Gabapentin is generally well-tolerated and is prescribed for conditions like nerve pain, seizures, and sometimes anxiety. However, like any medication, it carries potential risks and side effects. Understanding these risks can help in using gabapentin safely.
All medicines have side effects even when used correctly as prescribed, but in general the benefits of taking a medicine outweigh these risks. It is important to know that people respond differently to all medicines depending on their health, other medicines they are taking, the diseases they have, genetics, and many other factors.
As a result, we cannot determine the likelihood that someone will experience these side effects when taking gabapentinoids. Your personal health care professional knows you best, so always tell them about all other medicines you are taking and if you experience any side effects while taking your medicines.
How gabapentin works
In people with partial seizures, gabapentin works by decreasing abnormal activity in the brain. Experts believe gabapentin may cause brain cells to produce more of a chemical called GABA, which reduces abnormal electrical activity of brain cells.
In people experiencing nerve pain after having had shingles, gabapentin is thought to change the way pain signals are sent through the body and brain.
It’s not entirely clear how gabapentin works to treat restless legs syndrome.
1. Common Side Effects
These are usually mild and may resolve as the body adjusts to the medication:
- Drowsiness: May impair the ability to operate machinery or drive.
- Dizziness: Increases the risk of falls, especially in older adults.
- Fatigue: Can lead to reduced energy levels.
- Coordination Problems: Difficulty walking or controlling movements.
- Weight Gain: Often linked to increased appetite or fluid retention.
- Swelling: Particularly in the hands, feet, or legs.
2. Serious Risks
Sedation and Respiratory Depression
- High doses or combining gabapentin with other CNS depressants (e.g., opioids, alcohol, or benzodiazepines) may cause excessive sedation and slow breathing, which can be life-threatening.
Dependence and Abuse Potential
- Although gabapentin is not classified as a controlled substance in many regions, some individuals misuse it, particularly in combination with other substances. This risk is higher in people with a history of substance abuse.
Suicidal Thoughts
- Like other antiepileptic drugs, gabapentin has been associated with an increased risk of suicidal thoughts or behavior. Close monitoring is advised, particularly in the early stages of treatment.
Allergic Reactions
- Rare but severe reactions like Stevens-Johnson syndrome or anaphylaxis may occur. Symptoms include rash, difficulty breathing, and swelling.
Kidney Issues
- Gabapentin is excreted by the kidneys. People with impaired kidney function may require dose adjustments to avoid accumulation and toxicity.
Withdrawal Symptoms
- Abrupt discontinuation may lead to withdrawal effects such as anxiety, insomnia, nausea, or seizures. Tapering the dose gradually is recommended when stopping.
3. Risks for Specific Populations
Older Adults
- More susceptible to dizziness, sedation, and falls.
Pregnant or Breastfeeding Women
- Potential risks to the fetus or infant are not fully understood. Gabapentin is used cautiously during pregnancy and breastfeeding, weighing risks and benefits.
People with Depression or Anxiety
- May experience worsening of mood or increased suicidal thoughts.
4. Drug Interactions
Gabapentin can interact with:
- Opioids: Enhanced risk of sedation and respiratory depression.
- Antacids: May reduce gabapentin absorption; should be taken two hours apart.
- Alcohol: Increases drowsiness and dizziness.
5. Overdose Risk
Taking too much gabapentin can result in severe side effects, including:
- Extreme drowsiness
- Slurred speech
- Double vision
- Difficulty breathing
Minimizing Risk
- Follow Prescriptions: Take gabapentin exactly as prescribed.
- Avoid Alcohol and Other Depressants: To reduce the risk of sedation or respiratory issues.
- Communicate with Your Doctor: Inform them about other medications and health conditions.
- Monitor Mood Changes: Seek immediate help for suicidal thoughts or unusual behavior.
- Taper Off Slowly: Do not stop taking gabapentin abruptly without medical advice.
If you have concerns about gabapentin or specific symptoms, consulting a healthcare professional is the best course of action.