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. Paula
    Texas
    Reply

    This article was well written. I came across it doing a search for ‘hair loss and gabapentin’. It doesn’t show up in the standard side effects for the drug, but I figured users would know, and I was right.

    I have been on it for almost two years for Complex Regional Pain Syndrome caused by a major hand surgery. My dilemma is that it provided immediate relief from a very bad syndrome, but I am having more and more issues with the side effects. I cut myself back in the past 6 months to only 900mgs and I still have hair loss, fatigue, dry eyes, urinary issues, dry mouth, irritability, stomach pain and more pronounced short term memory problems. I also use a compound cream that contains gabapentin, on my hand.

    I wondered if there are any ‘healthy’ counter-actions I can do to minimize some of these side effects? The docs are woefully silent about how to counteract, other than change doses. Thanks for sharing your experiences, it helps to know the probable cause of hair loss, etc.!

  2. Annie
    Seattle, wa
    Reply

    People say Gabapentin isn’t addictive.
    Well… I say it is.
    I like it.
    I started taking it for hip pain. 300mg 3 times a day. Guess what? I sleep like a baby and my anxiety is lessened. I have been taking it for about 8 months. Sometimes only at night, sometimes all day. I use it more as a mood stabilizer and sleep aid now. Buuuuuttttt…… I’ve slowly noticed my eyes are getting bad. Not old age bad…. But new/blurry bad. I’m also noticing I forget things. I forget things from what I did yesterday to trying to pull certain words out when I’m talking. I’m 47. I don’t drink, or smoke, or take any other drugs, and I eat pretty healthy.
    I want to stop…. But I like it. I feel happier. Sigh. Damn you Gabapentin.

  3. Becca R.
    Brooklyn Md
    Reply

    Wow! I’m so happy I found this site! I was (like most) to see if my issues lately were “normal” For being on the medicine. I have had major stomach issues lately, it’s at it’s worse when I wake up for the 1st 7 hours of my day I look 6months pregnant from gas.

    I have been losing my hair, falling a lot and even though I have A.D.D. my attention span and concentration are so much worse then before. Mind you I’m ONLY 30!! My kids, husband and myself included have noticed I’ve been very irritable lately. I was on 300mg 3x a day. But since I got bumped to 400mg 2x a day and 800mg at night all these off the wall symptoms have popped up. Thank you all that have posted on here. I’m now going to have a talk with my doctor about weaning off and maybe trying lycira instead. I was put in this for neuropathy. There’s got to be something else that will work. Thx again.

    • Donna
      St. Louis, MO.
      Reply

      I first posted 2-3 months ago. I am the woman trying to taper from 4800mg of this horrid drug/day. I had no problems until the neurologist I was seeing began adding to my daily dose. I had developed bilateral neuropathy of my feet and legs. Now I wonder if Neurontin (Gabapentin) didn’t cause the neuropathy.

      I started using it for Resltless legs at night, and it really helped. However, I blindly followed my phsicians guidance, only to find I was placed on such a high dose that is never recommended. I tapered down to 2400mg/day for about 10 days, but was in all over body pain I had to increase the dose back up to 3600mg/day. I am still in a great deal of pain, and now, the neuropathy has spread to my hands.

      Current Doc wants me to stay at the 3600 for awhile. Meanwhile I am tapering off Zolpidem ER, which is actually Ambien, but in Extended Release from. I am trying to get off as many anti-cholinergic drugs as I can. Gabapentin, and most psychotropic/CNS-Acting drugs are of the anti-cholinergic effect class. Dry mouth, dry eyes, dry everything! I think Gabapentin can be effective when used in much lower dose. My hair is not falling out, I guess that’s something. But constipation is very bad, and the pain is life-altering! Am wondering if any of you with stomach pain are really suffering from effects of constipation? Anyway, thanks for listening. Anyone that has had success tapering from very high dose Gabapentin, I welcome any tips you can share. My heart goes out to all of you suffering from this drug

  4. diana m.
    Chesapeake, Va. 23320
    Reply

    I have just started on this drug for gastroparesis and it has helped greatly. I take 300 mg in the am and 300 in the pm. Hope my hair doesn’t start falling out as I went through that when I first got this disease. I also take Domperidone which isn’t helping very much now. I have a friend with the same disease who has been taking Gabapentin for a year. She now has her life back. My friend and I had been both been on Reglan and it was horrible. We call that the drug from HELL. She had to retire from her job as it affected her so badly. I am 72 years old and if I can have a few years free of horrible pain, then that’s ok with me. Death is the beginning of a wonderful life so I have no fear.

    Also, I know it sounds crazy, but I suggest mental word activity to help keep the mind sharp as meds can do strange things to the mind.

  5. Emily
    Ny
    Reply

    Hi, I have been on gabapentin for 1 year now 400mg every 4 hrs for neuropathy. I am now tapering off and have gotten down to 200mg 3 times a day and I have been having really bad stomach pain. Especially in the morning when I first wake up (the pain actually wakes me up in the morning) Was wondering if anyone else has experienced this while tapering? I am only cutting down 100mg per week. Any help would be greatly appreciated. Thanks

  6. SJB
    Ludlow Vt.
    Reply

    I am on 600mg 3x’s a day for spinal stenosis pain. After two months leg pain has subsided somewhat, approx 50%.. I am now noticing some fine motor clumsiness picking up small objects and now some tremors in hands, more noticeable holding paper or magazine. I am convinced it is from the gabapentin and am now begun self titrating down to 300 mg and then to 100 mg 3x’s a day untill i get off altogether. Surgery is probably only alternative for back so we’ll see how it goes. I’ll keepya posted.

  7. Linda
    Virginia
    Reply

    I have been on Gabapentin for 4 yrs. I have noticed my hair falling out..my eyebrows are almost gone.. I have severe muscle weakness and great fatigue. I was prescribed this medication for fibromyalgia. Now I can’t think.. I can’t remember names and lately I have had some concerns about driving. My Dr insists the side effects are worth the gains.. but I still have fibro pain! I have worked my way down to 2 300 gram pills in the morning and 2 at night..when I try to go any farther I have trembling and great anxiety.. plus my restless legs go crazy.. I am not able to sleep…. any help on getting off this medication is appreciated.

  8. Donna
    St. Louis
    Reply

    KLM – You are on mark!! Good for you for doing research on your own, and being proactive in your Mom’s care as well as your own. It is not easy to go up against the medical establishment. When my gut was telling me “no” I said OK, remaining passive. Kudos to you, my friend!

  9. Donna
    St. Louis, MO.
    Reply

    I am attempting to taper from a twice a day dose of gabapentin, 2400/dose. That’s right, 4800mg/day. I am in excruciating pain. I am literally house bound. I am also on several other CNS-acting drugs. I was able to taper from Duloxetine fairly quickly as I had developed SIADH. A disturbance of electrolytes, specifically Sodium, which can lower silently until one is in grave trouble. I am beside myself.

    I managed to bring myself down to 1200mg 2x/day for a couple days, but I am in trouble. Can not afford Treatment Centers. Suddenly the physicians are AWOL! The one who placed me on it, and the one who upped the dose. I do notice I am much more anxious, and that does not bode well going forward. Anyway, beware allowing anyone prescribing high dose Gabapentin for off-label use. Do not fall into this trap of Poly Prescription Drug Dependency. I am a late middle-age woman, and my body just can not handle this stress

  10. Johna980
    USA
    Reply

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  11. EJW
    Reply

    I am reading these comments because I wanted to check and see if my side effect was common with gabapentin. I have found that it is.
    After only, one dose, I have been having extreme abdominal/stomach pain. I have been on Lyrica for years. I asked for a generic because Lyrica is so expensive when you reach the donut-hole.
    I just called the pharmacy and I will go back to Lyrica. I will have to cut back on something else. I can not live with this pain.
    I wish you all the best of luck. And, I will keep you in my prayers.

  12. sdenne
    Reply

    I’m post-stroke. I had to learn to walk, talk and swallow again. I had double vision for awhile. I’ve had peripheral neuropathy on the complete right side of my body after the stroke.
    After 10 years of 3×300 gabapentin… hair balls around the house, anger management, loss of strength (for daytime activities), mild scalp psoriasis, some creaking in knee and neck (mild effect), minor swelling in legs (reduced by wearing pressure socks for long trips), some stiffness in hands; but all this might be because I’m 65 years old. lol My weight, around 195 lbs (stable). My height 5’9″ and shrinking (as I settle in to old age). BP: 130/70 (but I take lots of meds).
    My major concern is loss of hearing and tinnitus. I’m thinking gabapentin is a cause for this condition; but I also have to consider other contributors to tinnitus… caffeine, aspirin, Losartan, Atenolol, Hydrocone, Clonidine, etc.
    I suppose, after 10 years of gabapentin I should be on the quest for better solutions.
    I’ll probably wean myself off of gagapentin, Losartan, coffee and aspirin. I have hypertension (which gabapentin contributes to) and have to monitor my bp.
    Like “cappy”, just passing through. (No guarantee of replies). He probably forgot to check the “follow-up” box.
    Thanks for the plethora of experiences.
    Side effects:
    WEIGHT GAIN, LOSS OF HAIR (hair balls around the house), TINNITUS, RASH (eczema, head psoriasis), sadness (depression), LOSS OF ENERGY (greatly increased muscle weakness)(soporific, daytime), joint stiffness or pain (dryness, popping, grinding noises in knees, shoulders, ankles and neck), swelling of legs, dizziness (terrible balance problems), dry mouth, disorientation or confusion (a blithering idiot today), loss of vision (in one eye, partial, blurred vision and jerky eye-movements), increase or cause of pain (gotten neuropathy from neurontin), Stroke symptoms (Interesting, opposite of myself… I had several real strokes.)

  13. KLM
    Reply

    My mother went to the ER seeming like she had a life threatening stroke. The hospital left her on gabapentin. As I researched as I stayed with my mother, I notified the nurses that I thought it was the gabapentin. She had these “strokes” 3 nights in a row. The morning after I notified the nurses, a doctor gave an order to take her off the medicine. She did not have a “stroke” episode the following night after being taken off. So the doctor’s then said we can assume it was the gabapentin. I was written up in an incident report for trying to consult with nurses, and being mad at them after they told me I was no MD. Well, I was better than all 6 MD’s put together with my research and perhaps saving my mothers life. The Lord gave me this knowledge and this intelligence. Don’t have faith in Doctors. They may cause your death or the death of a loved one. Research medicines yourself, doctors do not follow through with research. Tell them to go to hell if they treat you like this. They will certainly end up there whn they answer to God. From this non MD, may God be with you and anyone on gabapentin, look for an alternative.

    • Carol
      California
      Reply

      How long was your mother on it before she had those symptoms? I am taking 300mg for sleep and it seems to have helped my stomach issues and made me more relaxed. I am having hot flashes which I never had before. I am 78. Other than one other over the counter drug i don’t know what could be causing them.

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