sleepy man

Q. I would like to know your feelings on the regular use of gabapentin for chronic insomnia. As a long time suffer of insomnia, my doctor has prescribed a myriad of drugs. Most recently upwards of 3600 mg of gabapentin at bedtime.

After more than 6 months of use I have noticed that gabapentin is taking a toll on my quality of life. Your thoughts please!

A. Gabapentin (Neurontin) was originally developed as an anti-seizure drug. It was approved by the FDA as an “add-on” treatment for patients with epilepsy in 1993. Although researchers do not completely understand how gabapentin works to control seizures, they think it affects production of a neurochemical in the brain called GABA (gamma-aminobutyric acid).

Pfizer, the manufacturer of the brand name Neurontin, got into major trouble when it marketed this drug for off-label uses. A company is not allowed to promote a medicine for things that the FDA has not approved. In Pfizer’s case, these unofficial uses for Neurontin included bipolar disorder, alcohol withdrawal, migraines and pain. The company eventually paid $430 million in penalties and admitted to fraudulent promotion.

We mention this because Neurontin is currently available generically as gabapentin. In addition to treating epilepsy, the drug now has official FDA approval for alleviating nerve pain caused by shingles (postherpetic neuralgia).

Even though gabapentin does not have the FDA’s blessing for treating other kinds of nerve pain (neuropathy), many doctors are using it for this purpose. Some physicians prescribe it to patients with fibromyalgia and migraines as well as to control hot flashes brought on by menopause, even though there is no official blessing from the FDA. This is not illegal. Doctors can prescribe any drug for any reason they see fit. That said, we could find little evidence to suggest that gabapentin would be helpful for insomnia. This is definitely an “off-label” use if ever there was one.

If there were few, if any, side effects associated with gabapentin we would not worry too much about the prescribing of this drug for so many off-label uses. But gabapentin has some potentially worrisome adverse effects. The FDA has issued this warning:

“Antiepileptic drugs (AEDs), including Neurontin [gabapentin], increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.”

The FDA also mentions an “unexpectedly high incidence of pancreatic acinar adenocarcinomas” [cancer] in male rats that received gabapentin. The agency adds the unhelpful caveat that the, “clinical significance of this finding is unknown.” In other words, no one knows whether this animal research means that men will be at higher risk for pancreatic cancer. This is not the sort of thing that the FDA requires drug companies to follow up on because the long-term research needed to detect a cancer signal can be quite challenging and expensive.

Gabapentin Side Effects:

  • Dizziness, vertigo
  • Fatigue and or tiredness
  • Unsteadiness or incoordination
  • Abnormal thinking, anxiety, hostility, confusion, amnesia,
  • Depression, suicidal thoughts, mood changes
  • Fluid accumulation in feet, edema of face or extremities
  • Digestive distress, indigestion, loss of appetite, gas, nausea, vomiting, diarrhea
  • Dry mouth, dental problems, gingivitis
  • Blurred vision, double vision, unusual eye movements (nystagmus)
  • Headache
  • Withdrawal seizures (never stop gabapentin suddenly!)
  • Blood disorders
  • Skin rash (alert your M.D. immediately if this occurs!)
  • Upper respiratory tract infections, fever
  • High blood pressure
  • Palpitations
  • Tremor, jerky movements
  • Joint pain, joint stiffness, arthritis

No one should ever discontinue gabapentin abruptly. Like so many medications that affect the central nervous system, sudden withdrawal may lead to unexpected side effects. Some that have been reported include anxiety, insomnia, nausea, pain, sweating and even seizures. Sadly, though, the FDA gives very little guidance to prescribers about how to gradually taper patients off gabapentin.

Bottom line: Gabapentin is an effective treatment for epilepsy and the excruciating pain that sometimes lingers after an attack of shingles. Although it is quite frequently prescribed for off-label uses, the benefit/risk ratio is not clear. The drug has many potentially serious side effects. We are surprised that your doctor prescribed such a heavy-duty drug for insomnia, especially at such a high dose. The “normal” dose of gabapentin for treating epilepsy or shingles pain would be up to 1800 mg daily. Although 3600 mg is sometimes prescribed, it would have to be considered a high dose, especially for an unapproved use.

Since you report that gabapentin is affecting the quality of your life in a negative way, perhaps it is time to talk to your doctor about reconsidering this drug and discussing a gradual withdrawal process. You may need to consult a sleep specialist to help you deal with your chronic insomnia in a more integrative manner.

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  1. tim
    ohio
    Reply

    I’ve been on gabapentin for a long time I’m having a problem in the bedroom and don’t know if its the drugs or not.

  2. Dan
    Atlanta
    Reply

    My psychologist prescribed this for me as a supplement to opiate withdrawal medication. It was 5 years ago. “It would help me relax,” she said. My mother had just passed away, and it seemed to be working. Soon I was up to 1600 mg daily, the “maximum effective dose,” from what I read at the time. I was under the delusion that the drug was rather benign, however, what I’m reading lately makes me think that what I considered relaxed is really the sluggishness I’ve been feeling for so long. My blood pressure has been high, but I never suspected a drug that had a “calming” effect could be the culprit. I think it’s time for me to get off this medication. As creatures of habit, sometimes it’s tough to make a change, even for the better. I’m glad I took the time to re look at this drug, otherwise there’s no telling how many more years I might have suffered.

  3. GAYLE
    United States
    Reply

    This is the worst medication I have ever been prescribed. 1200 mg a day added to the 21mg a day of vicoden that I take for rather severe mouth pain. If you can imagine someone who can check off every single major side effect and some of the minor side effects. I thought I was going blind. I was terrified that I was developing dementia. The depression was so severe that I seriously considered suicide. My only stabilizing moments were knowing that my little dog would have no one to love and care for her if I was gone. Being off balance I was sure that I would fall in front of people. Plus I gained 20 lbs in less than 8 weeks. 4 weeks ago my granddaughter found out that I was taking Gabapintin and was horrified because she had researched the effects for some other reason. I did not look into much but quit pretty much cold turkey. The hot flashes were as bad as anything I had during menopause. It has been 3 weeks since I quit so guess I am though the worst. I can actually see the computer screen now so I am researching – – and hope I can warn other people of how horrible and how debilitating this medication can be.

  4. Injured
    Reply

    Anyone else become ravenous with Gabapentin? Really fast weight gain? I’m up almost 10 pounds in a few weeks. Maybe as another poster said I’m not staying hydrated, causing me to crave carbs (sweets!). I never made that connection.

    • GAYLE
      Reply

      Yep – extremely hungry – but I tried to keep that in check. Put on 20 lbs anyway. Dry mouth = water by my side always.

    • Jodi
      Atlanta
      Reply

      I have been on Gabapentin for about one month and I have gained 15 pounds and drinking like crazy in dialysis already….. please help.

  5. John
    Long Branch, NJ
    Reply

    I just started very light dose of this. 100 MG 3x daily. And the fact is, it seems to give me heart arrhythmias. I’ve been haVing trouble with fasciculations in my forearms, and some paresthesia down my spine. And very high anxiety. Well see what happens next. But I don’t think this drug is worth strange feelings near my heart. Honestly, smoking pot seems to make me feel way better.

    • Chris
      Suffolk, Virginia
      Reply

      I have Cervical Spinal Stenosis. Bad pain in my neck and arms.
      Tried 100mg 3 X day also. It helped, but then I developed sleepiness, depression, and suicidal thoughts. Also whole body shocks and unexpected times. Marijuana worked the best, but the DEA has my Pain Doctor do a urine test every visit. She told me she could loose her license if she treated me with Norco 10mg 3 x day and allowed me to smoke MJ. And I have to pay a $200 copay for the test. I am very upset about this and wrote everyone from the President on down. So I am going to have to do the best I can with Gabapentin and NSAIDS. I can’t believe our Government has put this burden on my shoulders.

      • ana
        l.a.
        Reply

        yup sad thing the DEA has done to all chronic pain patients, 30 day scripts are for kids I’m 58 ddd severe intractable …am I getting myself trapped after 10 yrs norcos now dr swithin me over to gabapentin? First side effect severe migraines never had a headache before as bad. but sure took the spine pain away..

  6. Shell
    Reply

    I originally went on Gabapentin to treat lingering pain from a shingles outbreak. The shingles pain went away quickly, but I also noticed that the Gabapentin decreased my chronic pain from my fused cervical spine, and my headaches and disabling migraines became much, much less frequent (from daily to rarely). My doctor chose to keep me on Gabapentin to continue those benefits. (I had tried so many medications to prevent or stop migraines, and nothing had worked before. And I’d resigned myself to living with chronic pain from the spinal fusion. Gabapentin gave me pain relief and hope!!)

    After about 8-9 months on Gabapentin, my night vision got so bad that I didn’t want to drive at night. I was out later than I expected to be one day, and had to drive home in the dark, during a rainstorm. I was terrified! My vision was very blurred and just… off… (don’t have the words to describe it) and I felt like I was driving blind. I literally drove 20mph and pulled over to the curb every time a car got behind me. I went to the ophthalmologist, who did a number of tests, and then told me that my eyes are fine. The problem was coming from my brain — with Gabapentin being the likely cause.

    I weaned off the Gabapentin — without telling my doctor — and at first, felt fine. This was around the end of November. Then the headaches came back, a week or so later, followed by disabling migraines. By the first week of January, I was back in the doctor’s office, getting the standard four-injection “migraine cocktail” (it works, but it hurts!). And my doctor said, “What happened is simple. You stopped taking your migraine medicine and your migraines came back.”

    So I’m back on Gabapentin. I think that over the 8-9 months I was on it previously, I’d forgotten how bad my migraines truly are, and what it’s like to have them daily and have to go to the doctor’s office, urgent care or even the ER for relief. I can get by without driving at night. And I’ve noticed that the Gabapentin is helping me sleep better at night. And there are other pros and cons. For now, on balance, I’m taking my Gabapentin! It may not be a forever-med for me, but it’s definitely the right right-now med and I’m grateful to have it.

  7. Patricia
    Utica, NY
    Reply

    Gabapentin practically knocked me out on the first dose of 300mg. Rx read: 300mg every 4-6 hours. I immediately experienced crippling side effects associated with it – dizziness, profound loss of energy/tiredness, unpleasant mood, depressive feelings. I could not function for the next 12 – 24 hours or so.

    Thinking my reaction might be dose-related I tried it at half dose after recovering and still felt much worse, with somewhat milder effects of the same symptoms.

    Gabapentin should never have been prescribed for my condition anyway – “idiopathic” progressing peripheral neuropathy with ataxia. I think I know why the prescribing neurologist thought it might help, so I will not blame him for that, but the fact is that it did nothing whatsoever to alleviate the nerve symptoms I experience that are harbingers of increasing nerve damage, even while causing the most extreme side effects.

  8. me
    ma
    Reply

    BAD BAD BADDDDD started use to get off drug addiction, 800mg 3 times a day…honest and truthful PAY ATTENTION!!! at first great tons of energy so so happy, soon after mean and nasty mood swings highly unusual for me really! Cant finish my sentences like WOW memory loss…crapped me brains out…tried to stop felt awful, no energy, sweating, aches, anxious like never before….but worse got pregnant doc assured me it was no prob (almost no studies on this by the way) my child cant pay attention, angry, cant control emotion, cannot sleep!!! could this just be her maybe? but I HIGHLY Highly do not think so has no other probs but shes 3 and still cant sleep the night…oh and we both have gas….no lie worst thing ever…sound crazy I know just no time at the moment! educated 30yr old normal law student small drug prob short lived and then all this due to this drug

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