falls and breathing problems. Kidney function and other medicines should guide treatment.
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