Geriatric Use and Pediatric Use of Gabapentin for Neuropathic Pain

The total number of patients treated with Neurontin in controlled clinical trials in patients with postherpetic neuralgia was 336, of which 102 (30%) were 65 to 74 years of age, and 168 (50%) were 75 years of age and older. Totally 80% Gabapentin patients are seniors.

There was a larger treatment effect in patients 75 years of age and older compared with younger patients who received the same dosage.

Gabapentin
Gabapentin

Since gabapentin is almost exclusively eliminated by renal excretion, the larger treatment effect observed in patients ≥ 75 years may be a consequence of increased gabapentin exposure for a given dose that results from an age-related decrease in renal function. However, other factors cannot be excluded. The types and incidence of adverse events were similar across age groups except for peripheral edema and ataxia, which tended to increase in incidence with age.

Clinical studies of Neurontin in epilepsy did not include sufficient numbers of subjects aged 65 and over to determine whether they responded differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients.

In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and dose should be adjusted based on creatinine clearance values in these patients

Pediatrics: The safety and efficacy in patients under the age of 18 have not been established.

Safety data in 39 patients between the ages of 12 and 18 years included in the double-blind, placebo-controlled trials showed that, at doses of 900 to 1200 mg/day, the incidence of adverse events in this group of patients was similar to that observed in older individuals.

In controlled clinical trials involving patients, 3 to 12 years of age (N=323), psychiatric adverse events such as emotional lability, hostility, hyperkinesia and thought disorder were reported at a higher frequency in patients treated with gabapentin compared to placebo.

Geriatrics: Systematic studies in geriatric patients have not been conducted. Adverse clinical events reported among 59 patients over the age of 65 years treated with Neurontin did not differ from those reported for younger individuals. The small number of individuals evaluated and the limited duration of exposure limits the strength of any conclusions reached about the influence of age, if any, on the kind and incidence of adverse events associated with the use of Neurontin.

Gapapentin for Neuropathic Pain

Gabapentin (Neurontin) has FDA indication to treat postherpetic neuralgia and partial onset seizures.  Controlled clinical trials in diabetic neuropathy and postherpetic neuralgia show that gabapentin at 2400-3600 mg/day has a similar efficacy to tricyclic antidepressants and carbamazepine.  Consistent, though less compelling clinical evidence supports its use for neuropathic cancer pain, pain associated with HIV infection, chronic back pain and others (readers wanting more in depth research findings are urged to consult Reference 1).  Due to this emerging evidence, it is widely used for the treatment of neuropathic pain.  The exact mechanism and site of action of gabapentin is unknown.   Gabapentin is generally well-tolerated, easily titrated, has few drug interactions, and does not require laboratory monitoring.  However, cost may be a limiting factor for some patients.  Patients suitable for gabapentin should have a clear neuropathic pain syndrome, characterized by sharp, shooting, lancinating and/or burning pain, in a nerve root (radicular) or stocking/glove distribution. See Fast Fact #289 for a comparison of gabapentin with pregabalin a similar neuropathic analgesic.

Adult Dosing    Gabapentin is started at low doses (100 mg to 300 mg total daily) and increased by 100 – 300 mg every 1-3 days to effect.  A typical schedule might be: day 1-2: 300 mg nightly; day 3-4: 300 mg twice daily; day 5-7: 600 mg twice daily; day 8 onwards: 600 mg three times a day.  The usual effective total daily dose is 900-3600 mg, administered in three divided doses per day.  Titration should proceed more slowly in elderly patients. If gabapentin is discontinued, it should be done over a minimum of a week to prevent withdrawal seizures.

Pediatric Use    There is limited data available assessing its effectiveness in neuropathic pain in children. The American Pain Society recommends that gabapentin be considered for pediatric neuropathic pain especially when concurrent analgesics are found to be too sedating.  Their recommended initial dose is 2 mg/kg/day with a usual dosage range of 8 to 35 mg/kg/day divided into 3 daily doses.

Dosing in Renal Failure   Gabapentin doses must be reduced for patients with renal insufficiency.

  • Creatinine Clearance (CrCl) 30-60 ml/min: maximum daily dose is 1400 mg, divided.
  • CrCl 16-30 ml/min: maximum daily dose is 700 mg, given once daily.
  • CrCl 15ml/min: maximum daily dose is 300 mg, once daily.  Doses should decrease proportionally for CrCl less than 15 ml/min (e.g. 300 mg every other day for a CrCl of ~7.5 ml/min).
  • For patients on hemodialysis a supplemental dose is usually given after dialysis (usually 100-300 mg).

Adverse Reactions    Sedation, confusion, dizziness, and ataxia are the most common side effects, especially with rapid dose titration.  Tolerance to these effects appears to develop within a few days if the dose is held at the highest tolerated dose until symptoms improve or stabilize.

Dosage Formulations    Gabapentin is available in 100 mg, 300 mg, and 400 mg capsules, 600 mg and 800 mg tablets, and as a liquid (250mg/5mL).

Cost    Gabapentin is more expensive than older agents used for neuropathic pain (tricyclic antidepressants and older anti-epileptic drugs such as carbamazepine).  Generic gabapentin is available, although can cost ~$100 for 90 600 mg tablets.

Other Palliative Care Uses of Gabapentin    Small scale published trials have shown efficacy in the treatment of severe chronic hiccups, pruritus, postoperative pain and delirium, restless leg syndrome and hot flashes. Perhaps more compelling is its potential efficacy for chronic cough for which a randomized double-blind placebo controlled trial demonstrated significant improvement in cough-specific quality of life, cough frequency, and cough severity. See Fast Fact #200.

Summary    Gabapentin is a safe and effective adjuvant analgesic for neuropathic pain.  Physicians should become comfortable using and titrating gabapentin in patients with neuropathic pain syndromes.

References
  1. Moore R, Wiffen PJ, Derry S, Toelle T, Rice AS C. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD007938. DOI: 10.1002/14651858.CD007938.pub3
  2. Mishra S, Bhatnagar S, et al.  A comparative efficacy of amitriptyline, gabapentin, and pregabalin in neuropathic cancer pain: a prospective randomized double-blind placebo-controlled study. American Journal of Hospice and Palliative Medicine 2012;29:177-182.
  3. Caraceni A, et al. Gabapentin for neuropathic cancer pain: a randomized controlled trial from the gabapentin cancer pain study group. J Clin Onc. 2004; 22:2909-2917.
  4. American Pain Society. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 6th ed, Glenview, IL: American Pain Society, 2008.
  5. Micromedex Drug Database. Thompson Reuters. http://www.micromedex.com.
  6. Giampiero P, Aielli F, et al.  Gabapentin in the treatment of hiccups in patients with advanced cancer: a 5-year experience. Clin Neuropharm 2010; 33:179-180.
  7. Anand S, Gabapentin for pruritus in palliative care. Am J of Hospice and Pall Med 2012; 30:192-196.
  8. Dauri M, Faria S, Gatti A, et al. Gabapentin and Pregabalin for the Acute Post-operative Pain Management. A Systematic-Narrative Review of the Recent Clinical Evidences. Curr Drug Targets 2009, 10(8):716-33.
  9. Leung JM, Sands LP, et al.  Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients.  Neurology. 2006; 67:310-314.
  10. Saletu M, Anderer P, Saletu-Zyhlarz GM, et al. Comparative Placebo-Controlled Polysomnographic and Psychometric Studies on the Acute Effects of Gabapentin Versus Ropinirole in Restless Legs Syndrome. J Neural Transm 2010, 117(4):463-73.
  11. Butt DA, Lock M, Lewis JE, et al. Gabapentin for the Treatment of Menopausal Hot Flashes: A Randomized Controlled Trial. Menopause 2008; 15(2):310-8.

Version History:  This Fast Fact was originally edited by David E Weissman MD.   2nd Edition published August 2005; 3rd Edition May 2015. Version re-copy-edited April 2009; then again May 2015; renal dosing information adjusted to reflect current recommendations, and updated cost information added.

Fast Facts and Concepts are edited by Sean Marks MD (Medical College of Wisconsin) and associate editor Drew A Rosielle MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact’s content. The full set of Fast Facts are available at Palliative Care Network of Wisconsin with contact information, and how to reference Fast Facts.

Copyright:  All Fast Facts and Concepts are published under a Creative Commons Attribution-NonCommercial 4.0 International Copyright (http://creativecommons.org/licenses/by-nc/4.0/).  Fast Facts can only be copied and distributed for non-commercial, educational purposes. If you adapt or distribute a Fast Fact, let us know!

Disclaimer: Fast Facts and Concepts provide educational information for health care professionals. This information is not medical advice. Fast Facts are not continually updated, and new safety information may emerge after a Fast Fact is published. Health care providers should always exercise their own independent clinical judgment and consult other relevant and up-to-date experts and resources. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

 

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.

Off-label Use of Gabapentin

Gabapentin is an anticonvulsant prescription drug that goes by several brand names including, Neurontin, Gralise, Gabarone, and Fanatrex.

Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.

Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles.

Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

  • Capsule
  • Tablet
  • Solution
  • Suspension

It was approved by the FDA in December 1993 for the following main uses.

    1. Controlling certain types of seizures in people who have epilepsy
    2. Relieving nerve pain (think: burning, stabbing, or aches) from shingles
    3. Calming restless legs syndrome

Gabapentin is prescribed off-label for several conditions including:

    • migraine
    • anxiety disorders
    • fibromyalgia
    • bipolar disorder
    • insomnia

Gabapentin is also used off-label to treat chronic pain (as an alternative to opioid medications), alcohol use disorder (AUD), and substance use disorder (SUD).

Today there’s growing concern about increased misuse of gabapentin. Greater numbers of prescriptions means more access to gabapentin.

The risk of misuse is higher among those with an existing SUD — 15 to 22 percent. Overdose deaths have been reported when combined with other drugs.

Studies show an increase in overdose deaths in recent years linked to the rise in the number of overall prescriptions.

Certain drugs like opioids taken together increase the danger of overdose.

Several states are currently considering legislation to help stop this misuse. Many have put special monitoring requirements in place for gabapentin.

 

 

Why You should Stop Taking Gabapentin ?

People need a prescription to take gabapentin, which is available as a generic drug and under brand names that include Neurontin and Gralise.

It comes in the following forms:

    • capsule
    • tablet
    • solution
    • suspension

Doctors may prescribe gabapentin as an anticonvulsant to prevent partial seizures in a person with epilepsy. The Food and Drug Administration (FDA) have approved gabapentin for this use.

The FDA have also approved gabapentin as a pain reliever for postherpetic neuralgia and similar conditions affecting the nervous system. This pain can occur due to shingles.

In addition to these FDA-approved uses, doctors may prescribe gabapentin off-label to treat long-term lower back pain, although some experts have expressed concerns about this use.

Gabapentin may also help relieve symptoms of alcohol withdrawal in people with alcohol use disorder, according to research in JAMA Internal MedicineTrusted Source.

How does it work?

Gabapentin belongs to a class of drugs known as gabapentinoids. The chemical structure of gabapentin is similar to that of gamma-aminobutyric acid (GABA), a chemical that nerve cells use to transmit signals to muscles or other nerve cells.

However, gabapentin does not seem to affect GABA’s interaction with its target cells in the body, according to prescribing information for the medication. Scientists are not sure how gabapentin works to relieve pain or control seizures.

The medical community considers gabapentin a generally safe drug, although it can cause side effects.

Reasons you may choose to stop taking gabapentin

If you’ve been taking gabapentin, you and your doctor can discuss if the medicine is working. This might include a conversation about reducing or stopping the medicine for several reasons.

Side effects

Gabapentin has some side effects associated with it. Some might be serious or bothersome enough to stop the medicine.

Side effects can include:

  • allergic reactions (swelling of hands or face, itching, chest tightness, or trouble breathing)
  • suicidal thoughts or behavior
  • nausea and vomiting
  • fever or viral infection
  • lack of coordination and problems with movement which can cause falls or injury
  • drowsiness, dizziness, or tiredness which can affect driving or work activities
  • tremors
  • double vision
  • swelling of the feet or legs

Drug interactions

Central nervous system (CNS) depressants like alcohol and opioids taken together with gabapentin can increase drowsiness and dizziness.

Harmful effects can also include problems with breathing and mental status changes. Risk of death with co-use of opioids and gabapentin is up to 60 percentTrusted Source greater with doses of gabapentin over 900 milligrams per day.

Antacids with aluminum and magnesium like Maalox and Mylanta can reduce gabapentin’s effects. It’s best to take them separated by at least 2 hours.

You feel better

Remember, taking gabapentin might improve your symptoms of nerve pain or seizures but stopping the medication could bring symptoms back.

It’s important to talk with your doctor before you stop the medication on your own.

Gabapentin isn’t working

If your symptoms haven’t improved or you’re feeling worse, ask your doctor about other options to treat your condition.

It’s too expensive

If the cost of your medication is too high, ask your pharmacist or doctor about other medication choices.

These are all important reasons to consider stopping gabapentin. Remember, you and your healthcare providers are partners. They need to know if you’re having difficulty taking gabapentin. They can create a safe plan to stop the medicine and find an alternative that works better.

Safety and Risks of Taking Gabapentin

Gabapentin appears to work by altering electrical activity in the brain and influencing the activity of chemicals called neurotransmitters, which send messages between nerve cells. Brand names for gabapentin include Horizant, Gralise, and Neurontin. The medication is available in capsule, tablet, or liquid form.

In this article, we describe the uses, dosages, and side effects of gabapentin. We also look into the associated risks and other safety considerations.

People taking gabapentin should be aware of the following:

Risk of suicidal thoughts or behaviors

Some people experience thoughts of suicide or exhibit suicidal behavior when taking gabapentin or other anticonvulsants.

If a person or their loved one notices changes in mood or behavior, they should contact a doctor immediately.

Interactions with other medications and substances

Gabapentin can interact with other prescription or over-the-counter medications, vitamins, and herbal supplements.

Be sure to give the doctor a full list of current medications and supplements before taking gabapentin.

Results of a 2017 review suggest that the following are the main substances that interact with the drug:

  • caffeine, which is present in tea, coffee, and cola
  • ethacrynic acid, a diuretic
  • losartan, a medication for high blood pressure
  • magnesium oxide, a mineral supplement and antacid
  • mefloquine, an antimalarial drug
  • morphine, an opioid pain medication
  • phenytoin, an anti-seizure medication

If gabapentin causes sleepiness, speak to the doctor before taking other medications that can also cause drowsiness, including:

  • antianxiety medications
  • antidepressants
  • antihistamines
  • cold and flu medications
  • muscle relaxers
  • narcotics (pain medications)
  • sleeping pills

Presence of other health conditions

To ensure that gabapentin is safe to take, a person should tell their doctor if they currently have or have ever experienced:

  • breathing problems
  • depression or other mental health disorders
  • diabetes
  • dialysis treatment
  • drug and alcohol misuse issues
  • heart disease
  • kidney disease
  • liver disease
  • seizures (if taking gabapentin for conditions unrelated to seizures)

Risks during pregnancy and when breastfeeding

People who are pregnant, or intend to become pregnant, should tell their doctor before taking gabapentin.

Pregnant women should only take the drug if it is absolutely necessary. However, it is also essential to control seizures while pregnant.

Do not start or stop taking gabapentin for seizure control before talking to the doctor, who will assess the potential risks and benefits.

Gabapentin passes into breast milk, but its effects on babies are unknown. It is best to discuss this issue with a doctor before breastfeeding.

Potential for a drug allergy

Individuals with gabapentin allergies should not take the drug.

Also, the medication may contain other ingredients that can trigger allergy symptoms in some people. Discuss all drug and food allergies with a doctor before taking gabapentin.

Other safety considerations

Because gabapentin can cause drowsiness, anyone taking the drug should exercise caution while driving or using machinery.

Do not take antacids within 2 hours of taking gabapentin, as antacids reduce the body’s ability to absorb the drug.

People should also avoid alcohol or limit their intake while on gabapentin because there is a risk of adverse reactions.

What is the Side Effects and Interaction of Gabapentin (Neurontin ) ?

Gabapentin is a prescription medicine that’s used to treat partial seizures in adults and children who are at least 3 years old.

More commonly, it’s prescribed for nerve pain that’s caused by herpes-family viruses (for which it is approved by the U.S. Food and Drug Administration) or other causes for which it is prescribed “off-label.”

Gabapentin is in a class of drugs called anticonvulsants. The medicine works by calming excitement in the brain and changing the way your body senses pain.

Different brands of gabapentin are given for specific medical conditions. It’s important that you only take the brand name that your doctor prescribes.

The FDA approved this medicine in 1993.

What is the 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. sore throat
      11. sores, ulcers, or white spots on the lips or in the mouth
      12. swollen glands
      13. unusual bleeding or bruising
      14. 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. difficult or troubled breathing
      11. dizziness
      12. fast or irregular heartbeat
      13. headache
      14. increased thirst
      15. irregular, fast or slow, or shallow breathing
      16. itching or skin rash
      17. joint pain
      18. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
      19. loss of appetite
      20. muscle ache or pain
      21. nausea
      22. pale or blue lips, fingernails, or skin
      23. red skin lesions, often with a purple center
      24. red, irritated eyes
      25. unpleasant breath odor
      26. vomiting of blood
      27. 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 Side Effects of Gabapentin

      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. dryness of the mouth or throat
        15. earache
        16. excess air or gas in the stomach or intestines
        17. excessive tearing
        18. eye discharge
        19. feeling faint, dizzy, or lightheadedness
        20. feeling of warmth or heat
        21. flushed, dry skin
        22. flushing or redness of the skin, especially on the face and neck
        23. frequent urination
        24. fruit-like breath odor
        25. impaired vision
        26. incoordination
        27. increased hunger
        28. increased sensitivity to pain
        29. increased sensitivity to touch
        30. increased thirst
        31. indigestion
        32. noise in the ears
        33. pain, redness, rash, swelling, or bleeding where the skin is rubbed off
        34. passing gas
        35. redness or swelling in the ear
        36. redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
        37. runny nose
        38. sneezing
        39. sweating
        40. tender, swollen glands in the neck
        41. tightness in the chest
        42. tingling in the hands and feet
        43. trouble sleeping
        44. trouble swallowing
        45. trouble thinking
        46. twitching
        47. unexplained weight loss
        48. voice changes
        49. vomiting
        50. weakness or loss of strength
        51. 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.

How Gabapentin is Used ?

Gabapentin comes as a capsule, a tablet, an extended-release (long-acting) tablet, and an oral solution (liquid) to take by mouth.

Gabapentin is usually started at a low dose and then gradually increased. Be sure to follow your doctor’s instructions. A typical dose ranges between 900 mg and 1,800 mg daily, divided into three doses. You shouldn’t stop taking gabapentin suddenly. Be sure to talk to your doctor about the proper weaning procedure for the dose you’re taking.

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.

How Gabapentin Works

Gabapentin is believed to work by altering the release of glutamate and other neurotransmitters in your brain.1 Neurotransmitters send messages from one brain cell to another. Glutamate is really helpful for certain things, like learning new information. That’s because it gets your brain cells stirred up and active.

Kind of like a toddler with chocolate, though, if you have too much glutamate running around, your brain cells can become overstimulated. That can make all kinds of things go wrong.

Glutamate has more than one job, though. It also helps transmit pain signals in your brain and nerves. Too much glutamate may play a role in hyperalgesia, which essentially turns up the volume of pain.

Some diseases and conditions—including fibromyalgia—may interrupt this balance and let glutamate run amok. Gabapentin is believed to reduce your brain’s release of glutamate so the cells can calm down and your brain can function better.

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.

How Gabapentin is Used ?

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.

Gabapentin is somewhat commonly prescribed as a fibromyalgia treatment. It’s available as a generic and is also sold under the brand names Neurontin, Horizant, and Gralise.

Gabapentin is not FDA approved for treating this condition, so it’s prescribed off-label. However, the drug is chemically related to Lyrica (pregabalin), which is approved for fibromyalgia. In fact, Lyrica is sometimes referred to as the “son of Neurontin.”

Gabapentin is classified as an anti-seizure drug. It’s used to treat epilepsy, neuropathy (pain from damaged nerves), restless legs syndrome, and hot flashes. Fibromyalgia pain is similar to neuropathy, but whether this condition involves nerve damage still isn’t clear.

What You Should Know Before You Take Gabapentin Online ?

It is very important that your doctor check your progress at regular visits, especially in the first few months if you have epilepsy. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

Check with your doctor right away if you have a fever, rash, swollen, painful, or tender lymph glands in the neck, armpit, or groin, unusual bleeding or bruising, or yellow eyes or skin. These may be symptoms of a serious and life-threatening allergic reaction called drug reaction with eosinophilia and systemic symptoms (DRESS) or multiorgan hypersensitivity.

This medicine may cause serious allergic reactions, including anaphylaxis and angioedema. These can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Gabapentin may cause vision changes, clumsiness, unsteadiness, dizziness, drowsiness, sleepiness, or trouble with thinking. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert, well-coordinated, or able to think or see well. If these side effects are especially bothersome, check with your doctor.

This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors, such as feeling sad or hopeless, getting upset easily, or feeling nervous, restless, or hostile. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, tell your doctor right away.

Gabapentin will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicine or narcotics, other medicines for seizures (eg, barbiturates), muscle relaxants, or anesthetics, including some dental anesthetics. Check with your medical doctor or dentist before taking any of the above while you or your child are using gabapentin.

This medicine may cause respiratory depression, a serious breathing problem that can be life-threatening, when used together with narcotic pain medicines. Check with your doctor right away if you have pale or blue lips, fingernails, or skin, difficult or troubled breathing, or irregular, fast or slow, or shallow breathing.

Do not stop using gabapentin without checking with your doctor. Stopping the medicine suddenly may cause seizures. Your doctor may want you or your child to gradually reduce the amount you are taking before stopping it completely.

Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

This medicine comes with a Medication Guide. Read and follow the instructions carefully. Ask your doctor if you have any questions.

If you are using Gralise® tablets:

  • These should be taken with the evening meal.
  • Swallow the tablet whole. Do not crush, break, or chew it.

For patients with epilepsy who take gabapentin three times per day, do not allow more than 12 hours to pass between any 2 doses. The medicine works best if a constant amount is in the blood.

Neurontin® capsules, tablets, and solution may be taken with or without food.

You may break the scored Neurontin® tablets into two pieces, but make sure you use the second half of the tablet as the next dose. Do not use the half-tablet if the whole tablet has been cut or broken after 28 days. Ask your doctor or pharmacist if you have any questions.

Swallow the capsule whole with plenty of water. Do not open, crush, or chew it.

Measure the oral liquid using a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

If you take an antacid that contains aluminum or magnesium, wait at least 2 hours before taking gabapentin. Some examples of these antacids are Di-Gel®, Gaviscon®, Gelusil®, Maalox® and Mylanta®.

Only use the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

What is Gabapentin and What It is Used for ?

US Brand Name

      1. FusePaq Fanatrex
      2. Gabarone
      3. Gralise
      4. Neurontin

Descriptions

Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.

Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles.

Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

      • Capsule
      • Tablet
      • Solution
      • Suspension

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 Dosage and Administration

Typically, your doctor will prescribe 300 mg once a day, usually in the evening, to start. The dose will then be increased every three to five days. Some people will take 600 mg/day, others will increase to 3,600 mg/day—the maximum dose approved by the FDA.

If used as a mood stabilizer or anti-depressant, the dose is usually between 900 and 2,000 mg a day. But, it may also be increased for better results. Some people see improvement in their symptoms about a week after starting treatment. Others need about a month before they see significant improvement.

Gabapentin has a half-life of about six hours, so it must be taken three to four times a day.

How To Discontinue Gabapentin

Like other psychotropic drugs, you should ease off gabapentin gradually. There are some known withdrawal symptoms. This mostly comes from people who take high doses of the drug and suddenly stop. You should only abruptly discontinue this drug because of a serious side effect, and even then, it should be done with your doctor’s supervision and direction.

Gabapentin Overdose and Toxicity

It’s possible to fatally overdose on gabapentin. Reports of gabapentin being abused alone, and with opioids, prompted the FDA to release a warning statement (in December 2019) about the fatal risk of respiratory depression. Signs of overdose include:

  • Ataxia (decreased muscle coordination)
  • Diarrhea
  • Drooping eyelid
  • Drowsiness and lethargy
  • Double vision
  • Excitation
  • Hypoactivity
  • Labored breathing
  • Marked sedation
  • Slurred speech

If you suspect an overdose, you need immediate medical treatment. The only way to remove the drug is through kidney dialysis in the emergency room.

The off-lable use of Gabapentin for migraine

Neurontin is prescribed for the treatment of the following conditions in adults and children over 3 years:

Various forms of epilepsy. When used for controlling epilepsy, it is usually used in conjunction with another anti-epileptic drug.   Usually doctors prescribe prescribe Neurontin for patients to help them to treat your epilepsy when a current treatment is not fully controlling his/her condition. Neurontin is used as addition to the main treatment of epilepsy.

Peripheral neuropathic pain (long lasting pain caused by damaged nerves). This disease can occur and develop in various conditions: injury, diabetes, shingles, and others.

Your doctor may prescribe you Neurontin for the treatment of other diseases, if he thinks that it is a right medicine for your case which is offl-label use of Neurontin.

It is also widely used to treat Anxiety and Migraine prevention.

Gabapentin Off-Label Usage

One of Gabapentin “off-label” usage is for migraine prevention and treatment, including migraines with or without aura, vestibular migraines. It can reduce the frequency of headaches, pain intensity, and the use of symptomatic medications. Gabapentin is a good preventive therapy for migraines refractory to standard medications.

The chemical structure of gabapentin is related that of gamma-aminobutyric acid (GABA) which is a neurotransmitter in the brain. The exact mechanism as to how gabapentin controls epilepsy and relieves pain is unknown, but it probably acts like the neurotransmitter GABA.

The effective dose of gabapentin varies greatly. Some persons need only 200-300 mg a day whereas others may need 3000 mg or more a day. It may take several weeks to become effective, so it is important to stay on it for an adequate length of time.

The Efficacy of gabapentin in migraine prophylaxis experiment shows  gabapentin is an effective prophylactic agent for patients with migraine.

In the Clinical trials143 patients evaluated gabapentin for migraine prophylaxis.  After 3 months the patients taking gabapentin had a reduction of the migraine frequency by 1.5 migraines per month (or by 35.7%) compared with a reduction of 0.6 migraines per month for the placebo group. Also, gabapentin reduced the headache frequency by 50% or greater in 45% patients compared with only 16% patients on placebo. The most frequently reported adverse events  were asthenia, dizziness, somnolence, and infection.