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. Brian
    Magalia , Calif
    Reply

    I had tkr and was prescribed Hydrocodone…. 2 months later I realized that I had to get off it, I did, cold. and the withdrawal was not good.. I was put on Gabapentin…. after 2 weeks my joints were noticeably stiffer. Tho I had barely any pain I was all so stiff … hard to want to walk..
    So I looked this up and found that Gabapentin is addictive and one side effect I joint stiffness and muscles too..
    Blimey, now I have to get off these pills……………. so tomorrow I will cut the dose in half…
    Here I go again… Yuk.

  2. Harold
    Albuquerque
    Reply

    I started taking gabapentin about a month ago. Now my coordination is shot. I’m going to stop taking this drug because I have gotten no benefit from it at all. However no one seems to recommend how you should taper off.

  3. Ryan
    UK
    Reply

    Interesting, i have been taking Gabapentin for 3 weeks now, again, the moment i started taking this for PHN after Shingles i felt like this was my saviour, i slept like a baby, no pain – the joy!!
    Now, I’ve been back to work for 4 days since 6 weeks off, i have forgotten names, where I’ve parked my car and best of all i put an ID card in an ATM machine and wondered why i didn’t get any money!
    I can feel my head suddenly becoming fuzzy and an episode of forgetfulness kind of plays out in front of me without me having any power over it!
    I am currently taking 900mg per day spread 3 ways.

  4. Wut
    Ohio
    Reply

    I doubt it

    • Kirk
      SoCali
      Reply

      I have been taking Gabapentin for almost 2 years. I had a very severe case of shingles which left nerve damage on my left shoulder going up my neck and down to my pectoral. The pain is like someone blowing out a match and touching it to my skin; little electric shocks like watching lightning storms from above moving across Nebraska; and like little fire ants stinging. Of course when I put a shirt on…. fogeddaboudit!!. I wake up in the morning with this pain, and I take two 300 mg caps and two Ibuprofen, and in about an hour the pain fades away. I will feel the fireworks starting around noon and take a couple more, then maybe around dinner I will take the last 2. Some days more, depending on how active it is. I do not take any before bed time.

      Side effects must be the reason for my weight gain of 15 pounds in the last 2 years. I am 6 foot and 66 years of age. Sometimes I find myself dozing, with my head hanging down to my chest at my desk at work. My ears are ringing pretty good right now, so I do have the tinnitus, and lately I have had fluid weeping from my ears while sleeping, which I read is a side effect along with the hundreds listed. Emotionally and mentally I do not feel any side effects.

      The pain is still there in the morning, and I have read that the neuropathy from shingles can last for 3 years. After reading all of the horrendous side effects on this blog, I think I will start taking 1 capsule rather than two and see the effects. I will let you all know.

  5. sam
    missouri
    Reply

    I have been taking gabapentin for three weeks and am having the worst bouts of constipation I have ever endured in my life. Has anyone else had similar side effects? I am paraplegic and it’s tearing me up. Last episode took miralax, no effect, took mag citrate, it finally took 4 dulcolax tabs. Got straightened out and week later stopped up again.

    • Steven
      Oregon
      Reply

      I also had constipation with gabapentin. I took 300 mg daily for almost a month but then started having constipation. I dropped it to 100 mg but still had problems, as well as anxiety and sleepiness. I quit taking it. Some of us are very susceptible to constipation with any prescription pain med, and I wish doctors would pay more attention to that.

  6. Ruth
    Ca
    Reply

    I’ve only been on this 1 week 100 mgs a day for 3 days then started increasing to 200 mgs. At that point I started waking up with horrible anxiety, shoulders shaking and skin crawling. I feel a terrible fear all day long. I am stopping it. I can not function. Can’t leave my house. I’m hoping the suffering is of short duration. Was supposed to help nerve pain. I have 10X more mental and emotional pain. Don’t take this if you have the slightest bit of anxiety to begin with! I feel like I’m being mentally tortured!

  7. Shelley
    OR
    Reply

    I’ve been taking Gabapentin 300 mg 3X daily for a few weeks now. I feel my behavior has worsened. I’m trigger happy with my tongue…easily provoked and loose with the truth…ready to pounce on anyone who pushes my buttons. I’ve had to keep that in check over the years anyway, but since taking this medication, I feel powerless to control my behavior. It’s making relationships of all kinds very difficult. I may end up losing my job if I can’t get this under control.

    I have peripheral neuropathy in my feet which is why I’m taking it at all. Maybe I need to find a different line of work…

  8. Lisa
    Ohio
    Reply

    My husband took his first tablet (300 mg.) last night. He went to a pain management doctor with possible nerve pain from a hernia operation 3 months ago. The side effects from just one dose included headache, nausea, feeling disconnected, etc. Many describe same symptoms here. He is taking the 89 pills to police station to be disposed of. He said he is not willing to suffer the side effects and can not imagine swallowing another dose. It was going to be 300 mg day for 5 days, then 300 mg twice for 5 days, then 3 times a day after that. He would rather be in pain than this…

  9. Judy
    Melbourne
    Reply

    I have been prescribed for severe hot flushes. I can’t take HRT, or anything with phytosoy as I have had Oestrogen based breast cancer 4 years ago. I was on HRT when cancer diagnosed.
    I also have had severe depression, diagnosed as chronic, and have had one suicide attempt. I am on Exlaxine, 150, weaned down from 300 for 6 months now.
    I was told to start with 100, then increase to 200mg after 2 nights. Then to 300mg.
    I am not going to take as I will not risk my mental health balance, or taking a drug that is addictive .

    • sharon
      -
      Reply

      Everything you have said applies to me. Had breast cancer 4 years ago. Tried various drugs for hot flushes and on gabapentin now. It helps but I am suffering with severe stiffness in my fingers and hands. I take various drugs but this has only happened in last week. Convinced its these pills. Gonna come off them. Its scary.

  10. gail
    Reply

    Im trying to go down from 400 mgs 4 x daily to 300 mgs daily and the doctor said just stop the 400 and go to the 300 it would be alright cause I have not been on the 400 but a month well let me tell you im having terrible panic attacks I can’t brethe and my head is killing me so I have started taking 2 of the 400 and 2 of the 300 for a week then Im going to 1 400 and 3 of the 300 for a week then go to all 300. this sucks I never thought that this med was like this

    • Steve
      I cant remember
      Reply

      I’m on over 3600 ,Wow I thought this was my saving grace but, in the last six months I lost 3 jobs , I replaced 4 mg of Xanax and for this so called “non-narcotic”, so I know what memory loss is but, not like this I noticed a disconnect
      in my mind to ware I can’t even attempt to retrace my steps or sit and ponder a important situation because it feels like a circuit that thrived is now dead , in in my early thirties I,thrived in college, got a into a lucrative business sold it because of stress and , anxiety, now I watch it grow X 10 fold . As I look at the bigger picture world today like proabition in th 20″s is a medicated society , the answer is a pill and your not an addict because you get it from a person who we call , a doctor

  11. gail
    sc
    Reply

    How do you wean off of this med. without suffering?

  12. Erica
    Reply

    Wow. I have a Kidney Stone Disease with a damaged Urter. My nerves on my left side are so bad & I have HORRIBLE restless legs. I can’t sleep at night. I have Pain Medication that helps to a point, but I’m only 35 & I do not wanna be on that forever. I wanna have kids….so I was talking to my doctor about it & she proscribed this medication, but after reading all of this, I’m definitely not going to take it cuz it sounds like another drug I would just have to be weened off…..am I right?? Has anyone taken anything else along these lines that has actually helped & not made you a crazy person, like how I’m feeling?!! I need sleep! Thanks So Much

    • Kristy
      Reply

      Yes I’m pregnant now and trying to taper off and it’s horrible. Terrible anxiety enough to be hospitalized. Granted I have the stress of finding out I was pregnant adding to it but I blame gabapentin. I was prescribed it for restless legs and told numerous time it was non addicting and no withdrawal from two doctors and a pharmacist. What a joke stay away

  13. plevi
    Reply

    I’ve been taking this med for serious restless leg syndrome for half a year (the sleep specialist prescribed it after the dopamine agonist stopped working). This is the only available medication that helps now. However, it makes me anxious and extremely tired at the same time. Before taking Gabapentin I’d never had the anxiety, only the fatigue-probably because of the RLS. When I take this drug in the evening, my next day is ruined.
    beware of this drug those who can

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