sleepy man

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 wan 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.

Getting a Good Night’s Sleep

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. JOHN
    Georgia
    Reply

    just started taking this drug about two weeks ago for neuropathy from arterial bypass in my right leg and complained to my Doctor that there was still an immense amount of pain in my leg and foot. He doubled my dose to 200 mg three times daily, and after four days I felt as though the pain was twice as bad. Which brought me to looking online for the drug’s side effects when I saw this article concerning the increase of pain while using this drug. I will not be taking any more of this and what concerns me most is that neither he nor anyone in his office advised me to be aware of these possible side effects.

    • Meri
      Michigan
      Reply

      This is the first drug that was literally shoved down my throat whenever I asked for pain relief from one of the top 3 neurological diseases known to man. Instead of going a much safer route of prescribing narcotics, my physicians refused to prescribe anything that would remotely help with pain.

      We all know how serious opiate addiction is but I’ve never been an addict. If we suddenly had addicts getting high off insulin, would we automatically refuse to prescribe insulin to real diabetics that needed it? This is exactly what is happening to pain patients across America. More and more are committing suicide and many pain patients feel helpless because they are chained to their pain.

      Gabapentin was heavily marketed to be the cure-all for neuropathic issues but many patients know that this drug doesn’t work at all for pain. When pain patients request something else, they are prescribed something else, doses of this med are raised. And once again it doesn’t help at all. We need more physicians to open their eyes and their ears to the cries of pain patients that are seeking a better quality of life and not looking to get high!!

  2. Damien
    Maui
    Reply

    Like many who have commented, I to have chronic pain due to a degenerative L-5 vertebrae along with cervical stenosis, arthritis and Thoracic outlet syndrome. I started gabapentin many years ago but it had never helped with my pain. However, I’ve been prescribed gaba again by another doctor in a long line of doctors. Started 3 months ago at 200mg 1@ 8 hr. intervals.

    No reduction in pain so dose was increased by 100mg or 300 mg 3x’s a day. Still no relief. Now, I’m up to 800mg 3x’s per day and suddenly my left leg starts to swell, my eyes are leaking, my vision is blurred, my blood pressure has gotten out of hand and I’m forgetting words. This is really making me upset and frustrated with no empathy from my Doctor who wants to keep increasing the dosage.

    I’ve also gained weight and still no relief from pain. Prior to getting this new Dr. I had been taking only oxychodone 2, 5mg tabs every four hours or 12 tablets per day as needed. I had been taking that dosage for approx. 2 yrs without any complaints except that I didn’t want to keep taking so many pills. No side effects were evident except for some constipation which stopped with a capsule of sodium docusate daily.

    When I sought a new doctor, it was because I had moved and I asked at the very beginning if she would help me wean down to half the amount I was taking. After 1 year with her, I was doing just fine on 6 tablets 5mg every four hours or 2 every 8hrs. She then put me on gabapentin which takes me to the beginning of this thread. However, she has been complaining about the DEA getting invovled with this and that and that she had to stop the oxychodone and send me to a pain management doctor.

    At this time, the swelling in my left leg is moving to include my right leg and both arms. My blood pressure is thru the roof and I’m ready to strangle her. I have stopped going to her and am seeking another primary care physician who can maybe get me to where I was coping without having to take medication high blood pressure (amlodipine, and lisinopril) and 600 mg of ibuprofen which will destroy my liver and kidney, Benzonatate to help with coughing, asprin for the headaches and simvastatin for colesterol whic used to be good.

    Never needed any of that until the gabapentin. At the second opinion, which I got from going to emergency for the swelling, when the doctor saw me he said WHOA!!!. haha…Said to me he can’t suggest that I stop the high blood pressure meds or anything else for that matter but also stated that if I believed that the gaba was affecting me as such, that I could start taking less and let the pain management doctor know what and why. Pain med doc. said no keep taking the dosage. I’m not listening to him either.

    I have started taking half the prescribed amt. 400mg 3x’s or ebery 8 hrs. and in a week ( I started reducing last week) will reduce by half. What I can say at this time is that the withdrawals are brutal and you kind of have to try and work thru them. If you have access to any opiates, they will help, even just a small amt once a day till the gaba works it’s way out of your system.

    They say within 7-8 hrs and if you don’t take more it will start to work it’s way out. Depending on how much and how long you’ve been taking the Gaba makes a difference as to how long you will experience the withdrawals. I’m already losing any withdrawal symptoms. But again I have to oxy’s 5mg @ 3x’s per day. Still forget words, still have the swelling, still have the pain, but no longer compelled to strangle my ex primary care phys.

    Wishing the DEA would do their job instead of trying to do the Physicians job. And also wishing the best to all of you who have taken the time and courage to come out and share your private thoughts and conditions. Blessings to Ya’ll….

  3. Laura
    Flprida
    Reply

    Laura. I’m taking Gabapentim 100 mg for a week and feel all nervous and shaky. Think it’s the medication. Want to quit

  4. Nancy
    Colorado
    Reply

    I am currently weaning off of clonazepam after being on it for 20 plus years for insomnia. Problem is, I was drugged but no longer sleeping. I went to a sleep specialist for help getting off and he only recommended melatonin, which I had already tried. My PCP has been of no help, even though he is currently prescribing the drug, so I am doing this on my own. My husband was given gabapentin for neuropathay, that didn’t work for him.

    I am now down to 3/4 of a .5 mg clonazepam and read that going off of clonazepam can cause seizures. I’ve been taking 300 mg of gabapentin at bed time and it does help me sleep. I feel bloated and my clothes are tighter, but am so determined to get off of clonazepam, I’m willing to put up with the side effects. The weight hopefully will come off once I am off of both meds. Before I get a speech about taking my husband’s gabapentin, please know I have tried to get off of clonazepam for close to 15 years and failed.

    I was also on Ambien and got myself off of that two years ago. I am definitely foggy, having memory problems, weight gain, but I only have about eight weeks of 300 mg of gabapentin, so I am cutting the clonazepam .12.5 mg approx every week. Hopefully I can taper off of the Gabapentin without any problems. It isn’t a great drug, but clonazepam is worse.

  5. Tina D
    Tennessee
    Reply

    I was diagnosed with shingles that started in my inner ear. They first prescribed Lyrica​ which did not ease the itching or help aid in testing. A month ago I was prescribed Gabapentin 100 mg twice a day and then 300 mg at bedtime. I, like so many others, saw relief in the beginning but now just feel like I could sleep all the time. I am always tired and drained feeling. Trying to wean myself off all medication is hard when I have suffered almost 2 months with these shingles. Help!!

  6. Jeff
    Los Angeles
    Reply

    I started on 100 mg for a pinched nerve in lower spine. I was supposed to take it 3 times a day. It gave me flu symptoms nauseating me and so we cut back to 100 mg daily. Then I graduated to 200 mg three times daily. Still no change in pain so we went up finally to 600 mg four times daily. Ive been on this four years. It has done fine to stop the pain and did make me gain 20 pounds and extremely forgetful. Now recently I have been feeling depressed off and on and very sleepy. I don’t feel like I’m all there. Sometimes I feel like I’m going to black out. When I take an extra gabapentin I feel better. I don’t see any Benefit in this drug if it stops pain at first then has all these negative effects later. I’m going to wean myself off this drug because I believe it is causing worse problems making all the pain worse also. I’m going to try exercise machines to up my endorphins to feel better. Watch out this medicine will come back after making you feel better and bite you hard and you will not only feel you are loosing your mind but you will feel more pain and gain lots of weight, and feel depressed.

  7. Jeff
    Los Angeles
    Reply

    I started on 100 mg for a pinched nerve in lower spine. I was supposed to take it 3 times a day. It gave me flu symptoms nauseating me and so we cut back to 100 mg daily. Then I graduated to 200 mg three times daily. Still no change in pain so we went up finally to 600 mg four times daily. Ive been on this four years. It has done fine to stop the pain and did make me gain 20 pounds and extremely forgetful. Now recently I have been feeling depressed off and on and very sleepy. I don’t feel like I’m all there. Sometimes I feel like I’m going to black out. When I take an extra gabapentin I feel better. I don’t see any Benicia in this drug if it stops pain at first then has all these negative effects later. I’m going to wean myself off this drug because I believe it is causing worse problems making all the pain worse also. I’m going to try exercise machines to up my endorphins to feel better. Watch out this medicine will come back after making you feel better and bite you hard and you will not only feel you are loosing your mind but you will feel more pain and gain lots of weight, and feel depressed.

  8. Pat
    texas
    Reply

    Several years ago I was prescribed gabapentin post surgery for severe nerve pain for a nerve that was severely damaged. Well I took it for about a week and began to have bad hallucinations and apparently amnesia because only bits and pieces of my memory can be recalled. I lost several days and do not remember a thing. Talk about scary after I finally came to myself I got more scared than ever. What happened to that week?

  9. Christine
    ON
    Reply

    I used to take 1500 mg a day. I was told to take 3 (300 mg) in the morning and 2 at night. I was told that was wrong I had to take it evenly 3 times a day. I slowly upped my dosage as prescribed. I did this at a bad time and had a bad feeling about when I should be doing this.

    My cat had just died and I really confused my “changes” to “just” mourning. Well that was months ago and after complaining to my doctor and being told I had the flu and this and that, I finally suggested things changed at the same time as my dosage increase. I am taking 900 mg (3 capsules a day too many).

    So, now I have to wean myself off and pray my side effects won’t get worse before I get feeling better. I think I would like to get off them all together but am terrified of the withdrawl symptoms I have gotten in the past from missing a dose. I have been taking this medication for years for fibromyalgia.

  10. Nancy K
    Oklahoma
    Reply

    I have been on gabapentin for several years, 1st with brokeen foot. Then fell at work have had neck & shoulder surgery. Back is next. Have had depression, confusion, memory loss, can’t seem to get things in order, so I do nothing because of pain, have arthritis now, so everything difficult.

    But the drug helps me sleep at bedtime or I have continuing thoughts and can’t sleep, dr has tried so many drugs, but never took anything before injuries. So sick of feeling bad & pain.

  11. Sandra
    Durham, nc
    Reply

    I was prescribed gabapentin 100 am and 100 pm and 200 bedtime. I feel foggy, dizzy and bloated. I’m going to wean off it. It helped my anxiety initially but not now. I have only been on it for 3 weeks.

  12. Dave
    California
    Reply

    Gabapentin long term is bad! – Memory Loss, ADD so much more!
    Gabapentin starts off as the miracle cure then sneaks up and harms you!

    I am a chronic pain sufferer, with multiple herniated disks and DegDiskDisease. I have bi-lateral neuropathy down both legs that hurt so bad I want to cut them off.

    I took 600mg of Gabapentin 2-3x daily for 8yrs It was amazing at first then the bad started… Started dropping stuff, just passing out when pain got bad, Then it got real bad started getting memory loss (I forgot the name of the drug Id been taking for 10+years for an entire day! I would walk into a room and forget what I was doing constantly, Names? forget about it!) and ADD symptoms bad! (Racing thoughts, Inability to focus, cant finish tasks like extreme ADD!)

    So I opted for surgery to clear out the nerve paths in my spine… Didn’t work 100% but I wasn’t going back on Gabapentin that drug helped but did so much more damage! Its not worth it! My memory started to come back but I still get spots where I forget stuff I shouldn’t. the ADD is still in full swing I’m now having to see a Dr for that! Thank the lord I did not have withdrawal symptoms also! (I took low dose Nortriptyline for few weeks while coming off Gabapentin that may be why).

    DO NOT TAKE GABAPENTIN For long periods! Do not take more then 600MG a day! what I do now for mornings which are the worst for me (little better after surgery) I use a Quell 10’s unit (iTens also nice) so while Im sleeping its working when I get up first thing I put on shoes and walk on treadmill for 20-30min slow pace so Im tricking my brain signals naturally, yes your body will ache while walking till you adjust and it sucks but Its better then legs aching so bad you want to cut them off! to my fellow Leg Shakers find another way as gabapentin will hurt you and its hard to see that when it helps so much at first but the end is not worth it and does not justify the means.

  13. Sue
    Minnesota
    Reply

    Recently prescribed gabapentin 300 mg nightly for hot flashes, and it helped lessen these and with sleep, but the negative side effects are not what I bargained for. The most bothersome is the dazed/foggy-headed feeling, fluid retention, some joint pain and moderate constipation. I am going to stop this medication and opt for something more natural that doesn’t cause other problems.

  14. Maureen
    - Select -
    Reply

    Both my husband and I take Gabapentin for years now, I have neurophy and have develop chronic pain. They are now saying that it can result in you getting dementia and Alzheimer earlier! I take it 600 mg a day and then take 50 mg of Nortriptyline HCL. I have a hard time sleeping, the stinging pain keeps me awake!! What can I take, to get off these harmful drugs? My husband takes 900 mg 3 times a day! It has us worried, that we could lose our mind as we get older!! I am getting to be 60 years old and he is over 60 years old! I have gain a lot of weight, didn’t know that it could be the medication I was taking. I retain a lot of water too, so I am on 2 water pills a day!!

  15. Jared B
    San Bernardino, Ca
    Reply

    I’ve been taking Gabapentin for three months now. Unfortunately I misunderstood the directions about taking one capsule of 300mg three times a day. Instead of take it separately in intervals three times in a day, I took all three at once when I went to bed. Now I am experiences some kind of weird sensation in the left side of the face. It’s like a tingling, numb or inflammation feeling. So, I was wondering if anyone else made this mistake and if anyone can assure me that if I switch to the recommend three separate times during the day if this weird feeling in my face will go away.

  16. Lee
    Maine
    Reply

    My doctor put me on a low dose of gabepentin for arthritic nerve pain, and it appeared to work well at first. She then tripled the dose and that was when the side effects started. My head felt like it was swimming and my leg muscles began to ache, making it difficult to get up off the couch or walk up or down stairs. I am still feeling the effects and am extremely moody all the time. I want nothing but quiet with no distractions and no more stress. At the same time the doc is weaning me off my pain meds, which is adding to my stress level and moodiness. I wish she would leave me alone with the medications for pain that I have taken for the past 25 years with no problems until now. Some of us out there use narcotic pain medications responsibly and do not get high from taking them but now with the new laws, we feel like we are being ignored and demonized along with heroin addicts and pill heads.

    • Shirlee
      MN
      Reply

      AMEN

  17. Charles
    Brunswick GA
    Reply

    I was prescribed Gabapentin but I don’t know why. I have been taking 100 am, 100 pm, 200 at bedtime. As far as I know it has had no effect on my headaches.

    About the time I began taking it my eyes began discharging, and I developed sores around the eyes, and my vision became blurred. About three months ago I was prescribed 100 am 100 pm and 600 bed. I started to feel like I had the flu, and it became very bad. I weaned myself off it and felt normal again. About a month ago I was given 300 am, 300 pm, 300 bedtime. I became very ill with what I thought was the flu, and then it was like I had bronchitis with coughing, chest pain, difficulty breathing, sore joints, fever, sweating, chills, and total rotten feeling. they also took me off Oxycodone.

    I cannot say Gabapentin ever alleviated any pain. They said I was addicted to Oxycodone but I only took 1 30 mg. I also have watery very dark stools. I will go without rather than then take a chance. I also have dark thoughts, acute depression. Name it. I have it.

    i

  18. Janet
    Colorado
    Reply

    I have never done well with any medications, and pain meds in particular. Genetic testing shows that I’m a slow metabolizer and can’t process certain classes of drugs. But I have a lesion in my spine that causes “just shoot me” pain that is so debilitating. I finally tried a very small amount by opening a 100 mg capsule and putting a little on my tongue.

    I could not believe the difference it made in my pain level. I have been sleeping through the night all week for the first time in ages. The amount I’m getting this way is probably no more than 10-15 mg per dose, but perhaps the fact that I’m taking it sublingually makes it more effective.

    • Sharon
      Reply

      How long did your withdrawals from gaba last, I’m on day 3 and feel like I can’t breathe

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