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. Roger
    Anchorage
    Reply

    I have been on gabapentin (2700-3600mg) day for severe RLS and periferal neuropathy due to diabetes and a spinal injury, for several months. It has been quite helpful with few side effects except for some slightly swollen feet that may or may not be due to the drug. That said, with all the problems noted here I will certainly be on the lookout.

  2. Eileen
    Painesville, OH
    Reply

    I have been on 800 mg/day of Gabapentin since 2000 for nerve damage from two back surgeries. For years, I was tested to make sure I had no liver or organ damage. I have NEVER had any adverse side effects although, admittedly, I’m on a fairly low dosage. Perhaps I’m one of the lucky ones, but just wanted to let everyone know out there that this drug has been a God-send. Just wanted to throw out some positive feedback.

  3. Alex
    Reply

    I have been on 3,600mg of gabapentin per day for a couple of years now, I can tell you it has completely changed my life, my thought process is so much slower and remembering things have been very hard for me, I met a man today that knew me very well and I can’t recall his name or where I know him from.

    I have tried lowering my dosage on my own and can’t because the pain is too much if I don’t take them, I’m also taking tramacet for the pain on what the doctors have no idea what is wrong with me, I woke up with blisters one day on my legs and they pop and look like burn marks, this has reoccured and I’ve seen every specialist that you can think of, I’m 100% healthy as they say after multitudes of blood work, I thank God these marks are on my body or they’d think I was crazy!

    I still live in pain every day but can’t manage to work if I don’t take these stupid pills, wow, how I wish I could go back to living a normal life but that obviously isn’t going to happen any time soon, I’m so Thankful for a Loving Wife and for her sticking by my side through this…, these pills suck.

  4. Jim
    NJ
    Reply

    I take Gaba only at night 2 hours before bed. I take it for restless leg syndrome. Only 600mg. Won’t go any higher. helps me sleep. I don’t have the issues some of you have. Must be the lower dosage.

  5. Reg
    British Columbia
    Reply

    Oct 24, 2017; I started Gabapentin 11 days ago, for peripheral neuropathy. I told the doctor that I had statin pain, which seemed like it would never go away. And he said try Gabapentin. The pain and weakness vanished over 5 days so slowly I hardly noticed but I began to have no trouble going upstairs.

    Whether I had statin pain or neuropathy problems, I don’t care, simply because I’m so much better. My mood has improved and I haven’t felt this good since about 2005. I was recently so old beyond my 71 years and now I feel more like when I was 60, I believe.

    For me, this stuff is better than a vitamin because, unlike vitamins, I take it and I feel great. I can’t understand why people are having problems. My max daily dosage totals <500.

    • Maggie
      Boston
      Reply

      I take 600 mg at night for nerve pain from a C Spine issue, and I recently saw something about dental issues. I have been taking this med for about 5 years but I didn’t start to notice bad tooth issues until this past spring. It’s not worth it to me. If anyone has whatever weaning chart was mentioned in this article please share it.
      Thank you!

  6. Teena
    N.E.Lincs
    Reply

    I’ve just picked up my first packet of gabapentin which has been prescribed for me for fibromyalgia and chronic pain syndrome. I also suffer with depression and anxiety (for which I’m on venlafaxine).

    I was eager to try the gabapentin to help with my chronic, constant pain but after reading the leaflet that came with it and the experiences of people here, I’m now too afraid to even take one tablet! I shall just throw them away and suffer in silence.

    I’m horrified to hear how much all of you have suffered and I truly hope that you all recover in some way. Thank you for sharing your experiences and for being brutally honest!

  7. hmz
    ny
    Reply

    I gradually weaned myself off gabepentian without my drs knowledge. I was on it for just over a year at 18 mg per day. i could not take the fog, short temper, and lack of coordination any longer…neither could my family…I don’t know what to do about my constant neuopathy pain now, but I’d rather be in pain I think.

  8. Kristine
    Florida
    Reply

    I started taking this medicine 1 month ago for severe sciatica pain, and although it did remedy the pain in the pain in my ankle and calf, I am now having severe pain attacks in my right hand.

    This pain attack, as of now, leaves me crying. I can tell you I have a
    High tolererance for pain, until now. I go to bed at night in fear of another round of pain. Am I alone in this? Please reply!

  9. Maureen
    Avon, CT
    Reply

    I have SUFFERED tremendously from Fibromyalgia which then was changed to “Polymyalgia” by a Rheumatologist who prescribed Gabapentin. It takes the edge off and does help remove my pain. I started with 1 pill at night and now take 1 in the morning also. No side effects, thank God!

  10. Jacquie E
    07042
    Reply

    Using gabapentin causes a seepage of a clear liquid from between my toes or from underneath my arms. What it is, I am not certain.

  11. Richard F.
    Toledo, OH
    Reply

    I was prescribed gabapentin several months ago for numbness and tingling in my upper chest, head, and arms following chemotherapy for throat cancer at a dose increasing to 300 mg three or four times daily. At first it helped, but lately there is less effect, but the side effects have become unbearable.

    I have a severe tremor, loss of balance and incoordination, dry mouth, and insomnia. This is a terrible drug. I am now trying to taper off it, which is not easy because of withdrawal symptoms (anxiety, restlessness, etc.)

  12. Judy F
    Kennewick Washington
    Reply

    I’ve been taking This medication for 3 months. 1 capsule 300mg at night. Sometimes I feel confused. My concentration is bad. I concerned when I drive because I do not focus. I’m going to talk to my doctor about changing medicine.

  13. Maureen
    Indiana
    Reply

    I have a neighbor who was ordered Gabapentin for neuropathy in her feet. She immediately noticed that a horrible fog come over her. She became depressed, unable to do much of anything. She couldn’t stand how it had taken her over. Yet the pain persisted so she went back to the ER and while there told the doctor about how horrible the medicine was making her feel. He told her “well, then just stop it”, so that is what she did. She only took the medicine for something like 2-4 weeks, but then stopped it abruptly (which I am reading should never be done), and now 2 weeks after stopping it, she is still like a zombie. Depressed, in a fog, unable to tend to any of what she used to do. She used to be a very active person, working in the yard, active in church, very outgoing. Now all of the life has gone out of her. She sits in her house and stares. Doesn’t open the curtains on her windows, doesn’t go out side, or to church. And to look in her eyes, it looks like there is no one inside anymore. What can we do to help her? Does this ever wear off? Is there any kind of treatment to reverse these affects? IF ANYONE HAS ANY ANSWERS, PLEASE HELP!

  14. Ann
    Arkansas
    Reply

    I HATE Gabapentin. And I can’t stop taking it. I was prescribed this horrid medication for Restless legs. 300 mg 2-3 times per day. My legs ache ache ache until I can barely walk. They hurt all the time. AND I have gained a ton of weight and cannot lose it. My doctor does not believe me even though he is well aware of the weight gain. I hate this drug and I HAVE to take it I will get tingling in my hands and my legs wiggle and jerk. I have weaned myself down to 300 mg. at night. I need help. It is ruining my walking and coordination. I have no quality of life. WHAT DO I DO. I NEED HELP. PLEASE DON’T TELL ME THIS IS A DUPLICATE COMMENT. PLEASE HELP ME.

  15. Deb
    Madison, WI
    Reply

    My husband was prescribed Gabapentin in May of 2014. He took it – just 1 pill for 3 days – for neuropathic pain in his legs – and it ruined his life! He woke up on the 3rd morning and could not walk – had to crawl to the bathroom – his memory was all messed up – and still is to this day!! – he is depressed, anxious, has bouts of EXTREME FATIGUE. He also has “episodes” that we’re still trying to figure out.

    He just zones out, mumbles, stares, doesn’t remember anything, is super confused – like he’s in his own little world. On 1 day I had a husband that loved life, did NOT have any memory issues, loved to fish, read books, play X-Box games, loved being outdoors and 3 days later I had a husband that I did not even know anymore. It has ruined his life, my life, our lives. He has seen all kinds of doctors, had cat-scans, brain MRI’s, repeated EEG’s, blood tests, done chiropractic treatments, acupuncture, and nothing helps. Also, since taking the Gabapentin, now he can’t take hardly any other prescribed medications – he has the “severe” side effects if he does. It’s been a horrific 3+ years for us. We are 65 and 70 and couldn’t wait to be retired so that we could travel and now we just sit at home, go to appts, etc. etc. trying to figure out what happened to Dave……. I keep bringing up the fact that this ALL started on the 3rd day of that damn Gabapentin but the doctors all say that the affects wouldn’t still be going on today. I/WE DON’T have never agreed and after reading all of these other comments, for sure I am going to pursue this more!! Have any of you hired an attorney to help you? I truly feel for each and every one of you because I have seen in person the HORRIFIC side affects of this nasty drug.

    • Maggie
      Reply

      Hi Ann,
      There arr other meds for restless leg. I don’t remember why they are, but my mom took one that worked.
      This is not the only option for that condition. I’m not a doctor, but yours should be able to give you something else.

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