Category: Gabapentin

Withdrawal symptoms from gabapentin

It is rare to experience withdrawal symptoms from gabapentin, but it does happen. A review of medical journals published between 1993, when gabapentin was approved, and 2015, found 18 case reports of gabapentin addiction, dependence, or withdrawal.

Doctors publish case reports when they encounter a patient with a rare disorder or with a condition that they want to make their colleagues aware of. Case reports are significant because they help further knowledge and identify subjects worthy of future research.

It’s worth noting that just because there are so few reports of gabapentin withdrawal, doesn’t necessarily mean it’s as rare as people once thought. It’s possible that many people simply don’t seek treatment for gabapentin withdrawal.

According to the Drug Enforcement Administration (DEA), gabapentin use is on the rise. Doctors wrote more than double the amount of gabapentin prescriptions in 2017 as they did in 2011.

The illicit use of gabapentin also appears to be increasing.

In a small survey of prescription drug abusers in Appalachian Kentucky, 15 percent reported using gabapentin to get high. That number is a 165 percent increase from the year prior and a 2,950 percent increase from 2008.

It appears as though gabapentin dependence and withdrawal are most common among people who use at least one other substance, such as opioids or alcohol. In the case reports, all patients had past drug or alcohol addiction issues.

Opioid users have reported using gabapentin to intensify their high. Cocaine users have reported the same, as well as attempts to use gabapentin to help alleviate cocaine withdrawal.

Signs and Symptoms

Among the documented cases, gabapentin withdrawal began between 12 hours and 7 days after the last dose.

The majority saw withdrawal symptoms within 24 to 48 hours.

Common Symptoms

The most common symptom was agitation, occurring in about half of the recorded cases. Confusion and disorientation were the next most common symptoms, followed by:

      • Sweating
      • Gastrointestinal symptoms
      • Tremors
      • Fast heart rate
      • High blood pressure
      • Insomnia

In many of the cases reported in the medical journals, individuals entered gabapentin withdrawal without the intention to do so.

This was typically a result of running out of gabapentin or leaving it at home during a trip out of town.

This sample of cases is unlikely to be reflective of most people’s experiences with gabapentin withdrawal. The reason for this is that only people with severe or alarming symptoms seek emergency medical treatment.

Among the cases reported, gabapentin withdrawal symptoms typically peaked three days after someone’s last dose. In almost all cases, doctors eventually treated the symptoms by resuming the previous gabapentin dose. Once people resumed their dose, their symptoms disappeared within hours.

Gabapentin comes with serious risks if you don’t take it as prescribed.

Gabapentin oral capsule is used for short-term or long-term treatment.

The length of treatment depends on what condition it’s being used to treat. It comes with serious risks if you don’t take it as prescribed.

If you stop taking it suddenly or don’t take it at all:

    • For seizures: This can increase your risk of status epilepticus, which is a medical emergency. With this condition, short or long seizures occur for 30 minutes or more. If your doctor decides to reduce your dose or have you stop taking gabapentin, they will do this slowly. Your dose will be reduced or your treatment stopped over the course of at least one week.
    • For postherpetic neuralgia: Your symptoms won’t improve.

If you miss doses or don’t take it on schedule: Your medication may not work as well or may stop working completely. In order for this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

      • double vision
      • slurred speech
      • tiredness
      • loose stools

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: If you forget to take your dose, take it as soon as you remember. If you remember just a few hours before the time for your next dose, then only take one dose. Never try to catch up by taking two capsules at once. This could result in dangerous side effects.

How to tell if the drug is working: You should have fewer seizures. Or you should have less nerve pain.

Neurontin, Gralise, Horizant (gabapentin) and Lyrica, Lyrica CR (pregabalin): Serious Breathing Problems

TOPIC: Neurontin, Gralise, Horizant (gabapentin) and Lyrica, Lyrica CR (pregabalin): Serious Breathing Problems

AUDIENCE: Patient, Neurology, Pain Management, Pulmonology, Pharmacy

BACKGROUND: Gabapentin and pregabalin are FDA-approved for a variety of conditions, including seizures, nerve pain, and restless legs syndrome.

ISSUE:FDA is warning that serious breathing difficulties may occur in patients using gabapentin (Neurontin, Gralise, Horizant) or pregabalin (Lyrica, Lyrica CR) who have respiratory risk factors. These include the use of opioid pain medicines and other drugs that depress the central nervous system, and conditions such as chronic obstructive pulmonary disease that reduce lung function. The elderly are also at higher risk.

FDA is requiring new warnings about the risk of respiratory depression to be added to the prescribing information of the gabapentinoids. FDA has also required the drug manufacturers to conduct clinical trials to further evaluate their abuse potential, particularly in combination with opioids, because misuse and abuse of these products together is increasing, and co-use may increase the risk of respiratory depression.

RECOMMENDATION: Patients and caregivers should seek medical attention immediately if you or someone you are caring for experiences symptoms of respiratory problems, because these can be life-threatening. Symptoms to watch for include:

  • Confusion or disorientation
  • Unusual dizziness or lightheadedness
  • Extreme sleepiness or lethargy
  • Slowed, shallow, or difficult breathing
  • Unresponsiveness, which means a person doesn’t answer or react normally or you can’t wake them up
  • Bluish-colored or tinted skin, especially on the lips, fingers, and toes

Always inform your health care professional about all the drugs you are taking, including prescription and over-the-counter medicines and other substances such as alcohol.

Health care professionals should start gabapentinoids at the lowest dose and monitor patients for symptoms of respiratory depression and sedation when co-prescribing gabapentinoids with an opioid or other central nervous system depressant such as a benzodiazepine.

For more information visit the FDA website at: http://www.fda.gov/Safety/MedWatch/SafetyInformation and http://www.fda.gov/Drugs/DrugSafety.

Gabapentin forms and strengths

Forms and strengths

Generic: Gabapentin

  • Form: oral capsule
  • Strengths: 100 mg, 300 mg, 400 mg

Brand: Neurontin

  • Form: oral capsule
  • Strengths: 100 mg, 300 mg, 400 mg
Gabapentin Forms and Strength
Gabapentin Forms and Strength

Forms and strengths

Generic: Gabapentin

  • Form: oral capsule
  • Strengths: 100 mg, 300 mg, 400 mg

Brand: Neurontin

  • Form: oral capsule
  • Strengths: 100 mg, 300 mg, 400 mg

Dosage for postherpetic neuralgia

Adult dosage (ages 18–64 years)

  • Typical starting dosage: Day 1, 300 mg; day 2, 600 mg (300 mg two times per day, spaced evenly throughout the day); day 3, 900 mg (300 mg, three times per day, spaced evenly throughout the day). Your doctor may further increase your dosage after day 3.
  • Maximum dosage: 1,800 mg per day (600 mg, three times per day, spaced evenly throughout the day)

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years has not been established.

Senior dosage (ages 65 years and older)

Your kidney function may decrease with age. Your body may get rid of this drug more slowly. Your doctor may start you on a lower dose so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous. Your doctor may change your dose based on how well your kidneys are working.

Dosage for partial-onset seizures

Adult dosage (ages 18–64 years)

Typical starting dosage: 900 mg per day (300 mg, three times per day, spaced evenly throughout the day). Your doctor may increase your dose to 2,400–3,600 mg per day.

Child dosage (ages 12–17 years)

Typical starting dosage: 300 mg, three times per day, spaced evenly throughout the day. This can increase to 2,400–3,600 mg per day.

Child dosage (ages 3–11 years)

Typical starting dosage: 10–15 mg/kg/day, divided into three doses, spaced evenly throughout the day. Your child’s doctor may increase the dosage to meet your child’s needs.

Maximum dosage: 50 mg/kg/day.

Child dosage (ages 0–2 years)

Dosage for people younger than 3 years has not been established.

Senior dosage (ages 65 years and older)

Your kidney function may decrease with age. Your body may get rid of this drug more slowly. Your doctor may start you on a lower dose so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous. Your doctor may change your dose based on how well your kidneys are working.

Special considerations

Kidney problems: If you are older than 12 years and have kidney problems or are on hemodialysis, your dose of gabapentin will need to be changed. This will be based on how well your kidneys are working.

What is Gabapentin drug interactions ?

Gabapentin may interact with other medications

Gabapentin oral capsule can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Below is a list of medications that can interact with gabapentin. This list does not contain all drugs that may interact with gabapentin.

Before taking gabapentin, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Pain drugs

When used with gabapentin, certain pain drugs can increase its side effects, such as tiredness. Examples of these drugs include:

    • morphine

Stomach acid drugs

When used with gabapentin, certain drugs used to treat stomach acid problems can reduce the amount of gabapentin in your body. This can make it less effective. Taking gabapentin 2 hours after taking these drugs can help prevent this problem. Examples of these drugs include:

    • aluminum hydroxide
    • magnesium hydroxide

Gabapentin interactions

 

  • Adderall (amphetamine / dextroamphetamine)
  • Advil (ibuprofen)
  • Aleve (naproxen)
  • Ambien (zolpidem)
  • Aspirin Low Strength (aspirin)
  • Cymbalta (duloxetine)
  • Fish Oil (omega-3 polyunsaturated fatty acids)
  • Flexeril (cyclobenzaprine)
  • hydrocodone
  • ibuprofen
  • Klonopin (clonazepam)
  • Lipitor (atorvastatin)
  • Lyrica (pregabalin)
  • methadone
  • Metoprolol Succinate ER (metoprolol)
  • Metoprolol Tartrate (metoprolol)
  • Nexium (esomeprazole)
  • Norco (acetaminophen / hydrocodone)
  • oxycodone
  • Percocet (acetaminophen / oxycodone)
  • prednisone
  • ProAir HFA (albuterol)
  • Prozac (fluoxetine)
  • Suboxone (buprenorphine / naloxone)
  • Synthroid (levothyroxine)
  • tramadol
  • Tylenol (acetaminophen)
  • Vitamin B12 (cyanocobalamin)
  • Vitamin C (ascorbic acid)
  • Vitamin D3 (cholecalciferol)
  • Xanax (alprazolam)
  • Zoloft (sertraline)
  • Zyrtec (cetirizine)