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. Deborah
    Reply

    I just started Gabapentin for fibromyalgia and severe hand and forearm pain. 300mg. just knocks me out, and I am worried that when I am supposed to take this in the daytime I will not be able to function. Has anyone had increased tolerance after time on this drug?

  2. Sarah
    Boston
    Reply

    Just wanted to add my story… I started gabapentin about 2 years ago for central neuropathic pain and muscle spasms. I had already been in serious constant pain for a few years and had almost given up on living. I had ended up unemployed and, finally, barely getting out of bed because to do anything meant to experience an intolerable amount of pain. I started taking gabapentin and found relief so quickly that I was upset with myself for not having tried it earlier (I tried many other standard medications that didn’t help much or at all and most had terrible side effects).

    I improved steadily for over a year to where my pain is now manageable.
    I’ll never know for sure what is a side effect of the gabapentin and what is not but as I have started slowly tapering off in the past 6 months, I no longer have daily bouts of deep fatigue.
    I struggle with apathy that may be more rooted in the time prior to gabapentin but (other than the year prior to starting) was never a problem for me in the past.
    My teeth are a mess. My dentist has me on a special treatment now (things like fluoride toothpaste) because my teeth have deteriorated rapidly since starting this med, I have dry mouth.
    I gained 10 lbs rapidly to start. It never got worse than that but the apathy and fatigue made getting it off not yet possible and I am always hungry.
    I have nutritional deficiency like a low b12 test and believe I have low magnesium (not easily tested for).
    taking a simple b-complex vitamin, some magnesium and acupuncture (I believe) have made my taper down pretty easy so far.

    I definitely suggest taking a b complex vitamin, eating well and some magnesium. Gabapentin is thought to diminish nutrients in the body. Chronic pain and stress are also culprits.

    If you’re in pain where the consequences are that you’re ready to or have started giving up on life I suggest trying gabapentin. If you don’t live with others or have trusted people in your daily life make sure to keep a journal to see if your mood changes, some people have serious mood changes and we need to keep ourselves safe.
    Gabapentin may have given me my life back, I was on the highest possible dose of tramadol and it barely touched the pain, I’m glad I took it.
    Still, I believe that gabapentin is now keeping me from a fuller recovery and decent quality of life. I’m down to 300 mg a day this week and my pain levels have not changed. I hope I can manage without it but I’ll never go back to being in constant pain, I would take again if need be.

    But, I would never take this off label or before exhausting non medication treatments.

  3. Lucy
    NC
    Reply

    Here is a positive comment about Gabapentin. I am grateful that it alleviated my mother’s excruciating hip and leg pain. She has an erosive form of osteoarthritis. Nothing touched that pain, and she would take her pain medications too close together, and it affected her kidneys. She also began to act irrationally. We were fortunate that during a hospital stay, a doctor took her off stronger pain medications and patches, and tried this drug. Her pain left, her sanity returned. The side-effect was blurry vision in one eye sometimes, but she was over age 85, no longer driving , and being sane and pain-free was a tradeoff. We could care for her at home rather than have her put into a dementia unit of a nursing home.

  4. Darleen
    illinois
    Reply

    thank you.

  5. Tom
    Madison, WI
    Reply

    I have had no side-effects from gabapentin (at least nothing I’ve considered negative). I take 1200 mg 3xday and have been for several months now.

    In general, if you can deal with a problem without pharmaceuticals, you should.

    Anecdotal evidence. I used to work as a nursing assistant in a skilled nursing facility on the surgical rehab wing. We had a knee surgery patient who wouldn’t even take vicodin for pain control. Acetaminophen and that was it. When the R.N. asked her why, she said “I’ve been working in a pharmaceutical lab for decades and I know what’s in the drugs and what the unlisted side-effects are. I’ll deal with the pain.”

  6. Jessica G.
    Lexington, KY
    Reply

    I have been on gabapentin for over a year now. I have blurred vision, nasty thoughts about myself, I’m tired all the time, and I have gone from 100mg per day to 900-1200mg just to get any relief at all. To make matters worse, the doctor that prescribed it for me is making me go to a neurologist to be weaned off of it! So basically, I’m paying for his mistake, and I had to wait 6 weeks just for that referral to come available.
    I’m hoping to go on Lyrica. I have peripheral neuropathy (non-diabetic).

    Good luck to us all. Prayers to you that you become pain free.

  7. Nan
    Canada
    Reply

    I’m gob-smacked! I had no idea how severe and plentiful,the side effects of Gabapentin are.
    It was prescribed for nerve pain (which caused twisting in my feet and legs) due to spinal damage.
    It’s been about a year now, I’m taking approx…1200 mg spread out through the day.I was also having depo-medrol injections for Fibromyalgia. I stopped those, thinking they were causing the side effects. It has been months of more side-effects than I ever thought possible. I thought I was losing my mind…and then I found this page…I am normally a happy person, now I cry too much and life doesn’t hold much joy for me.
    I need to wean myself off …and perhaps only use them when absolutely necessary…
    I want to thank all of you for sharing your stories….I don’t feel so alone and scared anymore.

    • Jessica G.
      Reply

      You actually shouldn’t use them “only when necessary.” It’s one of those drugs that has to build up in your system, thus the weaning process. Good luck!

  8. Edie
    North Carolina
    Reply

    Took 100 mg tab for nerve pain due to bilateral mastectomy and reconstruction and it took me two days to get over the effects of that 1 pill. I’ll never take it again.

  9. Dawna
    Omaha, NY
    Reply

    I started Gabapentin 100-200mg at bedtime to address cervical neck disk problem and stenosis. I’ve been on it approximately 2 years. Last month I began to experience tinnitus. Anybody else? I’ve stopped taking Gabapentin two days ago. Looking through this thread, I suppose I might have to wean myself off. But this tinnitus is NUTS! I hope it stops…

  10. rp
    United States
    Reply

    This med gabapentin is crazy, hard time making sentences too, really hard time concentrating, I drink a lot of diet pepsi with it so it makes me real anxious too and tired, fatigued, but it has got rid of hot flashes for me and helps with the arthritis pain, I get real worried about the chest pain and shortness of breath though, guess I need to call my doctor.

  11. lauren phillips
    kingwood, wv
    Reply

    Gabapentin should not be considered non narcotic. It has all the above mentioned side effects and more. The FDA should be looking closer at this medication. I do not understand why we cannot treat the living better than we treat the dying. People are people, not case numbers. One size DOES NOT FIT ALL. Insurance companies limit the length of stay for patients they treat with medications resulting in adverse reactions, side effects and even death.

  12. 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.

    • Lee
      Texas
      Reply

      Was on 10mg hydros, 4 times a day, Dr. then put me at 3 times a day, Thanks to the DEA and its NEW reschedule of Hydro, Drs are less likely to prescribe. So Dr. put me on 300mg a day three times a day. 1st week dizzy and confused, wore off and it worked quite well on Pain.

      I have High blood pressure, started noticing ringing in ears and blurred vision. I noticed that my blood pressure started to rise after taking Gaba. I didn’t realize that Gaba could raise blood pressure, My doctor should have at least gone over with me that this could be a problem. In there pursuit to get everyone off narcotics, they are prescribing far worse drugs that due more damage than good.

    • Deborah
      Milwaukee
      Reply

      I would say it is the gabapentin. Blocking nerve pain for me also blocks the nerve response to pleasure.

  13. 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.

  14. 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.

  15. 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.

    • Lrus
      Hell
      Reply

      I also have been prescribed gabapentin for nerve pain big mistake I am now on the couch 5 days into withdrawals. This medication is addictive and I was never told this. I am so angry at my dr the FDA and anyone else that is ok with this evil pill. I want to sue them all. I am actually fighting for my sanity back.

      Sorry I am ranting but I find it so unfair that the people we trust to keep us safe can get away with prescribing this pill and not going over all the withdrawal symptoms with patients it’s just a crime in itself hopefully I can come back in a month and shed some light on my prognosis to u all who r enduring this painful experience good luck to us!!!

    • onyx
      Reply

      Yes, I’m hungry, but even though I only eat the same amount as always, and resist the excess hunger, I’ve gained weight. You can’t help it on this drug. I exercise, too.

  16. 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..

  17. 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.

  18. 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.

  19. 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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