Gabapentin

Gabapentin misuse can have a high risk for a potentially life-threatening overdose, as it can slow down life-sustaining bodily functions. 

Gabapentin abuse can also lead to addiction. It may require professional treatment to manage it safely. 

What Is Gabapentin?

Gabapentin is an anticonvulsant medication that was originally used as a muscle relaxer and anti-spasmodic medication. It was determined to be more effective for treating postherpetic neuralgia (nerve pain and common complication of shingles), an adjunctive therapy for the treatment of partial seizures with or without other anticonvulsants, and moderate to severe restless legs syndrome (RLS). 

It is also used off-label to treat a variety of conditions, including alcohol withdrawal and dependence. 

Gabapentin is available in both generic form and under brand names such as Neurontin, Horizant, and Gralise. 

Gabapentin works in a similar fashion to the naturally occurring neurotransmitter GABA in the brain to calm down excited neurons, which can contribute to seizures and feelings of nerve pain. Gabapentin is a prescription medication that can slow some of the nerve signals in the brain, having a calming effect.

How Does Gabapentin Work?

GABA, or gamma aminobutyric acid, is an inhibitory neurotransmitter that is a naturally occurring chemical messenger produced by the brain to block specific impulses between nerve cells — impulses that can lead to seizures and pain sensations. 

GABA functions to slow down some functions of the central nervous system, minimizing neuronal excitability. Gabapentin mimics the mechanisms of GABA in the brain, which then can calm these excited nerve cells to manage partial seizures or nerve pain. 

Addiction Treatment With Gabapentin

Gabapentin is commonly used off-label during addiction treatment, particularly for alcohol use disorder. It has been shown to be effective in treating alcohol dependence and symptoms related to relapse, including dysphoria (feelings of unease and unhappiness), insomnia, and alcohol cravings. 

Gabapentin is generally used in the abstinence maintenance phase of alcohol use disorder (AUD) treatment. Studies show that it can be effective for managing alcohol withdrawal symptoms and improving rates of abstinence. 

How Gabapentin Works in the Brain 

Alcohol is a substance that interacts with levels of GABA in the brain, increasing them. 

When you stop drinking suddenly after drinking regularly for a long period of time, this can cause levels of GABA to drop significantly. This can result in an overfiring of nerve signals, tremors, and potential seizures. Gabapentin can help to smooth these sensations out by calming the excited nerve cells. 

Gabapentin is most regularly used as an adjunctive treatment method for alcohol addiction. This means it is commonly used with other medications at the same time. Higher doses seem to be more effective with daily doses of 1800 mg. 

Gabapentin’s Effectiveness

Additional trials have shown that gabapentin can be effective for treating alcohol withdrawal symptoms, minimizing drinking, and increasing abstinence rates when used in the following way:

• Gabapentin is started on day three of abstinence (commonly after medical detox). For three days, it is administered morning, noon, and night in doses of 300 mg.
• On days 5 through 112, gabapentin is administered in doses of 300 mg in the morning and at noon. In addition, it’s given in a dose of 600 mg at bedtime for a total of 1200 mg daily.

Gabapentin is most often a pill or tablet that is swallowed, and it has a half life of about five to seven hours. This means that it will be most commonly given in multiple doses throughout the day to keep withdrawal symptoms and alcohol cravings to a minimum.

Can Gabapentin Be Addictive?

Gabapentin is not a controlled substance. It is readily available, and because of this, it’s on the rise as a drug of abuse. Abusing gabapentin (using it without a prescription in doses and methods not directed by a medical professional) can lead to gabapentin dependence and addiction. 

Addiction is when drug use becomes compulsive, and you are unable to stop taking the drug even if you try to and want to. Gabapentin can be an addictive drug.

What Are the Signs of Gabapentin Addiction?

Any misuse of gabapentin (taking it without a prescription or in a way other than it is prescribed) is abuse, and this increases the risk for addiction. Signs of gabapentin addiction include the following:

• Taking the medication in between doses or in larger amounts than prescribed
• Altering the medication, such as chewing it, crushing it to then snort or smoke it, or dissolving and then injecting it
• Continuing to take the medication after a prescription has run out
• Exaggerating symptoms to try and get more medication
• Doctor “shopping,” or going to multiple doctors to try and get more prescriptions
• Trying to stop taking it and not being able to 
• Cravings for gabapentin
• Withdrawal symptoms when gabapentin wears off 
• Taking gabapentin in physically risky situations
• Continuing to take gabapentin despite knowing that it will trigger negative social, interpersonal, physical, and/or mental health issues
• Shifting social circles and activities to spend more time using, obtaining, or recovering from gabapentin
• Inability to consistently keep up with school, work, or home obligations

What Are the Signs & Symptoms of Gabapentin Withdrawal?

Gabapentin use and abuse can lead to dependence due to its GABA-like functions. This can mean that the brain will struggle to regulate levels of GABA without gabapentin’s interaction. This can lead to withdrawal effects. 

Withdrawal symptoms can start within 12 hours to 7 days of stopping gabapentin. Symptoms of gabapentin withdrawal can include the following:

• Agitation
• Anxiety
• Irritability
• Confusion
• Nausea
• Vomiting
• Diarrhea
• Tremors
• Irregular heart rate
• Dizziness
• Headache
• Insomnia

Withdrawal symptoms will typically last up to 10 days. They are often best managed by slowly weaning off the medication or through a medical detox program.

What Are the Side Effects of Gabapentin?

All medications can have side effects. These side effects can be compounded by not taking the medication exactly as directed. 

In general, gabapentin is considered a safe and effective medication when taken as prescribed under the direction of a medical professional. Common side effects of gabapentin can include the following:

• Headache
• Dizziness
• Fatigue or drowsiness
• Nausea and vomiting
• Memory loss
• Speech issues
• Fever
• Unusual eye movements
• Coordination issues

More serious side effects can occur if you take too much gabapentin at a time or mix it with other substances, particularly central nervous system depressants. This can increase your risk for overdose.

Can You Overdose on Gabapentin?

Gabapentin abuse can lead to overdose. Between 2019 and 2020, the drug was involved in almost 10 percent of overdoses in the states studied during this time. Most of the overdose deaths involving gabapentin also involved an opioid drug. A person is far more likely to overdose on gabapentin when mixing it with other drugs such as opioids. 

An overdose can cause the following symptoms:

• Mental confusion
• Nausea, diarrhea, and vomiting
• Extreme drowsiness or loss of consciousness
• Shallow breathing and trouble breathing
• Decreased muscle coordination
• Low blood pressure 
• Irregular heart rate
• Coma 
• Death

A gabapentin overdose can be a medical emergency. If one is suspected, seek immediate medical attention. Be sure to let medical providers know if any other substances are also involved.

Treatment Options for Gabapentin Addiction

While gabapentin is a medication that is often used during substance abuse and addiction treatment, it can also be abused and lead to addiction when not used as directed. 

Treatment for gabapentin addiction will be similar to treatments for other forms of drug abuse. It can include detox and rehab, which can be either inpatient or outpatient depending on the severity of the addiction and individual circumstances.

Treatment programs for gabapentin addiction will likely include the following:

• Group and individual therapy and counseling sessions
• Medication management
• Life skills training
• Educational programming
• Relapse prevention 
• Support groups

The Bottom Line

Gabapentin is a useful medication for treating partial seizures and nerve pain related to shingles as well as alcohol withdrawal and addiction. It does have potential for misuse and addiction, so its use should be closely monitored. It should only be taken as prescribed.