Gabapentin Chemical and Physical Properties

Gabapentin was introduced in 1993 in the UK and early 1994 in the USA as an adjunctive therapy in the treatment of refractory partial seizures and secondarily generalized tonic-clonic seizures. Although being a lipophilic analog of the neurotransmitter GABA, gabapentin appears to exert its anticonvulsive function by a GABA receptor independent mechanism, possibly involving the L-system amino acid transporter protein.

Gabapentin easily crosses the blood brain barrier and exhibits a favorable pharmacokinetic profile with high tolerability. It does not interfere with the metabolism of other concomitant administered antiepileptic drugs, thus having a low potential for drug interactions. Studies are currently underway for the use of gabapentin as mono-therapy for the treatment of various seizures.

Gabapentin capsules, tablets, and oral solution are used along with other medications to help control certain types of seizures in people who have epilepsy. Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down). Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.

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.

Computed Properties

Molecular Weight 171.23678 g/mol
Molecular Formula C9H17NO2
XLogP3 -1.1
Hydrogen Bond Donor Count 2
Hydrogen Bond Acceptor Count 3
Rotatable Bond Count 3
Exact Mass 171.125929 g/mol
Monoisotopic Mass 171.125929 g/mol
Topological Polar Surface Area 63.3 A^2
Heavy Atom Count 12
Formal Charge 0
Complexity 162
Isotope Atom Count 0
Defined Atom Stereocenter Count 0
Undefined Atom Stereocenter Count 0
Defined Bond Stereocenter Count 0
Undefined Bond Stereocenter Count 0
Covalently-Bonded Unit Count 1

What side effects can this medication cause?

Gabapentin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • drowsiness
  • tiredness or weakness
  • dizziness
  • headache
  • uncontrollable shaking of a part of your body
  • double or blurred vision
  • unsteadiness
  • anxiety
  • memory problems
  • strange or unusual thoughts
  • unwanted eye movements
  • nausea
  • vomiting
  • heartburn
  • diarrhea
  • dry mouth
  • constipation
  • increased appetite
  • weight gain
  • swelling of the hands, feet, ankles, or lower legs
  • back or joint pain
  • fever
  • 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:

  • rash
  • itching
  • swelling of the face, throat, tongue, lips, or eyes
  • hoarseness
  • difficulty swallowing or breathing
  • seizures
  • 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).

Gabapentin Is widely Used for Menopausal Hot Flashes

Extended-release (ER) gabapentin (Serada, Depomed), an investigational nonhormonal drug, improves sleep and reduces hot flashes in menopausal women, according to a phase 3 clinical trial known as BREEZE 3.

The results were presented here at the North American Menopause Society (NAMS) 23rd Annual Meeting.

insomnia2

“Right now, if women don’t want to take hormones, and if over-the-counter products, acupuncture, and lifestyle changes do not work, we don’t have any FDA [US Food and Drug Administration] approved therapies,” said lead researcher JoAnn Pinkerton, MD, who is professor of obstetrics and gynecology at the University of Virginia in Charlottesville and past president of NAMS.

A New Drug Application was submitted for gabapentin ER in July. If approved, the drug will be the first nonhormonal, nonantidepressant treatment for the bothersome symptoms of menopause, Dr. Pinkerton explained.

BREEZE 3 looked at the effect of gabapentin ER on hot flashes and on sleep. Data were presented in 2 different abstracts by 2 different investigators.

Gabapentin is used to control epileptic seizures and restless leg syndrome, and recently was approved by the FDA for the treatment of postherpetic neuralgia.

The ER formulation was developed to be taken twice a day instead of 3 times a day, which significantly decreases the adverse-effect profile, Dr. Pinkerton said.

“With the short-acting version, 20% of patients were somnolent or dizzy. In this trial, with the extended-release formulation, the rate of somnolence or dizziness started at 11% and went down to 3% very quickly. It was very well tolerated and very few people discontinued treatment because of those symptoms,” she said. At the end of 6 months, people felt significantly better, she added.

Gabapentin Improves Insomnia

In the sleep part of BREEZE 3, gabapentin was found to have a positive impact on sleep disturbance. Researchers assessed the impact of gabapentin using 2 measures of sleep: the Insomnia Severity Index (ISI) score and the daily sleep interference (S/I) score.

At baseline, the mean ISI scores were 17.54 in the gabapentin group and 17.33 in the placebo group, indicating moderate insomnia, and the mean S/I scores were 7.3 and 7.4, respectively, indicating a moderate to severe sleep disturbance.

After 12 weeks, there was a clinically meaningful reduction in ISI score in the gabapentin group, compared with the placebo group (8.7 vs 6.3; = .0044), and in S/I score (3.6 vs 2.8;P = .0056). Reductions out to week 24 were maintained in the ISI score (8.6 vs 6.2; P = .0068) and in the S/I score (3.9 vs 3.0; P = .0084).

“I was happy that sleep was looked at in an objective way. If you ask many women, their hot flushes at night really bother them. If they can’t sleep because of hot flushes, they basically cannot function during the day, so we need to look at sleep separately,” said Risa Kagan, MD, from East Bay Physicians Medical Group, Alta Bates Summit Medical Center, in Berkeley, and clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco, who led the sleep part of BREEZE 3.

Dr. Kagan added that, although it is fine to look at all of the data objectively, in the end, the aim is to help women transition through the menopause. “This was not just a placebo effect, this was actually a statistically significant improvement in sleep over placebo,” she explained.

http://www.medscape.com/viewarticle/772249

What is Hot Flash ?

A hot flash is the sudden feeling of warmth in the upper body, which is usually most intense over the face, neck and chest. Your skin might redden, as if you’re blushing. A hot flash can also cause sweating. If you lose too much body heat, you might feel chilled afterward. Night sweats are hot flashes that happen at night, and they may disrupt your sleep.

Although other medical conditions can cause them, hot flashes most commonly are due to menopause — the time when menstrual periods become irregular and eventually stop. In fact, hot flashes are the most common symptom of the menopausal transition.

There are a variety of treatments for bothersome hot flashes.

Menopause Hot Flashes: The Cold Truth

Symptoms of  Hot Flash

During a hot flash, you might have:

  • A sudden feeling of warmth spreading through your chest, neck and face
  • A flushed appearance with red, blotchy skin
  • Rapid heartbeat
  • Perspiration, mostly on your upper body
  • A chilled feeling as the hot flash lets up
  • Feelings of anxiety

The frequency and intensity of hot flashes vary among women. Hot flashes may be mild or so intense that they disrupt daily activities. They can happen at any time of day or night. Nighttime hot flashes (night sweats) may wake you from sleep and can cause long-term sleep disruptions.

How often hot flashes occur varies among women, but most women who report having hot flashes experience them daily. On average, hot flash symptoms persist for more than seven years. Some women have them for more than 10 years.

Hot Flash Diagnosis

Your doctor can usually diagnose hot flashes based on a description of your symptoms. Your doctor might suggest blood tests to check whether you’re in menopausal transition.

Hot Flash Treatment

The most effective way to relieve the discomfort of hot flashes is to take estrogen, but taking this hormone carries risks. If estrogen is appropriate for you and you start it within 10 years of your last menstrual period or before age 60, the benefits can be greater than the risks.

Medications such as antidepressants and anti-seizure drugs also might help reduce hot flashes, although they’re less effective than hormones.

Discuss the pros and cons of various treatments with your doctor. If hot flashes don’t interfere with your life, you probably don’t need treatment. Hot flashes subside gradually for most women, even without treatment, but it can take several years for them to stop.

Hormone therapy

Estrogen is the primary hormone used to reduce hot flashes. Most women who have had a hysterectomy can take estrogen alone. But if you still have a uterus, you should take progesterone with estrogen to protect against cancer of the lining of the uterus (endometrial cancer).

With either regimen, the therapy needs to be tailored to your needs. Guidelines suggest using the smallest effective dose for symptom control. How long you use the treatment depends on the balance of your risks and benefits from hormone therapy. The goal is to optimize your quality of life.

Some women who take progesterone with estrogen therapy experience progesterone-related side effects. For women who can’t tolerate oral progesterone, a combination drug of bazedoxifene with conjugated estrogens (Duavee) is also approved for treating menopausal symptoms. Like progesterone, taking bazedoxifene with estrogen may help you avoid the increased risk of endometrial cancer from estrogen alone. Bazedoxifene might also protect your bones.

If you have had or are at risk of breast or endometrial cancer, heart disease, stroke or blood clots, talk to your doctor about whether estrogen therapy is right for you.

Antidepressants

A low-dose form of paroxetine (Brisdelle) is the only nonhormone treatment for hot flashes approved by the U.S. Food and Drug Administration. Other antidepressants that have been used to treat hot flashes include:

  • Venlafaxine (Effexor XR)
  • Paroxetine (Paxil, Pexeva)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)

These medications aren’t as effective as hormone therapy for severe hot flashes, but they can be helpful to women who can’t use hormones. Possible side effects include nausea, difficulty sleeping or drowsiness, weight gain, dry mouth or sexual dysfunction.

Other prescription medications

Other medications that might offer relief for some women include:

  • Gabapentin (Neurontin, Gralise, others). Gabapentin is an anti-seizure medication that’s moderately effective in reducing hot flashes. Side effects can include drowsiness, dizziness, water retention in the limbs (edema) and fatigue.
  • Pregabalin (Lyrica). Pregabalin is another anti-seizure medication that can be effective in reducing hot flashes. Side effects can include dizziness, drowsiness, difficulty concentrating and weight gain.
  • Oxybutynin (Ditropan XL, Oxytrol). Oxybutynin is a pill or patch most often used to treat urinary conditions like overactive bladder. It may also help relieve hot flashes in some women. Side effects can include dry mouth, dry eyes, constipation, nausea and dizziness.
  • Clonidine (Catapres, Kapvay, others). Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes. Side effects include dizziness, drowsiness, dry mouth and constipation.

Nerve block procedure

A procedure known as stellate ganglian block has shown promise for treating moderate to severe hot flashes, but more research is needed. It involves injecting an anesthetic into a nerve cluster in the neck. The treatment has been used for pain management. Side effects include pain and bruising at the injection site.

Gabapentin for Chronic Neuropathic Pain and Fibromyalgia

This review is an update of a review published in 2011, itself a major update of previous reviews published in 2005 and 2000, investigating the effects of gabapentin in chronic neuropathic pain (pain due to nerve damage). Antiepileptic drugs are used to manage chronic neuropathic pain and fibromyalgia.

What are the signs and symptoms of fibromyalgia?
What are the signs and symptoms of fibromyalgia?

OBJECTIVES:

To assess the analgesic efficacy and adverse effects of gabapentin in chronic neuropathic pain and fibromyalgia.

SEARCH METHODS:

We identified randomised trials of gabapentin for chronic neuropathic pain or fibromyalgia by searching the databases MEDLINE (1966 to March 2014), EMBASE (1980 to 2014 week 10), and CENTRAL in The Cochrane Library (Issue 3 of 12, 2014). We obtained clinical trial reports and synopses of published and unpublished studies from Internet sources, and searched Clinicaltrials.gov. Searches were run originally in 2011 and the date of the most recent search was 17 March 2014.

SELECTION CRITERIA:

Randomised, double-blind studies reporting the analgesic and adverse effects of gabapentin in neuropathic pain or fibromyalgia with assessment of pain intensity, pain relief, or both, using validated scales. Participants were adults.

DATA COLLECTION AND ANALYSIS:

Three review authors independently extracted efficacy and adverse event data, examined issues of study quality, and assessed risk of bias. We performed analysis using three tiers of evidence. First tier evidence derived from data meeting current best standards and subject to minimal risk of bias (outcome equivalent to substantial pain intensity reduction, intention-to-treat analysis without imputation for dropouts; at least 200 participants in the comparison, 8 to 12 weeks duration, parallel design), second tier from data that failed to meet one or more of these criteria and were considered at some risk of bias but with adequate numbers in the comparison, and third tier from data involving small numbers of participants that were considered very likely to be biased or used outcomes of limited clinical utility, or both.For efficacy, we calculated the number needed to treat to benefit (NNT), concentrating on at least 50% pain intensity reduction, and Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT) definitions of at least moderate and substantial benefit. For harm we calculated number needed to treat for harm (NNH) for adverse effects and withdrawal. Meta-analysis was undertaken using a fixed-effect model. We emphasised differences between conditions now defined as neuropathic pain, and other conditions like masticatory pain, complex regional painsyndrome type 1 (CRPS-1), and fibromyalgia.

MAIN RESULTS:

Seven new studies with 1919 participants were added. Another report (147 participants) provided results for a study already included, but which previously had no usable data. A further report (170 participants) used an experimental formulation of intrathecal gabapentin. Thirty-seven studies (5633 participants) studied oral gabapentin at daily doses of 1200 mg or more in 12 chronic pain conditions; 84% of participants were in studies of postherpetic neuralgia, painful diabetic neuropathy or mixed neuropathic pain. There was no first tier evidence.Second tier evidence for the outcome of at least 50% pain intensity reduction, considered valuable by patients with chronic pain, showed that gabapentin was significantly better than placebo in postherpetic neuralgia (34% gabapentin versus 21% placebo; NNT 8.0, 95% CI 6.0 to 12) and painful diabetic neuropathy (38% versus 21%, NNT 5.9, 95% CI 4.6 to 8.3). There was insufficient information in other pain conditions to reach any reliable conclusion. There was no obvious difference between standard gabapentin formulations and recently-introduced extended-release or gastro-retentive formulations, or between different doses of gabapentin.Adverse events occurred significantly more often with gabapentin. Persons taking gabapentin could expect to have at least one adverse event (62%), withdraw because of an adverse event (11%), suffer dizziness (19%), somnolence (14%), peripheral oedema (7%), and gait disturbance (9%). Serious adverse events (3%) were no more common than with placebo.There were insufficient data for direct comparisons with other active treatments, and only third tier evidence for other painful conditions.

AUTHORS’ CONCLUSIONS:

There was no top tier evidence that was unequivocally unbiased. Second tier evidence, with potentially important residual biases, showed that gabapentin at doses of 1200 mg or more was effective for some people with some painful neuropathic pain conditions. The outcome of at least 50% pain intensity reduction is regarded as a useful outcome of treatment by patients, and the achievement of this degree of pain relief is associated with important beneficial effects on sleep interference, fatigue, and depression, as well as quality of life, function, and work. About 35% achieved this degree of pain relief with gabapentin, compared with 21% for placebo. Over half of those treated with gabapentin will not have worthwhile pain relief. Results might vary between different neuropathic pain conditions, and the amount of evidence for gabapentin in neuropathic pain conditions except postherpetic neuralgia and painful diabetic neuropathy, and in fibromyalgia, is very limited.The levels of efficacy found for gabapentin are consistent with those found for other drug therapies in postherpetic neuralgia and painful diabetic neuropathy.

Gabapentin for Chronic Neuropathic Pain and Fibromyalgia

Study Population: Adults with postherpetic neuralgia or diabetic neuropathy

Efficacy Endpoints: 50% pain intensity reduction

Harm Endpoints: Dizziness, somnolence, ataxia, edema

Narrative: Neuropathic pain, when the pain generator is the nerve itself, occurs in a variety of conditions including diabetes mellitus and postherpetic neuropathy. The exact mechanism of action for these conditions is unclear. Some speculate that aberrant nerve signal modulation may be a culprit, which would explain why neuropathic pain rarely responds adequately to traditional analgesics, and why an effective treatment has proven elusive. Further complicating matters for patients, neuropathic pain typically is chronic in nature. Given the chronic nature and the poorly understood etiology, neuropathic pain is a challenge to treat and to study.

Patients generally consider a 50% reduction in their chronic pain a useful outcome because it has been associated with important beneficial effects on sleep interference and depression.1 Physicians have tried a variety of medicines off-label including opiates, antidepressants, and antiepileptics to relieve patients’ neuropathic pain. One such drug, gabapentin (Neurontin), received approval by the U.S. Food and Drug Administration (FDA) in 1993 as an adjunct medicine for partial seizures and additional FDA approval in 2002 for the treatment of postherpetic neuralgia.2 Gabapentin remains off-label when used to treat diabetic neuropathy.

This summary uses a Cochrane review, updated in 2014, to address the efficacy of gabapentin compared with placebo to palliate neuropathic pain.3 The Cochrane review includes 37 trials enrolling more than 5,600 patients. Overall, there were limited quality data to permit analysis of other neuropathic indications other than postherpetic neuralgia and diabetic neuropathy. Oral gabapentin dosed at 1,200 mg or more daily demonstrated a 50% reduction in pain intensity, with a number needed to treat (NNT) of eight for postherpetic neuralgia and an NNT of six for diabetic neuropathy. Gabapentin treatment was associated with several adverse effects including dizziness (number needed to harm [NNH] = 8), somnolence (NNH = 11), ataxia (NNH = 13), and edema (NNH = 21). There were no obvious differences in patient response with doses greater than 1,200 mg. The NNT for gabapentin is similar to a recent meta-analysis that demonstrated an NNT of seven.4

Caveats: The Cochrane reviewers indicated that high-quality evidence was lacking, which limits the strength of the conclusions and the resulting NNTs in this analysis. Moreover, only postherpetic neuralgia and diabetic neuropathy had been studied adequately to generate numerical estimates for the purposes of this review. Although patients with other neuropathic conditions were included in the Cochrane review, specifically fibromyalgia, the efficacy of gabapentin could not be evaluated in the treatment of these conditions because of a lack of quality data.

The regulatory and research history of gabapentin is important and relevant in any attempt to understand how related data should be applied or extrapolated. There are a number of peer-reviewed publications,5,6,7 publicly available court documents,8 investigative lay press reports,9 and high-profile scientific editorials10 that all strongly suggest that available data on gabapentin cannot be comfortably extrapolated or applied to practice. For this reason, we have rated gabapentin for chronic neuropathic pain yellow, meaning we believe that a proper answer is not yet available. In the future, we hope to see high-quality, randomized, non–industry-funded data that may offer reliable and valid answers to the question of the efficacy of gabapentin for neuropathic pain and other conditions.

There are patients who appear to benefit from gabapentin. This is particularly important in the case of postherpetic neuralgia, which can severely impact quality of life, and psychological and physical well-being.11,12 The challenge is identifying the minority of patients who derive benefit and finding the proper dose,13 both of which seem to depend on patients’ clinical response to a trial of therapy.

Notably, few guidelines exist for the treatment of neuropathic pain. One, from the National Institute for Health and Care Excellence in the United Kingdom, includes the use of gabapentin as a first-tier treatment for all neuropathic pain.14 Similarly, the European Federation of Neurological Societies includes gabapentin as a first-tier agent in its guideline for neuropathic pain, specifically including painful polyneuropathy and postherpetic neuralgia.15 The American Academy of Neurology with other organizations issued a joint guideline in 2011 indicating only that gabapentin should be considered for the treatment of painful diabetic neuropathy.16

The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the U.S. Air Force medical department or the U.S. Air Force at large.

The original manuscript was published in Medicine by the Numbers, American Family Physician as part of the partnership between TheNNT.com and AFP.

 

Gabapentin and Tramadol Comparision

Gabapentin is an anti-epileptic medication, 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. Gabapentin is used in adults to treat nerve pain caused by herpes virus or shingles (herpes zoster). The Horizant brand is also used to treat restless legs syndrome (RLS).  The Neurontin brand is also used to treat seizures in adults and children who are at least 3 years old.  Neurotin (generic, gabapentin) is NOT classified as an ADDICTIVE substance.

Normally Gabapentin is prescribed to patients with nerve Pain and Nerve damage. A lot of patients are taking it for  diabetic nerve pain.

 

But it is possible to develop a physical dependence on the drug. In fact, people can experience withdrawal symptoms for up to 45 days after they stop taking gabapentin. Although gabapentin does give some people a euphoric “high” which can cause gabapentin abuse, gabapentin abusers do not present with the kind of compulsive, drug-seeking behavior or strong cravings that indicates addiction.

Tramadol Addiction

Natural opiates are acquired by processing the dried “milk” of the opium poppy plant. Synthetic opiates, on the other hand, are formulated in labs to create a product with an identical chemical structure. These drugs––both natural and synthetic forms––compose a group of painkillers called opioids that alleviate the symptoms of discomfort associated with pain.

Tramadol is a synthetic opioid analgesic––or pain reliever––which has been approved by the United States Food and Drug Administration to treat moderate to severe pain in adults. Analgesics like Tramadol bind to receptors throughout the central nervous and the gastrointestinal systems. The narcotic, also known as a CNS depressant, dulls or eliminates the sensation of pain signaled to the brain.

According to the DEA, Tramadol has more than one name, including its chemical name, 2-[(dimethylamino)methyl]-1-(3-methoxyphenyl)cyclohexanol, and its trade name, Ultram. The prescribed pain medication should be administered orally in tablet form, dosed between 50mg and 100mg, at a rate of every 4 to 6 hours, as needed. Dosages should not exceed 400mg in a single day. In 2014, the United States Drug Enforcement Administration listed Tramadol under the Schedule IV classification for controlled substances because of its abusive potential.

Gabapentin Vs. Tramadol.

gabapentintram

gabapentintram2

gabapentintram3

 

Gabapentin is better Analgesic than Tramadol and It is Illegal to Buy Tramadol Online

 

How is Gabapentin Supplied ?

Neurontin (gabapentin) capsules, tablets, and oral solution are supplied as follows:

100 mg capsules

White hard gelatin capsules printed with “PD” on one side and “Neurontin/100 mg” on the other; available in:

Bottles of 100: NDC 0071-0803-24

300 mg capsules

Yellow hard gelatin capsules printed with “PD” on one side and “Neurontin/300 mg” on the other; available in:

Bottles of 100: NDC 0071-0805-24
Unit dose 50’s: NDC 0071-0805-40

400 mg capsules

Orange hard gelatin capsules printed with “PD” on one side and “Neurontin/400 mg” on the other; available in:

Bottles of 100: NDC 0071-0806-24
Unit dose 50’s: NDC 0071-0806-40

600 mg tablets

White elliptical film-coated scored tablets debossed with “NT” and “16” on one side; available in:

Bottles of 100: NDC 0071-0513-24

800 mg tablets

White elliptical film-coated scored tablets debossed with “NT” and “26” on one side; available in:

Bottles of 100: NDC 0071-0401-24

250 mg/5 mL oral solution

Clear colorless to slightly yellow solution; each 5 mL of oral solution contains 250 mg of gabapentin; available in:

Bottles containing 470 mL: NDC 0071-2012-23

Storage (Capsules)

Store at 25°C (77°F); excursions permitted to 15° – 30°C (59° – 86°F) [see USP Controlled Room Temperature].

Storage (Tablets)

Store at 25°C (77°F); excursions permitted to 15° – 30°C (59° – 86°F) [see USP Controlled Room Temperature].

Storage (Oral Solution)

Store refrigerated, 2°-8°C (36°-46°F)

Distributed by: Parke-Davis Division of Pfizer Inc, NY, NY 10017. Revised May 2013

Babapentin Oral Solution

What is Gabapentin ? What is your Experience with Gabapentin?

What is Gabapentin and What is Gabapentin Used for ?

Gabapentin is used with other medications to prevent and control seizures. It is also used to relieve nerve pain following shingles (a painful rash due to herpes zoster infection) in adults. Gabapentin is known as an anticonvulsant or antiepileptic drug.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

Gabapentin may also be used to treat other nerve pain conditions (such as diabetic neuropathy, peripheral neuropathy, trigeminal neuralgia) and restless legs syndrome.

Gabapentin is an anti-epileptic medication, 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.

Gabapentin is used in adults to treat nerve pain caused by herpes virus or shingles (herpes zoster).

The Horizant brand is also used to treat restless legs syndrome (RLS).

The Neurontin brand is also used to treat seizures in adults and children who are at least 3 years old.

Use only the brand and form of gabapentin that your doctor has prescribed. Check your medicine each time you get a refill at the pharmacy, to make sure you have received the correct form of this medication.

Gabapentin is also commonly prescribed for many off-label uses, such as treatment of restless leg syndrome, anxiety disorders, insomnia, and bipolar disorder. There are, however, concerns regarding the quality of the trials conducted and evidence for some such uses, especially in the case of its use as a mood stabilizer in bipolar disorder.

 

What is your Experience with Gabapentin?

This is a good question, in that it made me revisit this topic after a long time and gave me some new perspectives.

Firstly, some general comments:

  • FDA approval of any drug for any indication is always subject to updation
  • Non-approved usage of a medicine happens all the time; the only legal binding is that a company cannot promote/market an off-label use for a drug (this is my own conclusion, subject to correction)
  • FDA approval is not binding on countries other than the US

Now for some specific comments (I am quoting directly from this article: Gabapentin Therapy in Psychiatric Disorders: A Systematic Review, by Berlin, Butler, and Perloff (the points are so good, I didn’t bother editing or paraphrasing, except for some bolding and ellipsis)

  • Gabapentin was originally approved by the US Food and Drug Administration (FDA) for the treatment of partial seizures in 1993
  • Subsequent approval for postherpetic neuralgia in 2002
  • Within a decade of initial FDA approval, gabapentin’s second most common use became off-label prescription for psychiatric disorders (mainly for anxiety disorders)
  • Gabapentin’s use in psychiatric disorders has been shrouded in controversy, from the 1996 lawsuit against Warner-Lambert for promoting Neurontin for off-label indications, including psychiatric disorders
  • Gabapentin has a limited, generally well-tolerated side effect profile, and … has minimal drug-drug interactions
  • Gabapentin has … a proposed mechanism well-established for treating neuropathic pain and seizure
  • Numerous case reports and reviews suggest gabapentin’s potential efficacy as either monotherapy or adjunctive therapy in the treatment of bipolar disorder, depression, anxiety disorders, posttraumatic stress disorder (PTSD), alcohol dependence, and other types of drug abuse.

The authors then did a very thorough search for articles on studies, case reports or reviews looking into the (off-label) use of Gabapentin for various psychiatric conditions.

They conclude that:

  • Gabapentin does appear to provide benefit for some anxiety disorders, although randomized controlled trials have been limited to social phobia, anxiety in breast cancer, and perioperative anxiety.
  • To date, no studies exist for gabapentin efficacy in generalized anxiety disorder.
  • There is limited evidence to suggest the use of gabapentin in depression, PTSD, and OCD
  • Multiple studies suggest gabapentin has some efficacy in alcohol dependence, withdrawal, and craving.
  • As for gabapentin’s use in other types of substance dependence, there are no data to support its efficacy in cocaine or methamphetamine dependence.

Here is an application to the “21st meeting of the WHO Expert Committee on Selection and Use of Essential Medicines” for the inclusion of gabapentin on the WHO Model List of Essential Medicines, submitted by International Association for the Study of Pain (IASP), the Neuropathic Pain Special Interest Group (NeuPSIG) of the IASP, and the International Association of Hospice and Palliative Care (IAHPC), and supported by similar bodies in numerous other countries.

Here is the opening statement from this application:

We are applying for the inclusion of gabapentin as an analgesic agent for the management of neuropathic pain (central and peripheral) in adults. The medicine has regulatory approval for the treatment of several neuropathic pain states in adults by numerous stringent regulatory bodies (including the Food and Drug Administration [1] and European Medicines Agency [2]).

I am not aware of the outcome of this application (haven’t had the time to search for the relevant information).

To balance it all, here is a very good article (by Goodman & Brett): Gabapentin and Pregabalin for Pain — Is Increased Prescribing a Cause for Concern?

 taking a very critical look at all the off-label use of these medicines, the paucity of evidence, and the poor quality of research that exists in this particular area.

Finally, some personal comments from me:

  • Lack of evidence does not mean there is evidence of lack (of efficacy, for example)
  • Clinical Trials, including RCTs are good evidence, but still not absolute
  • Off-label use for any drug is between the doctor and the patient, with mutual understanding and informed consent
  • The use of Gabapentin as a sedative is neither well-studied, nor recommended.
  • Mild to moderate sedation is a common enough side-effect for patients and doctors to be tempted to use it that way; but if you have no other use for Gabapentin, then you are better off not taking it – there are many other better drugs for that.

Gabapentin is not Suitable for Children under 6 Years of Age

Gabapentin is not suitable for children under 6 years of age but, if it has been prescribed for a child who is older than this, check the label carefully to make sure you are giving the correct dose.

Gabapentin is FDA approved as an anti-convulsant for the treatment of Epilepsy and seizures resulting from other disorders. It is used to treat neuralgia and neuropathy, both of which are syptoms of many different diseases; such as, diabetic neuropathy or Shingles related neuralgia, among other disorders like fibromyalgia, as well as, physical trauma.

Dr.s also prescribe it for general anxiety and panic disorders, instead of more addicting benzodiazepines. and very recently it has been tried as a treatment for major depression and mood disorders.

It can help potentiate the efficacy of analgesic drugs, mostly opiate/opioid medications. It also helps mitigate the unpleasant side effects of withdrawal from opiates during titration and cessation of those drugs.  It can treat Restless Leg Syndrome (RLS).

It is not a controlled substance in the United States, and has a very low abuse potential, because it’s efficacy is dose dependent, with limited bioavailability and therefore, the higher the dose the less effective it is. It’s a gabapentinoid and it’s molecular structure is similar to that of GABA , making it a GABA analog, and it works by inhibiting Voltage-dependent Calcium channels (VDCC), it often is thought of as a GABA agonist, like benzodiazepines, but that is incorrect.

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.

The Horizant brand of gabapentin should not be taken during the day.  For best results, take Horizant with food at about 5:00 in the evening.

Both Gralise and Horizant should be taken with food. Neurontin can be taken with or without food.

If you break a Neurontin tablet and take one 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.

Measure liquid medicine 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 brand 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 take gabapentin. Any medical care provider who treats you should know that you take seizure medication.

This medication can cause you to have a false positive urine protein screening test. If you provide a urine sample for testing, tell the laboratory staff that you are taking gabapentin.

Store at room temperature away from light and moisture.

  • Before starting this treatment, read the manufacturer’s printed information leaflet from inside the pack. The leaflet will give you more information about gabapentin and any possible side-effects from taking it.
  • Take gabapentin exactly as your doctor has told you to. You will be advised to take a small dose when you first start taking gabapentin and then to increase your doses over a few days as your body gets used to it. Your doctor or pharmacist will explain this to you and your dose will also be on the label of your pack.
  • Gabapentin is not suitable for children under 6 years of age but, if it has been prescribed for a child who is older than this, check the label carefully to make sure you are giving the correct dose.
  • You can take gabapentin before or after meals. Swallow the tablets/capsules with a drink of water.
  • Once you are taking a regular amount of gabapentin, try to take your doses at the same times each day. This will help you to avoid missing any of your doses.
  • If you do forget to take a dose, take it as soon as you remember, but do not take two doses together to make up for a forgotten dose.
  • If you need to take an antacid or indigestion remedy, do not take it during the two hours before and the two hours after you take gabapentin. This is because they interfere with the way gabapentin works.

Store the liquid medicine in the refrigerator. Do not freeze.

Common, Major and Minor Side Effects of Gabapentin

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

      1. Clumsiness or unsteadiness
      2. continuous, uncontrolled, back-and-forth, or rolling eye movements

More common in children

      1. Aggressive behavior or other behavior problems
      2. anxiety
      3. concentration problems and change in school performance
      4. crying
      5. depression
      6. false sense of well-being
      7. hyperactivity or increase in body movements
      8. rapidly changing moods
      9. reacting too quickly, too emotional, or overreacting
      10. restlessness
      11. suspiciousness or distrust

Less common

      1. Black, tarry stools
      2. chest pain
      3. chills
      4. cough
      5. depression, irritability, or other mood or mental changes
      6. fever
      7. loss of memory
      8. pain or swelling in the arms or legs
      9. painful or difficult urination
      10. shortness of breath
      11. sore throat
      12. sores, ulcers, or white spots on the lips or in the mouth
      13. swollen glands
      14. unusual bleeding or bruising
      15. unusual tiredness or weakness

Incidence not known

      1. Abdominal or stomach pain
      2. blistering, peeling, or loosening of the skin
      3. clay-colored stools
      4. coma
      5. confusion
      6. convulsions
      7. dark urine
      8. decreased urine output
      9. diarrhea
      10. dizziness
      11. fast or irregular heartbeat
      12. headache
      13. increased thirst
      14. itching or skin rash
      15. joint pain
      16. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
      17. loss of appetite
      18. muscle ache or pain
      19. nausea
      20. red skin lesions, often with a purple center
      21. red, irritated eyes
      22. unpleasant breath odor
      23. vomiting of blood
      24. yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  1. Blurred vision
  2. cold or flu-like symptoms
  3. delusions
  4. dementia
  5. hoarseness
  6. lack or loss of strength
  7. lower back or side pain
  8. swelling of the hands, feet, or lower legs
  9. trembling or shaking

Less common or rare

      1. Accidental injury
      2. appetite increased
      3. back pain
      4. bloated or full feeling
      5. body aches or pain
      6. burning, dry, or itching eyes
      7. change in vision
      8. change in walking and balance
      9. clumsiness or unsteadiness
      10. congestion
      11. constipation
      12. cough producing mucus
      13. decrease in sexual desire or ability
      14. difficulty with breathing
      15. dryness of the mouth or throat
      16. earache
      17. excess air or gas in the stomach or intestines
      18. excessive tearing
      19. eye discharge
      20. feeling faint, dizzy, or lightheadedness
      21. feeling of warmth or heat
      22. flushed, dry skin
      23. flushing or redness of the skin, especially on the face and neck
      24. frequent urination
      25. fruit-like breath odor
      26. impaired vision
      27. incoordination
      28. increased hunger
      29. increased sensitivity to pain
      30. increased sensitivity to touch
      31. increased thirst
      32. indigestion
      33. noise in the ears
      34. pain, redness, rash, swelling, or bleeding where the skin is rubbed off
      35. passing gas
      36. redness or swelling in the ear
      37. redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
      38. runny nose
      39. sneezing
      40. sweating
      41. tender, swollen glands in the neck
      42. tightness in the chest
      43. tingling in the hands and feet
      44. trouble sleeping
      45. trouble swallowing
      46. trouble thinking
      47. twitching
      48. unexplained weight loss
      49. voice changes
      50. vomiting
      51. weakness or loss of strength
      52. weight gain

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Gabapentin is a prescription and we do not suggest you take it for a long time. You need take some health food or USANA CellSentials™ to make yourself more strong. If you want to make yourself happy and more beautiful without any pain, please check Celavive Skin Care and Whitening Teeth

Side effects requiring immediate medical attention

Along with its needed effects, gabapentin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking gabapentin:

More common

  • Clumsiness or unsteadiness
  • continuous, uncontrolled, back-and-forth, or rolling eye movements

More common in children

  • Aggressive behavior or other behavior problems
  • anxiety
  • concentration problems and change in school performance
  • crying
  • depression
  • false sense of well-being
  • hyperactivity or increase in body movements
  • rapidly changing moods
  • reacting too quickly, too emotional, or overreacting
  • restlessness
  • suspiciousness or distrust

Less common

  • Black, tarry stools
  • chest pain
  • chills
  • cough
  • depression, irritability, or other mood or mental changes
  • fever
  • loss of memory
  • pain or swelling in the arms or legs
  • painful or difficult urination
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Incidence not known

  • Abdominal or stomach pain
  • blistering, peeling, or loosening of the skin
  • clay-colored stools
  • coma
  • confusion
  • convulsions
  • dark urine
  • decreased urine output
  • diarrhea
  • dizziness
  • fast or irregular heartbeat
  • headache
  • increased thirst
  • itching or skin rash
  • joint pain
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • loss of appetite
  • muscle ache or pain
  • nausea
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • unpleasant breath odor
  • vomiting of blood
  • yellow eyes or skin

Side effects not requiring immediate medical attention

Some side effects of gabapentin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Blurred vision
  • cold or flu-like symptoms
  • delusions
  • dementia
  • hoarseness
  • lack or loss of strength
  • lower back or side pain
  • swelling of the hands, feet, or lower legs
  • trembling or shaking

Less common or rare

  • Accidental injury
  • appetite increased
  • back pain
  • bloated or full feeling
  • body aches or pain
  • burning, dry, or itching eyes
  • change in vision
  • change in walking and balance
  • clumsiness or unsteadiness
  • congestion
  • constipation
  • cough producing mucus
  • decrease in sexual desire or ability
  • difficulty with breathing
  • dryness of the mouth or throat
  • earache
  • excess air or gas in the stomach or intestines
  • excessive tearing
  • eye discharge
  • feeling faint, dizzy, or lightheadedness
  • feeling of warmth or heat
  • flushed, dry skin
  • flushing or redness of the skin, especially on the face and neck
  • frequent urination
  • fruit-like breath odor
  • impaired vision
  • incoordination
  • increased hunger
  • increased sensitivity to pain
  • increased sensitivity to touch
  • increased thirst
  • indigestion
  • noise in the ears
  • pain, redness, rash, swelling, or bleeding where the skin is rubbed off
  • passing gas
  • redness or swelling in the ear
  • redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
  • runny nose
  • sneezing
  • sweating
  • tender, swollen glands in the neck
  • tightness in the chest
  • tingling in the hands and feet
  • trouble sleeping
  • trouble swallowing
  • trouble thinking
  • twitching
  • unexplained weight loss
  • voice changes
  • vomiting
  • weakness or loss of strength
  • weight gain

How Are Depression and Erectile Dysfunction related?

For some men, depression can accompany the condition of erectile dysfunction (ED). It is common for men with ED to feel angry, frustrated, sad, unsure of themselves, or even less “manly.” Such feelings may lead to a lack of self-esteem and, in severe cases, to depression.

Depression that accompanies ED is treatable. The first step in addressing your concerns about ED-related depression is to be honest with yourself, your partner, and your doctor. After depression has been brought out into the open, coping with it will be easier and less stressful.

Antidepressants and other psychiatric medicines may cause Erectile Dysfunction

      • Amitriptyline (Elavil)
      • Amoxapine (Asendin)
      • Buspirone (Buspar)
      • Chlordiazepoxide (Librium)
      • Chlorpromazine (Thorazine)
      • Clomipramine (Anafranil)
      • Clorazepate (Tranxene)
      • Desipramine (Norpramin)
      • Diazepam (Valium)
      • Doxepin (Sinequan)
      • Fluoxetine (Prozac)
      • Fluphenazine (Prolixin)
      • Imipramine (Tofranil)
      • Isocarboxazid (Marplan)
      • Lorazepam (Ativan)
      • Meprobamate (Equanil)
      • Mesoridazine (Serentil)
      • Nortriptyline (Pamelor)
      • Oxazepam (Serax)
      • Phenelzine (Nardil)
      • Phenytoin (Dilantin)
      • Sertraline (Zoloft)
      • Thioridazine (Mellaril)
      • Thiothixene (Navane)
      • Tranylcypromine (Parnate)
      • Trifluoperazine (Stelazine)

The List of Prescription Drugs That May Cause Erectile Dysfunction

Erectile dysfunction (ED) is a common side effect of a number of prescription drugs.

While these medications may treat a disease or condition, in doing so they can affect a man’s hormones, nerves or blood circulation. The result may be ED or an increase in the risk of ED.

If you have ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:

      • Diuretics (pills that cause an increase in urine flow).
      • Antihypertensives (medication for high blood pressure).
      • Antihistamines.
      • Antidepressants.
      • Parkinson’s disease drugs.
      • Antiarrhythmics (medication for irregular heart action).
      • Tranquilizers.
      • Muscle relaxants.
      • Non-steroidal anti-inflammatory drugs.
      • Histamine H2-receptor antagonists.
      • Hormones.
      • Chemotherapy medications.
      • Prostate cancer drugs.
      • Anti-seizure medications.

Drugs that may cause erection problems

Many medicines and recreational drugs can affect a man’s sexual arousal and sexual performance. What causes erection problems in one man may not affect another man.

Talk to your health care provider if you think that a drug is having a negative effect on your sexual performance. Never stop taking any medicine without first talking to your provider. Some medicines may lead to life-threatening reactions if you do not take care when stopping or changing them.

The following is a list of some medicines and drugs that may cause erectile dysfunction (ED) in men. There may be additional drugs other than those on this list that can cause erection difficulties.

Antidepressants and other psychiatric medicines:

      • Amitriptyline (Elavil)
      • Amoxapine (Asendin)
      • Buspirone (Buspar)
      • Chlordiazepoxide (Librium)
      • Chlorpromazine (Thorazine)
      • Clomipramine (Anafranil)
      • Clorazepate (Tranxene)
      • Desipramine (Norpramin)
      • Diazepam (Valium)
      • Doxepin (Sinequan)
      • Fluoxetine (Prozac)
      • Fluphenazine (Prolixin)
      • Imipramine (Tofranil)
      • Isocarboxazid (Marplan)
      • Lorazepam (Ativan)
      • Meprobamate (Equanil)
      • Mesoridazine (Serentil)
      • Nortriptyline (Pamelor)
      • Oxazepam (Serax)
      • Phenelzine (Nardil)
      • Phenytoin (Dilantin)
      • Sertraline (Zoloft)
      • Thioridazine (Mellaril)
      • Thiothixene (Navane)
      • Tranylcypromine (Parnate)
      • Trifluoperazine (Stelazine)

Antihistamine medicines (certain classes of antihistamines are also used to treat heartburn):

      • Cimetidine (Tagamet)
      • Dimenhydrinate (Dramamine)
      • Diphenhydramine (Benadryl)
      • Hydroxyzine (Vistaril)
      • Meclizine (Antivert)
      • Nizatidine (Axid)
      • Promethazine (Phenergan)
      • Ranitidine (Zantac)

High blood pressure medicines and diuretics (water pills):

      • Atenolol (Tenormin)
      • Bethanidine
      • Bumetanide (Bumex)
      • Captopril (Capoten)
      • Chlorothiazide (Diuril)
      • Chlorthalidone (Hygroton)
      • Clonidine (Catapres)
      • Enalapril (Vasotec)
      • Furosemide (Lasix)
      • Guanabenz (Wytensin)
      • Guanethidine (Ismelin)
      • Guanfacine (Tenex)
      • Haloperidol (Haldol)
      • Hydralazine (Apresoline)
      • Hydrochlorothiazide (Esidrix)
      • Labetalol (Normodyne)
      • Methyldopa (Aldomet)
      • Metoprolol (Lopressor)
      • Nifedipine (Adalat, Procardia)
      • Phenoxybenzamine (Dibenzyline)
      • Phentolamine (Regitine)
      • Prazosin (Minipress)
      • Propranolol (Inderal)
      • Reserpine (Serpasil)
      • Spironolactone (Aldactone)
      • Triamterene (Maxzide)
      • Verapamil (Calan)

Thiazides are the most common cause of erectile dysfunction among the high blood pressure medicines. The next most common cause is beta blockers. Alpha blockers tend to be less likely to cause this problem.

Parkinson disease medicines:

      • Benztropine (Cogentin)
      • Biperiden (Akineton)
      • Bromocriptine (Parlodel)
      • Levodopa (Sinemet)
      • Procyclidine (Kemadrin)
      • Trihexyphenidyl (Artane)

Chemotherapy and hormonal medicines:

      • Antiandrogens (Casodex, Flutamide, Nilutamide)
      • Busulfan (Myleran)
      • Cyclophosphamide (Cytoxan)
      • Ketoconazole
      • LHRH agonists (Lupron, Zoladex)
      • LHRH agonists (Firmagon)

Other medicines:

      • Aminocaproic acid (Amicar)
      • Atropine
      • Clofibrate (Atromid-S)
      • Cyclobenzaprine (Flexeril)
      • Cyproterone
      • Digoxin (Lanoxin)
      • Disopyramide (Norpace)
      • Dutasteride (Avodart)
      • Estrogen
      • Finasteride (Propecia, Proscar)
      • Furazolidone (Furoxone)
      • H2 blockers (Tagamet, Zantac, Pepcid)
      • Indomethacin (Indocin)
      • Lipid-lowering agents
      • Licorice
      • Metoclopramide (Reglan)
      • NSAIDs (ibuprofen, etc.)
      • Orphenadrine (Norflex)
      • Prochlorperazine (Compazine)
      • Pseudoephedrine (Sudafed)
      • Sumatriptan (Imitrex)

Opiate analgesics (painkillers):

      • Codeine
      • Fentanyl (Innovar)
      • Hydromorphone (Dilaudid)
      • Meperidine (Demerol)
      • Methadone
      • Morphine
      • Oxycodone (Oxycontin, Percodan)

Recreational drugs:

      • Alcohol
      • Amphetamines
      • Barbiturates
      • Cocaine
      • Marijuana
      • Heroin
      • Nicotine

Alternative Names

Impotence caused by medications; Drug-induced erectile dysfunction; Prescription medicines and impotence