sleepy man, Klonopin for insomnia

Gabapenin is one of the most commonly prescribed drugs by doctors. At last count over 50 million prescriptions were dispensed annually. It is used for an amazing array of off-label indications. That means physicians are giving it to patients for conditions that the Food and Drug Administration has never approved and for which there may be modest scientific support at best. The reader who asked the question below provides a classic example of just such prescribing. We would not get concerned if this drug was perfectly safe. But gabapentin side effects are not trivial as you will discover in our answer below.

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).

The Off-Label Marketing Boondoggle:

Pfizer, the manufacturer of the brand name Neurontin, got into major trouble when it marketed this drug for off-label uses. A company has historically not been 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).

Off-Label Prescribing Continues:

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

Gabapentin Discontinuation Syndrome (aka Withdrawal):

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.

Stories from Readers:

When you read a long list of gabapentin side effects, like those listed above, your eyes glaze over almost instantly. Drug companies have recognized this, which is why there is so much prescription drug advertising on TV and in magazines. There was a time when the pharmaceutical industry worried about telling patients about such serious side effects as irregular heart rhythms, hypertension or blood disorders. Not any more. They realize that even warnings about heart attacks, strokes or death do not scare people away.

The only way we can help you understand what such side effects are like in real life is to share stories from visitors to this website. Here are just a handful. You can read hundreds more in the comment section at the bottom of this article.

Sue in Corvallis, Oregon writes about her husband:

“My husband has been on gabapentin for anxiety and depression for over 3 years now. The doctors started him on this to get him off the benzodiazepines he had been on for 20 years.

“While it seemed to help in the beginning, they kept increasing the dose. He is currently on 2700 mg per day (900 mg x 3). That is way too much.

He has changed so much – cries hysterically, has mood swings, goes from insomnia to sleep deprivation. He has tremors, blurred vision and now talks about suicide all the time. He is so discouraged.

“If the FDA has not okayed gabapentin for anxiety and depression why do docs prescribe it? I am ready to complain to the drug company! He and I just want his life back. Lying in bed 85% of the time is not helpful.”

Susan in Milton, Florida shares a tragic story:

“My boyfriend was prescribed gabapentin for his diabetic neuropathy. I can see now that he became more withdrawn and one evening left the house without my knowledge and went to the hospital where they prescribed sertraline (Zoloft) and counseling the following Monday.

“He committed suicide Saturday morning. If I had been told by his doctor about the side effects of gabapentin I could have done something to prevent his death.”

Lynn in Mobile, Alabama warns about weight gain from gabapentin (she isn’t the only one):

“I have been on gabapentin (800 mg 3 x daily) for about 13 years. It was prescribed for spinal problems and pain problems in general. When I first started gabapentin it  worked great. But I experienced a tremendous amount of weight gain, like close to 100 pounds!

“As time has gone on I have noticed my life has changed so much. I have developed random weird thoughts. I never want to go anywhere or do anything except sit in my recliner and watch tv.

“I feel a nervous wreck if it’s been awhile since I have taken my gabapentin. I have an overwhelming feeling sometimes, like a flash in my mind of suicidal thoughts. My mind feels scrambled. It is very hard to explain.

“My pain is so unbearable sometimes that I am afraid to get off gabapentin. I am 44 years old and weighing around 250 pounds! I look horrible and don’t want anyone to see me period.”

Jonanne in England has had trouble getting off gabapentin:

“I had been on gabapentin for about two years for nerve damage from gallbladder surgery. I was on 300 mg 3 times a day. These tabs were a wonder drug and took my pain away almost immediately.

“Now two years later I returned to the doctor and told her I would like to come off this medication as I feel it’s time. For the last few weeks she weaned me off them with a withdrawal chart, which I followed till the last tablet. Just two days after being completely off gabapentin the side effects have hit me: dizziness, headaches, nausea, and I actually fainted, which I have never done before in my life.

“The doctor told me I had come off gabapentin too quickly and to start taking a lower dosage. I started weaning myself off gabapentin  gradually again, but still the same symptoms. I have not taken any pills for 5 days and the dizziness and headaches are back. I am not sleeping. I am also having hot sweats in the night and feeling very low in mood. I am not going back on gabapentin! I am going to persevere even with these symptoms and hope I can cope. I feel like I am going around the bend and will never get better.”

The People’s Pharmacy 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 VERY gradual withdrawal process. You may need to consult a sleep specialist to help you deal with your chronic insomnia in a more integrative manner.

You may find our recently revised Guide to Getting A Good Night’s Sleep worth consulting.

People with nerve pain may find our one-hour interview with David Casserett, MD, quite fascinating. In it he talks about medical marijuana for “neuropathic” pain. It is titled, “How One Doctor Changed His Mind About Medical Marijuana.”

Show 1027: How One Doctor Changed His Mind about Medical Marijuana (Archive)

If you are worried about the psychoactive properties of marijuana, you may find this article about canabidiol (CBD) oil of substantial interest. It may ease nerve pain without causing people to get “high.”

This article was revised: 12/8/2016

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  1. Wanda
    Grand Island, Nebraska
    Reply

    My doctor recently Rx’ed me Gaby 300mg 2xdaily for lumbar nerve pain. I suffer from severe depression and take Venlafaxine. I also have DID personality disorder. These 2 meds are contraindicated togeather. I currently feel manic and completely impulsive. I’m having rapid personality switches. And feeling crazy! I think this is a big mistake since my doctor did NOT take into account my Psych issues.

  2. Brad
    Nashville, TN
    Reply

    I have been on gabapentin 300mg for three weeks and it has helped me tremendously. I have degenerative disc disease with stenosis of the spinal cord in all lumbar vertebrae, stenosis at the L5 foramen and a history of a dislocation of my sacrum. For 10 years I resisted suggestions of taking gabapentin and opioids, but occasionally did ask for a muscle relaxer when I had an aggravation. This last time when the MD (a brilliant and sincere man) suggested I TRY gabapentin, I gave in. I am so glad I did!

    Please note that this physician and the others suggested I TRY the drug to see how it worked for me. That means I must monitor it’s effects and use good judgement to determine if it is right for me.

    BUT, when I returned home with the medication, before a single pill went into my mouth I was on the internet reading about this drug. Why? Because I didn’t give up my common sense, my free will over my actions, nor my responsibility for my own body just because someone gives me a medication to try. The Rx says every 8 hours, and I don’t doubt it could be more effective at minimizing the pain if I took it every 8 hours. But I only take it twice during the day because I want to minimize my body’s tolerance of the drug and the chance of interaction with other drugs while I sleep. That is my choice and my responsibility. If I were an unconscious patient and a MD gave me a med I might could say I was not responsible (but in truth when I go to a hospital I SUBMIT to their care and judgment). But I am conscious and responsible for my choices, my body and what I put into it. If I drink alcohol I am responsible for monitoring it’s effects on me. If I get drunk and drive, it is my responsibility not the person who sold me the alcohol or the car. The same principle applies here.

    Through the years I have seen several physicians. They have all told me TRY this, TRY that. Generally I believe they all want to help and they gave their best advice about precautions, therapy, TRYING medication, and healing expectations for my condition.

    However, as a living, breathing, thinking human being I am responsible for how I use the information and the medication the physicians entrust me with. I am also responsible for seeking additional information above and beyond what the MDs give me and educating myself about my own unique situation. That is done to fulfill my responsibility to care for my own body. That is also done to maximize my quality of life and productivity.

    On my own I discovered that riding my bicycle is good for my back. On my own I discovered that doing pull-ups helps relieve pain and strengthens my back muscles without putting stress on my spine. I came up with exercises which when combined with the exercises the medical system gave me gives me the best result. I just have to be disciplined enough to do them and be aware of my body and what it tries to tell me. And I have to be smart enough to minimize risk of future aggravation. If we are not careful it can be easy when our pain is reduced to do something to aggravate chronic conditions.

    If a drug manufacturer misrepresents and hides information about harmful effects of a drug then that is unethical and criminal. If a physician gives you a Rx to try a drug, then he is not responsible if you become tolerant or addicted, or if it is not even helpful. Additionally, It is not a giant leap in logic to think that if a drug is cleared by the FDA (meaning there were double blind studies that substantiated this application) for use of shingles-related neuropathy, that it might also work for neuropathy of other causes. Neuropathy can have many causes and many characteristics. To require double blind studies for all applications of neuropathy would not only be ridiculous, but it would make medications even more expensive.

    Currently there is what is being called an “Opioid Epidemic” in the US. Why is that? Several factors. Yes, drug manufacturers have some responsibility to accurately research and represent their drugs, but only through use of a drug overs years can data be collected about it’s “true” effects. Yes, MDs have responsibility to judiciously prescribe and teach how to use opioids and as well as other meds. But an MD cannot feel your pain and he should not require you to be convulsed in spasms before he prescribes pain medication. Patients report pain based on their perception and their attitudes about pain. MDs prescribe meds based on the patient’s report and other symptoms. He became an MD to help people, so he prescribes the pain medicine as best as he is able to help the person in front of him.

    But the ultimate reason there is an opioid epidemic is that patient’s are not being responsible in the use of the medications. They don’t pay attention to the physicians or the pharmacist’s instructions about the medication. They don’t pay attention to the written information that comes with their drugs, but they follow their feelings. They don’t pay attention to time and take it too frequently. They don’t use caution with multiple drugs and end up with interactions. They don’t think, hmmm perhaps if this medication feels so good I could become tolerant or addicted (whether physically or psychologically). They don’t pay attention to what their bodies are saying and end up in a medication induced state that threatens to take their life or rob them of a rewarding and productive future.

    Who said we are not supposed to feel pain anyway? Didn’t we learn as children that it is part of life? When my son fell and skinned his knee and cried, I cleaned the wound, put a bandaide on it and comforted him with words and hugs and maybe an ice pop. I tried to distract him from the pain with a game, VCR, or reading a book to him. I did not give him pain medicine. He got through those events and but hopefully the pattern and the lesson he will retain.

    Through experiences like this children learn some things: We will experience hurts and pain in life, but we will get through it. Take care of the wound which is the source of the pain and protect it to facilitate its healing. If we don’t focus on the pain, it will not seem so big or consume us. If we do focus on the pain it seems like all that there is. So we focus on something else to help us get through it. Interacting with other people helps to take our mind off our pain.

    Somewhere along the way people experience events and conditions which include pain. Somehow that pain becomes very big in their lives. They reach for the easiest and fastest remedy that will relieve their pain. Some people decide they should not have to feel pain. Maybe they develop a fear of pain. They allow the pain to become their focus. Each day of their life is spent trying to ease the pain.

    Now there is a growing backlash to the “Opioid Epidemic” which threatens to limit the ability of physicians to judiciously help patients with genuine pain issues. It threatens to take away medications from patients who can responsibly use medications. It threatens to lower the bar of access to the level of responsibility of those who refuse to be responsible for their own actions.

    If I am able to use drugs responsibly and I do, I should have reasonable access to them. If other people refuse to accept their responsibility I should not be denied access to a drug because of them. Furthermore, while drug manufacturers should be held responsible for deliberately misrepresenting drugs and physicians for cases of recklessly improper prescribing of drugs, neither should be held responsible for the irresponsibility and poor choices of patients.

    Electricity is a wonderful thing. It enriches the lives of people the world over. But if you don’t respect electricity it can kill you! If you mix electricity and water it can kill you! If that happens it is not the fault of the power utility. You have to apply common sense and use it safely.

    The same is true with gabapentin, opioids or any other drug. The same is even true for food and nutritional supplements. It is the same with cars. It is the same with alcohol. The list goes on.

    Educate yourself. Be responsible. Be active it can reduce pain. Develop an informed medication schedule that works for you. Put it in writing. Follow the schedule. Plan for success. Succeed. No one can do it for you. As the saying goes, “Failing to plan is planning to fail.”

  3. Rick
    California
    Reply

    I was prescribed gabapentin, 3600 mg/day as part of a botched detox for trazodone dependence. Long story short, I am now fully dependent on increasing doses of gabapentin, will probably have to go to the hospital to be detoxed this time. This is a dangerous drug with significant potential for severe dependence.

  4. Sigmund
    Reply

    It spiked my libido at 150 mg, 3x per day. Then all went back to normal. When my doctor increased my dose I experienced the same thing. My thoughts were a bit jumbled and I got spacey.

  5. JMFS
    Reply

    132 lb female, 325 mg 2 x day for cervical spondylosis / stenosis. I was taking it with Vicodin for a week, but that made me far too stupid. I thought it was the Vicodin; however, I’m now of the thought it’s the Gabapentin. I’m also on a tapering dose of dexamethasone to reduce inflammation. 8 mg one week, 6 mg last week, 4 mg starting tomorrow.

    The spasms I was experiencing prior to taking the medications have now subsided and only crop up when I get stressed out. 10 hours after taking the meds I start to feel lucid again so I get about 2 hours of clarity. 30 minutes after taking them I can feel the fuzz swooping in. My forehead starts to kind of buzz. Concentration is difficult, nothing tastes right – I can only really detect temperature (lemonade tastes like cleaner, cinnamon doesn’t register as a flavor, that sort of thing – it’s like chewing on texture and temperature). I’m chewing my cheeks and lips like mad as well as drinking larger than usual quantities of water. Mainly it’s the concentration that’s bothering me because I have to be able to think logically, but instead I feel fragmented. I feel dumb, but I know it’s the fog from the drug and keep reminding myself of that.

    I see my doc on Wednesday and will be asking to reduce the dosage so I can balance the pain with being able to function normally until I can get to my next step. Everyone asking for advice here needs to pick up the phone and call their doctor. This is not a place for help, only information. If the current doc isn’t getting answers, get a second opinion and tell him Every other drug you’re on so they can get it right. Some of the dosages I’m seeing on here for the conditions make me wonder how some of y’all function! There has to be a better alternative for many of these conditions, but remember that it’s going to take Time for the medicine to get out of your body. Especially for those on the 1,000+ dosages, wow!

    • Brad
      Reply

      Of the drugs you listed, Steroids make me the most scattered/very jittery and they make my mouth VERY dry. Hydrocodone does give me a bit of a dry mouth and does slow my reaction time but I can still function ok. After 3 weeks now of taking the gabapentin 300mg twice daily it hasn’t caused me to have dry mouth nor has it prevented me from functioning.

      I have worked a very busy and mentally, emotionally and physically demanding job. I would note that I normally stay well hydrated so it’s an ingrained habit. I feel like it may be giving me a slight bit of emotional insulation from stress tho. I think for you to peg your symptoms on gabapentin when you are taking all three drugs and when the other two drugs are known to cause the Sx you said is not reasonable. There is no “do not operate machinery or drive” warning that comes with gabapentin; there is with Hydrocodone. Yet I know we each have our own unique biology and metabolism.

  6. Dan
    Wisconsin
    Reply

    As a long term high dose gabapentin user for fibromyalgia, bipolar, and neuropathy I suffered withdrawal syndrome by trying to drop the dose too fast. The key is to have sufficient supply and the means to titrate dosage by no more than 100 mg per week. Fortunately, gabapentin literally flows right through you unchanged without the liver. You don’t have to be hyper accurate with the dosage reduction. Cut the pill in sections and use the powder and chunks if you have to get the dosage needed. BE PATIENT! You CAN get off relatively quickly and easily if you are patient and can stick to the titration schedule. If you take it for seizures you could have one if you do not have another medication in your body to control them. Tell your doctor what/how you are doing. If you experience problems simply go back up in dosage temporarily. Taking it again relieves it.

  7. Marco
    usa
    Reply

    I was prescribed Gabapentin for Shingles relief 3 times a day. I took that and it really helped the pain. I change to 2 a day within 4 days and 1 at night now for a week. The day before yesterday I was not going to take it, but I could not sleep and my feet would jerk, so I took it. Today is 5am and I did not sleep at all last night because of sleepless and jerky moves on my leg. I think I am done taking it.

  8. Shay
    Utah
    Reply

    I’ve been taking Gabapentin for 3 years now. I started for the nerve pain in my back from several slipped discs and a protrusion. I take 300mg 3X a day. I’ve never experienced any of these side effects that others are stating they’ve had. It works great for me and I’ve found it even helps with my anxiety. I was also told that this medication does not interfere with other meds and is safe to take. So far, so good!

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