How Gabapentin Works ?

How it works

  • Gabapentin is a medicine that may be used for the treatment of certain seizure disorders or nerve pain.
  • Experts aren’t sure exactly how gabapentin works, but research has shown that gabapentin binds strongly to a specific site (called the alpha2-delta site) on voltage-gated calcium channels. This action is thought to be the mechanism for the way it relieves nerve-pain and lowers the risk of seizures.
  • Gabapentin enacarbil (brand name Horizant) is a prodrug of gabapentin which has been designed to overcome the limitations of gabapentin, such as poor absorption and a short duration of action. Gabapentin enacarbil is effective for restless legs syndrome (RLS) and postherpetic neuralgia (nerve pain that occurs following Shingles).
  • Gabapentin belongs to the group of medicines known as anticonvulsants.

Tips of Taking Gabapentin

  • The Neurontin brand of gabapentin can be taken with or without food. If you break a 600mg or 800mg Neurontin tablet in half, be sure to take the other half at your next dose or within 28 days.
  • The Gralise brand of gabapentin cannot be substituted for other gabapentin products due to different administration requirements (once daily versus three times daily for other products). Gralise should be taken with food at the evening meal. Gralise tablets should be swallowed whole; do not cut, crush, or chew.
  • Horizant (gabapentin enacarbil) tablets should be swallowed whole and taken with food. For restless leg syndrome, take at roughly 5 PM. Do not cut, crush, or chew the tablet. Do not interchange Horizant with other gabapentin products.
  • Use a manufacturer-provided or pharmacist-provided measuring cup calibrated for liquid formulations when measuring liquid doses of gabapentin. Do not use a kitchen measuring device or teaspoon because these may be inaccurate.
  • For dosage schedules of three times daily do not allow more than 12 hours between doses.
  • Monitor for mood changes and report any evidence of new or worsening mood or depression to the prescribing doctor.
  • Do not take gabapentin at the same time as antacids such as Maalox or Gaviscon. Separate administration by at least two hours. Take exactly as directed by your doctor, do not increase or decrease the dose without his or her advice.
  • Avoid operating machinery, driving, or performing tasks that require mental alertness if gabapentin makes your drowsy or impairs your judgment.
  • The side effects of gabapentin, such as dizziness or drowsiness, may increase your risk of falling. Remove any fall hazards from your home if possible (such as loose rugs), and be careful when ascending or descending stairs.
  • Talk to your doctor if you experience any worsening of your mood or if you develop any suicidal thoughts.
  • Do not stop taking gabapentin without your doctor’s advice as it may precipitate a withdrawal reaction (symptoms include agitation, disorientation, confusion). When the time comes to discontinue gabapentin your doctor will tell you how to taper it off.
  • Seek urgent medical advice if you develop a rash, fever, difficulty breathing, or facial swelling while taking gabapentin.

Downsides of Taking Gabapentin

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Dizziness, drowsiness, tiredness, fever, and nystagmus (a rapid and uncontrollable movement of the eyes). Drowsiness caused by gabapentin may affect your ability to drive or operate machinery. Alcohol and other drugs with sedative properties enhance this effect.
  • May cause behavioral problems, hostility or aggression, or thought disturbances when used to treat epilepsy in children aged three to twelve years.
  • Other side effects may include blurred vision, amblyopia (lazy eye), dry mouth, peripheral edema (fluid retention in the feet and hands), tremor, sexual dysfunction, and gastrointestinal disturbances.
  • Best titrated up slowly to reduce the risk of side effects; however, this may delay the onset of an effect.
  • Similar to other anticonvulsant medicines, gabapentin may increase the risk of depression and suicidal thoughts, particularly in young adults under the age of 24.
  • Gabapentin has been associated with a discontinuation syndrome when abruptly stopped. Symptoms include anxiety, insomnia, nausea, pain, and sweating. It should be tapered off slowly under a doctor’s advice.
  • The dosage of gabapentin needs to be reduced in kidney disease.
  • Rarely, hypersensitivity reactions may occur. Symptoms may include fever, rash, swollen lymph nodes, swollen facial features, or throat swelling.
  • May interact with some other medications including antacids, hydrocodone, morphine, and other drugs that cause sedation or dizziness. May also cause false-positive results on some urinary protein tests.
  • There have been some reports of gabapentin misuse and abuse, particularly in people with a history of drug abuse. Be alert for this possibility.
  • Gabapentin requires three times daily administration because of its short duration of effect. Gabapentin enacarbil (brand name Horizant) only requires once-daily dosing.
  • Only effective for partial-onset seizures, not other types of seizure disorders.
  • Some branded and generic forms of gabapentin are not interchangeable.

 

Upsides of Taking Gabapentin

Upsides of Taking Gabapentin

  • May be used in addition to other medication to reduce seizure frequency in adults and children aged three and older with partial-onset seizures.
  • May be used in the management of postherpetic neuralgia (persistent nerve pain following Shingles infection) in adults.
  • Gabapentin enacarbil (brand name Horizant) may be used to relieve restless legs syndrome (RLS) or nerve pain associated with postherpetic neuralgia. This prodrug of gabapentin only requires once-daily dosing.
  • Gabapentin is available as a generic; however, not all generics are interchangeable with some branded versions of gabapentin.
  • Gabapentin may be used off-label (this means for an indication that has not been approved by the FDA but may still have a place in therapy) for some other indications such as fibromyalgia, persistent hiccups, migraine prevention, and hot flashes.

Gabapentin Allergies and Gabapentin Side Effects

Gabapentin can cause a reaction called anticonvulsant hypersensitivity syndrome. This syndrome can be life-threatening. Call your doctor right away if you have a rash, a fever, and swollen lymph nodes.

Gabapentin can cause also cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives
  • rash

Don’t take this drug again if you have ever had an allergic reaction to it before. Taking it a second time after any allergic reaction to it could be fatal (cause death).

COMMON side effects


If experienced, these tend to have a Severe expression

  • Loss Of Muscle Coordination
  • Nystagmus, A Condition With Involuntary Eye Movements

If experienced, these tend to have a Less Severe expression

  • Dizziness
  • Drowsiness
  • Fluid Retention In The Legs, Feet, Arms Or Hands
  • Inducing Of A Relaxed Easy State
  • Low Energy

INFREQUENT side effects


If experienced, these tend to have a Severe expression

  • Depression
  • Feelings Of Hostility
  • Memory Loss
  • Mental Status Changes
  • Mood Changes
  • Trouble Breathing

If experienced, these tend to have a Less Severe expression

  • A Bacterial Infection Of The Middle Ear
  • A Feeling Of General Discomfort Called Malaise
  • A Type Of Speech Disorder Called Dysarthria
  • An Infection Due To A Virus
  • Backache
  • Blurred Vision
  • Constipation
  • Cough
  • Diarrhea
  • Double Vision
  • Dry Mouth
  • Generalized Weakness
  • Hyperactive Behavior
  • Lazy Eye
  • Muscle Tremors
  • Nausea
  • Throat Dryness
  • Throat Irritation
  • Vomiting
  • Weight Gain

RARE side effects


If experienced, these tend to have a Severe expression

  • A Condition With Muscle Tissue Breakdown Called Rhabdomyolysis
  • A Hypersensitivity Reaction To A Drug
  • A Significant Type Of Allergic Reaction Called Anaphylaxis
  • A Skin Disorder With Blistering And Peeling Skin Called Stevens-Johnson Syndrome
  • A Type Of Allergic Reaction Called Angioedema
  • A Type Of Significant Allergic Skin Reaction Called DRESS Syndrome
  • A Yellowing Of The Eyes Or Skin From Buildup Of Bilirubin Called Jaundice
  • Abnormal Liver Function Tests
  • Bullous Pemphigoid
  • Confusion
  • Decreased Lung Function
  • Erythema Multiforme, A Type Of Allergic Skin Reaction
  • Fainting
  • Increased Eosinophils In The Blood
  • Irritability
  • Low Amount Of Sodium In The Blood
  • Multiple Organ Failure
  • Suicidal Thoughts
  • Swollen Lymph Nodes

If experienced, these tend to have a Less Severe expression

  • A Skin Rash
  • A Stuffy And Runny Nose
  • Agitation
  • Altered Interest In Having Sexual Intercourse
  • Anxious Feelings
  • Behavioral Problems
  • Decreased Appetite
  • Difficulty Concentrating
  • Difficulty Sleeping
  • Enlarged Breasts
  • Excessive Sweating
  • Fever
  • Headache
  • High Blood Sugar
  • Increased Creatine Kinase Levels
  • Indigestion
  • Pain
  • Pink Eye
  • The Inability To Have An Erection

People with kidney problems cannot buy gabapentin online

When you have a kidney problem, your body processes this drug more slowly than normal. This may cause the drug to increase to dangerous levels in your body. Talk to your doctor about whether this drug is safe for you.

You are not allowed to buy gabapentin online if you want to refill. You must take this prescription under your local doctor instruction.

What special precautions should I follow?

Before taking gabapentin,

  • tell your doctor and pharmacist if you are allergic to gabapentin, any other medications, or any of the inactive ingredients in the type of gabapentin you plan to take. Ask your pharmacist for a list of the inactive ingredients.
  • you should know that gabapentin is available in different forms that may be prescribed for different uses. Ask your doctor to be sure that you are not taking more than one product that contains gabapentin.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antidepressants; antihistamines; medications for anxiety; medications that make you feel dizzy or drowsy; medications for mental illness; naproxen (Aleve, Anaprox, Naprosyn, others); opioid (narcotic) medications for pain such as hydrocodone (in Hydrocet, in Vicodin, others), morphine (Avinza, Kadian, MSIR, others), or oxycodone OxyContin, in Percocet, in Roxicet, others); sedatives; medications for seizures; sleeping pills, and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • if you are taking antacids such as Maalox or Mylanta, take them at least 2 hours before you take gabapentin tablets, capsules, or solution.
  • tell your doctor if you have or have ever had lung or kidney disease. If you will be taking the extended-release tablets, also tell your doctor if you need to sleep during the day and stay awake at night.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking gabapentin, call your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking gabapentin.
  • you should know that this medication may make you drowsy or dizzy, may slow your thinking, and may cause loss of coordination. Do not drive a car or operate machinery until you know how this medication affects you, and your doctor agrees that it is safe for you to begin these activities.
  • if you are giving gabapentin to your child, you should know that your child’s behavior and mental abilities may change while he or she is taking gabapentin. Your child may have sudden changes in mood, become hostile or hyperactive, have difficulty concentrating or paying attention, or be drowsy or clumsy. Have your child avoid activities that could be dangerous, such as riding a bicycle, until you know how gabapentin affects him or her.
  • remember that alcohol can add to the drowsiness caused by this medication.
  • you should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking gabapentin for the treatment of epilepsy, mental illness, or other conditions. A small number of adults and children 5 years of age and older (about 1 in 500 people) who took anticonvulsants such as gabapentin to treat various conditions during clinical studies became suicidal during their treatment. Some of these people developed suicidal thoughts and behavior as early as one week after they started taking the medication. There is a risk that you may experience changes in your mental health if you take an anticonvulsant medication such as gabapentin, but there may also be a risk that you will experience changes in your mental health if your condition is not treated. You and your doctor will decide whether the risks of taking an anticonvulsant medication are greater than the risks of not taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood); talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; giving away prized possessions; or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

People with epilepsy cannot buy Gabapentin online

If you have epilepsy, you cannot buy gabapentin online. You must have your street local doctor write prescription for you and you can refill your gabapentin by online pharmacies.

Don’t stop taking gabapentin suddenly. Doing this can increase your risk of having a condition called status epilepticus. This is a medical emergency during which short or long seizures occur for 30 minutes or more.

Gabapentin can cause problems in children aged 3–12 years who have epilepsy. It raises their risk of thought problems as well as behavioral problems, such as being hyper and acting hostile or restless.

Before taking Gabapentin

You should not use gabapentin if you are allergic to it.

To make sure gabapentin is safe for you, tell your doctor if you have ever had:

      • lung disease, such as chronic obstructive pulmonary disease (COPD);
      • kidney disease (or if you are on dialysis);
      • diabetes;
      • depression, a mood disorder, or suicidal thoughts or actions;
      • a drug addiction;
      • a seizure (unless you take gabapentin to treat seizures);
      • liver disease;
      • heart disease; or
      • (for patients with RLS) if you are a day sleeper or work a night shift.

Some people have thoughts about suicide while taking this medicine. Children taking gabapentin may have behavior changes. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Seizure control is very important during pregnancy, and having a seizure could harm both mother and baby. Do not start or stop taking gabapentin for seizures without your doctor’s advice, and tell your doctor right away if you become pregnant.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

Gabapentin for Depression, Mania and Anxiety

1. What Exactly is Gabapentin (Neurontin)?

This particular drug is an anticonvulsant. It is not related chemically to other anti-convulsants or other mood regulating drugs on the market.


2. When Did the FDA Approve Gabapentin for marketing in the United States? How Can It Be Promoted?

On December 30, 1993, Gabapentin got final approval, which meant that it could be marketed in the United States. It is only marketed as an anticonvulsant. However, it has also been used for restless leg syndrome, pain issues, hot flashes, tremors, and a wide variety of psychiatric disorders.


3. Is There a Generic Version of Gabapentin Available?

Since its manufacturer no longer has patent protection on the drug, there are generic versions of Gabapentin on the market.


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4. What is the Difference Between Gabapentin and Other Mood Stabilizing Medications?

 

There are two major ways that Gabapentin differs from similar drugs on the market:

  • Gabapentin has been proven to be effective for people who have hard-to-treat depression or other mood disorders
  • The side effects are relatively minor

5. How is Gabapentin Different from Valproate and Carbamazepine?

There are claims that Gabapentin was successful in helping with rapid cycling and mixed bipolar states in people who have not received relief from valproate or carbamazepine. It appeared that Gabapentin helped more with anxiety and agitation than the other two drugs. It has also been shown that Gabapentin could aid people with certain types of tardive dyskinesia.


6. What Types of Mood and Anxiety Disorders Can Best Be Treated with Gabapentin?

Experts say that it is too early to tell which types of disorders will get the best results from Gabapentin. There are not a lot of reports on Gabapentin’s use. Many experts don’t recommend the use of Gabapentin for mood disorders. There is more data from people who have hard-to-treat bipolar disorder than unipolar depression, although some people with unipolar disorder have gotten good results from Gabapentin. In time, it can be proven that Gabapentin can be used to treat a variety of mood disorders.


7. Can Gabapentin Be Used for the Treatment of Mixed Bipolar States? Can It Prevent Future Episodes of Mania and Depression?

Right now, there isn’t a lot of evidence that Gabapentin can be used for treating people with bipolar disorder.


8. Should a Person Take Any Laboratory Tests Before Taking Gabapentin?

Before a patient starts Gabapentin therapy, they should undergo a thorough medical examination to rule out any medical issues. This includes any blood or urine tests. Medical evaluations are important as issues such as thyroid conditions can undermine the therapy.


9. How Do You Initiate Gabapentin Therapy?

The therapy will be started with 300 mg once a day, usually in the evening. The dose will then be increased every 3 to 5 days. Some people will see an increase with 600 mg/day, others will see increases up to 4,800 mg/day.


10. Are There Potential Interaction Issues for People Taking Carbamazepine, Valproate or Lithium?

No interactions between Gabapentin and valproate, carbamazepine or lithium have been reported.


11. What is the Typical Final Dose That Would Be Prescribed to Someone Taking Gabapentin?

If used as a mood stabilizer or anti-depressant, the final dose is usually between 900 and 2,000 mg a day. However, some patients have been known to need up to 4,800 mg a day to get good results.

Gabapentin has a half-life of about six hours, so it must be administered 3 to 4 times a day.


12. How Long Does It Usually Take for Gabapentin to Work?

Some people see improvement in their antigenic and/or anti-depressant symptoms about a week after starting treatment. Others need about a month before they see significant improvement.


13. What Are Gabapentin’s Side Effects?

  • Dizziness
  • Double Vision
  • Fatigue
  • Nystagmus (involuntary eye movement)
  • Sleepiness
  • Tremors
  • Unsteadiness

Most people notice side effects the first few days after an increase in their dose. They usually fade after a while.


14. Are There Any Side Effects That Force People to Stop Taking Gabapentin?

The side effects that are most likely to keep people from continuing Gabapentin therapy are the following symptoms:

  • Dizziness
  • Fatigue
  • Nausea and/or vomiting
  • Sleepiness
  • Unsteadiness

15. Are There Any Psychiatric Side Effects That Come From Taking Gabapentin?

There are some rare side effects, which include the following symptoms:

  • Agitation
  • Decreased libido
  • Depersonalization
  • Increased libido
  • Mania
  • Paranoia

16. Does Gabapentin Interact with Any Other Prescriptions or Over-The-Counter Medications?

There are only a few interaction issues that are known. Antacids have been known to decrease absorption of the drug, as well as lower the blood level by 20%. Gabapentin could also increase the level of concentration of some oral contraceptives by up to 13%. However, these two interaction possibilities are not clinically significant in any way.


17. Are There Any Interaction Issues Between Gabapentin and Alcohol?

Alcoholic beverages have been known to increase the discomfort of Gabapentin’s side effects.


18. Is It Safe for a Woman Who Is Pregnant, About to Become Pregnant, or Nursing to Take Gabapentin?

The FDA placed Gabapentin in pregnancy category C. According to studies done on animals, there was harm done to fetuses. However, there have been no studies done on humans. Despite all this, experts believe that the benefits gained from taking Gabapentin may outweigh its risks.


19. Can Children and Adolescents Safely Take Gabapentin?

In other countries besides the United States, children have been prescribed Gabapentin. However, Gabapentin has only been approved for use in adolescents above the age of 12.


20. Can Elderly People Use Gabapentin?

The elderly seem to experience similar effects to younger people. There isn’t a lot of precedent with using this drug to treat psychiatric disorders in this population.


21. Can Symptoms Occur if Gabapentin is Discontinued?

Like other psychotropic drugs, people 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. People should only abruptly discontinue Gabapentin because of a serious side effect.


22. If Taken In Overdose, is Gabapentin Toxic?

There isn’t a lot of data on overdoses. People have been known to survive overdoses of up to 49,000 mg of Gabapentin without serious health consequences.


23. Can This Medication Be Taken with MAO Inhibitors?

This particular combination doesn’t present any special issues.


24. How Much Does Gabapentin Cost?

According to Buying Gabapentin, generic Gabapentin can cost between $10-$27 for ninety 100mg or 300mg capsules and between $14-$53 for ninety 400mg capsules.


25. Can People Who Received Little Benefit From Other Psychotropic Drugs Get Good Results From Gabapentin?

Gabapentin is mostly used by people with mood or anxiety disorders that have not been adequately treated with other medications.


26. Are There Any Disadvantages to Gabapentin?

There isn’t a lot of available information about side effects. There’s also the fact that Gabapentin’s use with people with mood disorders is relatively new. Because of this fact, it’s not known whether people who initially respond to Gabapentin will continue to do so after years of use.

Because of the short half-life of the medication, people will need to take divided doses throughout the day.

Studies have not been able to prove that Gabapentin is effective as a mood control agent.

This medication can also cause suicidal thinking. This effect is similar to that of other anticonvulsants.


27. Why Do Doctors Prescribe Gabapentin When There Are Other Mood Stabilizing Medications That Have Been Around for Many Years? These Medications Have Been Shown to Be More Effective in Double-Blind Studies That Are Placebo-Controlled.

There are two reasons why physicians prescribe Gabapentin over more established drugs. The first reason is that not everyone improves with the older, more established medications. The second is that some people can’t deal with the side effects of the other drugs.


28. Is Gabapentin Available in Countries Other Than the United States?

Yes. Gabapentin is available in over 40 countries.

 

For postherpetic neuralgia or restless legs syndrome:

Gabapentin has not been studied in children for the management of postherpetic neuralgia or restless legs syndrome. It should not be used in people younger than 18 years.

For treating partial seizures

Gabapentin should not be used to treat partial seizures in children younger than 3 years.

Serious Side Effects of Gabapentin

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Changes in mood or anxiety. Symptoms can include:
    • thoughts of suicide or dying
    • attempts to commit suicide
    • anxiety that’s new or gets worse
    • crankiness that’s new or gets worse
    • restlessness
    • panic attacks
    • trouble sleeping
    • anger
    • aggressive or violent behavior
    • extreme increase in activity and talking
    • unusual changes in behavior or mood
  • Changes in behavior and thinking, especially in children ages 3 to 12 years. Symptoms can include:
    • emotional changes
    • aggressiveness
    • trouble concentrating
    • restlessness
    • changes in school performance
    • hyper behavior
  • Serious and life-threatening allergic reaction. Symptoms can include:
    • skin rashes
    • hives
    • fever
    • swollen glands that do not go away
    • swollen lips and tongue
    • yellowing of your skin or the whites of your eyes
    • unusual bruising or bleeding
    • severe tiredness or weakness
    • unexpected muscle pain
    • frequent infections

Gabapentin Tolerance and Addiction Potential

Gabapentin is not considered psychologically addictive. However, 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 abuse, gabapentin abusers do not present with the kind of compulsive, drug-seeking behavior or strong cravings associated with other more common depressants such as opioids, alcohol or benzodiazepines.

Tolerance will develop to the anxiolytic effects with prolonged continous usage. After cessation, the tolerance returns to baseline in 7-14 days. Withdrawal symptoms or rebound symptoms may occur after ceasing usage abruptly following a few weeks or longer of steady dosing, and may necessitate a gradual dose reduction.