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. Lilly H
    washington
    Reply

    In 2003 I came down with vasculitis. Awful, awful time! For 3 years I struggled just to take care of daily duties. I finally went to a doctor who put me on Gabapentin ( non had previously)…a wonder drug for me! I got some of my life back. Along the way the dosage was increased because of the nerve pain. I have neuropathy. Along with the increase came side effects that I didn’t attribute to this medicine and I didn’t start checking into the side effects deeper until I ended up with low blood sugar. So in the end I had gained weight, had suicidal thought 24–7, my personality had changed 24-7, low blood sugar and who knows what else. These effects were huge for me. I started cutting back on my dosage… slowly with my doctors help, and am at the point of cutting back again. I must say that as soon as I lowered the dosage, the side effects started to disappear. I am more tired but the trade-off is one that I embrace happily. I love these forums. I learn a lot from you people. So my advice is–when you start taking a new medicine, don’t just take a shallow overview as to what the side effects are, but check many sites and compare what is said, to what you are feeling. Well worth it!!!

  2. patrick p.
    Saugatuck, MI
    Reply

    After year with a spinal cord injury at c-5 & C-6 I’ve had chronic pain and neuropathy in hands and feet. (former Boston Marathoner) that injury occurred during a cervical spine operation. The next year I had a fibular graf from C-# to C-7. these were inn 1992 & 1993.
    Ive had the past 5-6 years quite alot of pain and muscle neurons would not release my muscle spasms in my legs, I’d have to wait til the neuron “gave up” and tears running down my cheeks. Some thjought it may be Isaac’s syndrome. Doctor put me on Gabapentin for these spasms.

    In 2013 U of M neurology diagnosed me with NYSTAGMUS. This did not bother me much if at all. In 2014 (Oct.) my doctor put me on GABAPENTIN. in Jan 2015 I started losing my equilibrium, and seemed to have ataxia.. Since January 2015 my eyes and “equilibrium” coordination have becom progressevily worse.. Since March I seem to have developed “vertigo” or the NYSTAGMUS has become worse! if I ever got pulled over by the police.. I’d never pass the field test!! Pain in my Trapazoids and the SCM muscles on my right side are extremely painful… as I even type this letter. For years Ive been on Hydrocodone and valium for pain andd to stop my legs from jumping at night!!My main problem now is that I cant get to sleep, leg jum p and I fal asleep from exhaustion. The muscle spasms have beed decreased this past year but have the m occasionally. My vision “vertigo” Nystagmus ia getting worse by the month. Could GABAPENTIN magnify the NYSTAGMUS?? My perphrical vision is bad. I cannot make out people faces from the side. I quit GABAPENTIN 8-17-15…The Neurological-Opthamologist said that seein that I stopped for @ days just contine NOT taking GABAPENTIN. Question,,,if GABAPENTIN cause mu recent (6-& months) eye problems, will vision return to normal eventually after quitting GABAPENTION 300 mg? Was down to 2 a day (eventually 1 a day the past 4 months) Will have to stop here painbecoming too intense just typing. Regards, psp

  3. Candis
    Pine Grove, CA
    Reply

    My husband was prescribed gabapentin as a prescription to help with pain in his fingers and arms due to neck and back surgery in 1994. This surgery was due to an industrial accident that split open his hardhat and jammed his spine and neck. The prescription is for 300 mg 3X’s a day.

    After reading about all the side effects, we decided to start with only 100 mg taken before bedtime. After 3 weeks of only the 100 mgs once at night, his nerve pain is better but the side effects are out of control.

    The effects are: clumsiness, behavior problems, anxiety, crying, depression, false sense of well-being, loss of memory, rapid changing in moods and unusual tiredness.

    We will consult the Doctor on how to discontinue Gabapentin with minimal withdraw symptoms. His original surgeon said he would need additional surgery after about 10 years due his body adjusting to pins in his neck etc. I feel the drug was prescribed as a “Quick Fix” due to workman’s compensation insurance not wanting to absorbed the additional surgery costs. Good luck to all who use this drug and make sure you monitor the side effects.

    • Chris
      MI
      Reply

      When I started on Gabapentin I was prescribed 300mg, 3x per day and for the first week was to take it only at night, and then morning and night for a week, then 3x per day after that. The first few times I took it I had many of the same side effects, but then it got better until the next time I ramped up, but then got better. My body adjusted to it after a few days, and as long as I now keep a steady amount of gabapentin in my system these side effects stay away for me. When I miss a dose the nerve pain comes back and I start to get side effects. I think what might be happening with your husband is that he is going up and down too much and doesn’t have a steady dose in his system. Gabapentin passes through the body quickly, in about 6 hours, so the next day he might be having withdrawals. If he gets these side effects right after taking it, that is a different story and it probably isn’t for him. If the side effects happen during the following day then these are withdrawal type symptoms.

      After a year I now take 400mg, 4 times per day and can work and have my life back again. Herniated discs at T9-T10, L4-L5, L5-S1, expecting chronic pain to never really get resolved, and yes, I feel like a pharmaceutical test subject, but without it I don’t know what I would have done…

  4. Richard
    California
    Reply

    This drug is obviously helpful for many people. I have used it briefly and it is of some use to me for chronic nerve pain. But my condition is probably permanent and I do not want to be a test subject for the drug industry in regard to the long term impacts of gabapentin/nerontin, which apparently continues to be a poorly understood drug. I am considering other alternatives.

    My only serious comment here is that physicians are prescribing this drug at high doses. Two doctors pushed this drug at me and neither of them discussed withdrawal. Neither
    warned of side effects other than depression and thoughts of suicide. I find this very disturbing. I’ve learned far more about “medications” on message boards like this one than I have from ANY physician whom I have ever consulted.

  5. Michael
    St. Marys Ontario
    Reply

    I’m going to be very honest here. I finished my taper on Monday, after 7 days of 100mgs, split 50/50 every 12 hours. I am so happy that I jumped off at that point. Life is good without gabapentin. The WDs came on fast, stayed for a couple of days. Now I’m free. I’m sleeping, I’m eating. Life is good.

  6. Penny
    Al.
    Reply

    I was put on gabapentin by a physchiatrist along with klonopin and cymbalta for anxiety and depression. This was about a 1 1/2 years ago, I quit seeing doc because was doing good, so I weaned myself off of klonopin and then cymbalta. I am only taking 300 mg. of gabapentin 100 in morning and 200 at night..So a couple weeks ago, I just tapered my morning dose by 50 milligrams, started getting little jittery and not sleeping well after 3rd day, by 8th day I was crying, jittery, had akithasia, insomnia, burning and tingling in legs and arms, anxiety went through the roof, nervous system was shot.stomach problems. bad.pain in back and hips..So the 10th day, I couldnt stand it any longer and re instated. Still not feeling good, so gonna take an extra 100 mg. up from 300 mg to 400 in afternoon…Just makes me sick, I want off this so bad, I dont know why some people have such intense withdrawals and others do not…Anyone got any suggestions..

  7. LS
    Texas
    Reply

    I take 100gm 2-3 times daily for non diabetic neuropathy and L4 and L5 discs bulge plus deteriation of spine. I also take a low does of Tramadol for the pain.
    GABA has been great! For the pain. I have Tested it a couple of times by going off and it really is the gaba that’s helping.
    No weight issue, a bit of dizziness but I can live with that easier than the pain.

  8. Hazel Long
    Orlando, Fl 32812
    Reply

    I want to subscribe to People’s Pharmacy

  9. valerie
    Nixa mo
    Reply

    Gapentin caused me to gain 30 lbs in a 7 mos period.It caused extreme brain fog, and caused me to have a drunk like feeling if I only got 6 hours of slerp. I was put on this drugcfor Neuropathy caused by a back injury at a job. Oh yes as I’m typing this I can barely keep my eyes open today at work because they ate so dry and irritated from it. Thanks Gabapentin!!

  10. Michael
    St. Marys Ontario
    Reply

    This is my second post here. I’m on a taper, it’s hell. I picked up 100mg liquid and a syringe. The good news is I’m on a total of 150mgs in a 24 hour period. 100mgs at 11:00pm and then 50mgs at 11:00am. In six days I stop the 100mg in the 11:00pm and continue the 50mg in the 11:00am. Seven days latter I drop the 50mg dose. Then I’m free. Willing to do the dance after that. Most posts mgs. are much higher. I feel lucky, going to say good by to gabapentin for ever.

    • Penny
      Al.
      Reply

      How did your detox go? Are you free from gabapentin?

  11. Pearl
    UK
    Reply

    My new young neuro consultant prescribed 100mg x 3 time daily of Gabapentin, he told me it would change my life!
    I took them the first day as prescribed, went to bed, got up next day and went shopping to buy a linen jacket and being a size UK 16 was troubled that I had to buy a size 18. I thought that I was having a “fat” day, ladies will know what I mean. When I got home I tried on a good fitting blouse, and bingo the front wouldn’t even meet. My chests had ballooned to melon sized proportions. I took a directic , binned the Gabapentin and intend to speak first to my pharmacist and then go and see my GP. I am grateful I found this blog and I will remember everyone of us who suffer in my prayers. Medical practitioners need to know the truth about this monster medication even though some people tolerate and benefit from it.

  12. Pearl
    UK
    Reply

    l. My new young neuro consultant prescribed Gabapentin, 100mg x 3 times daily for when I suffer episodes — his word not mine. I am the typical elderly woman who has had knee and hip replacements because of arthritis, still suffer in all my other joints in particular the neck and arms. Very limited mobility and standard of life is really poor, like waiting for God.

    I have taken only 3 of these monster pills over 24 hours, and believe it if you will but my breasts have swollen beyond imagination. I bought a summer jacket yesterday and instead of buying my usual UK size 16 I had to buy a size 20!!! I am not exaggerating, it’s the truth. After finding this blog today, for which I am eternally grateful, the pills are flushed away and I will go and exchange the jacket for my proper size.

    My prayers are with all my fellow suffers, but don’t include my consultant!

    • derek
      United States
      Reply

      I’m having sort of the same problem, but it’s just that my ankle was swollen and my knees hurt its starting to slowly go away I haven’t taken it in about a week and I still have some pain. Does anyone know when this will stop? I just don’t want to be in pain anymore.

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