gabapentinoids

The opioid epidemic has doctors looking for alternative treatments to ease pain. Many have turned to a category of medications called gabapentinoids.

What Are Gabapentinoids?

This category includes the anti-seizure drug gabapentin (Neurontin) as well as pregabalin (Lyrica). Both drugs are prescribed for nerve pain. Pregabalin is also prescribed for pain due to fibromyalgia, while gabapentin is sometimes prescribed to reduce epileptic seizures.

How Many People Take Gabapentinoids?

From 2002 through 2015, use of these two medications more than tripled (Johansen, JAMA Internal Medicine, online Jan. 2, 2018). The people most likely to be taking gabapentin or pregabalin tended to be older individuals with multiple health problems.

The researcher reported the dramatic increase in gabapentinoids in JAMA Internal Medicine. He notes that there isn’t much long-term safety data for these medications. The potential for overdose and the high rates of off-label prescribing are also worrisome. He advises his medical colleagues to use these drugs cautiously “given the lack of proven long-term efficacy and the known and unknown risks of gabapentinoid use.”

This is not the first red flag to be raised in the medical literature. A notice was published in The New England Journal of Medicine (Aug. 3, 2017) titled “Gabapentin and Pregabalin for Pain–Is Increased Prescribing a Problem?”

In it, the authors, Drs. Goodman and Brett, write:

“We believe, however, that gabapentinoids are being prescribed excessively — partly in response to the opioid epidemic…Patients who are in pain deserve empathy, understanding, time, and attention. We believe some of them may benefit from a therapeutic trial of gabapentin or pregabalin for off-label indications, and we support robust efforts to limit opioid prescribing. Nevertheless, clinicians shouldn’t assume that gabapentinoids are an effective approach for most pain syndromes or a routinely appropriate substitute for opioids. Although gabapentinoids offer an alternative that is potentially safer than opioids (and presumably more effective in selected patients), additional research is needed to more clearly define their role in pain management.”

Side Effects of Gabapentinoids:

We have heard from some readers who reported that gabapentin made them suicidal.  That is unusual, but side effects such as dizziness, fatigue, balance problems, drowsiness, cognitive difficulties and visual problems are not uncommon.

Pregabalin can cause adverse reactions such as sleep disorders like sleepwalking. It too may trigger dizziness, drowsiness, fatigue, visual difficulties and cognitive complaints. Doctors should warn patients about pregabalin withdrawal problems. The drug should never be stopped suddenly.

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  1. Lyn
    LA
    Reply

    I have been taking g Gabapentin for well over 10 years for very bad ideopathic neorapathy in feet and legs, burning stabbing all nite. I take 1200 mg. In 4 doses. It has helped with the pain about 70 percent of the time. I am glad to have that relief, amen to that. I do have very worse balance problems and will probably end up in a w wheelchair. BUT, Gabapentin is the only drug I have researched and used to be effective for neuropathy pain. Millions of people have neuropathy, you would think that Big Pharma would come up with a cream or drug that is effective and safe. Come on Big Boys.

  2. Carolyn
    NC
    Reply

    My husband takes Gabapentin as needed for back pain. He doesn’t take it very often, but finds it very helpful in relieving his pain when other options have failed. We have noticed no adverse side effects.

  3. Carmie
    Reply

    My mother – 88 yrs old – was diagnosed with trigeminal neuralgia (around her right eye) this year. We had to rule out a whole lot of other things via eye docs, MRI, hospital visits, and a temporal arterial biopsy. Gabapentin worked immediately for her pain. She takes 300mg 3x daily, and as had no side effects that we can see. And I have watched for them. The drug seems to continue to lessen her episodes and keep them to a minimum of a few seconds when they occur. It’s hard to watch her suffer when the intense pain strikes.

    I would, however, like to lower her dose and will talk to her neurologist about it with mom next week. I also would like to look into medical cannabis, probably a CBC cream. Mom gave me a thumbs up on the that, I hope the neurologist will help.

  4. betty
    California
    Reply

    Started taking a low dose of gabapentin recommended by my doctor for idiopathic peripheral neuropathy. After one dose woke up with dizziness, nausea and inability to walk without falling which lasted all day. Never took the drug again.

  5. Anne
    VA
    Reply

    I have been on gabapentin for diabetic neuropathy for about 5 years. My podiatrist suggested I change the dosage from 300mg to 900mg. After taking the second pill, I experienced nausea and dizziness. My body does not respond well to medication so I decided to slowly adjust to the new dosage. After more than a year, I’ve gotten to 600mg by taking one pill in the morning and the other at night. The neuropathy will have to be extremely unbearable for me to try taking the full 900mg.

  6. Dianna
    Tx
    Reply

    What do you expect someone to take when their are in pain most of the time? There is nothing otc you can buy that will help this person. So what do you propose for this person to do, buy
    Drugs on the street.

  7. Banjoboy
    Reply

    My doctor strongly recommended Neurontin for life-long severe migraine headaches. I thought the drug was heaven-sent, migraines stopped totally. However, I began to have prostate pains and significant urgency at urination. I was told there is nothing in the literature that indicated any relationship or problems with the prostate, however, as the pains continued and were constant, I wanted to stop the drug, but told I had to gradually taper off, and the pain continued until I was completely off the drug. At a later date, my doctor had be try Neurontin again, but the results were again the same, and I stopped it again, and got relief from the prostate pain again. A couple of years later I was diagnosed with prostate cancer, and wondered if there was a connection, but never got an answer.

  8. Chuck
    Reading, PA
    Reply

    I was on as much as 1000 mg per day of gabapentin at one point in desperate attempt to stop the pain. My wife said I was becoming very irritable to say the least. She basically made me stop it. I was also having some dizziness and cognitive issues. Luckily I found and started taking metformin which for me was a godsend. It stopped 90-95% of all the pain and pins needles that I suffered.

  9. Don
    Sandy Or.
    Reply

    I had back surgery a month ago, gabapentin allowed me to quit taking opioids in one week and it helps take the edge off my leg nerve pain.

  10. Jamie
    North Carolina
    Reply

    My husband took gabapentin for pain after he had surgery. It changed his personality. He became so angry that I had to review all his emails he sent for work because he sent some pretty harsh ones to co-workers and his boss told him to calm down. He is usually a very calm and considerate person with colleagues so we all knew something was off. He stopped it after a week or so and went back to his normal self. He will never take that medication again.

  11. Judy E
    MO
    Reply

    I was prescribed Gabapentin for the extreme pain/discomfort of unbearable excezma itching, in place of trying light treatments, which he said don’t always work. The gabapentin gave me extreme chest pains so I quit ( the prescribing dermatologist agreed). A different dermatologist said I should just put on a bikini and lie in the sun, just short of burning. Getting sun on my back, chest and legs was the answer, even though I spend many hours a day gardening,but those areas are covered up.

  12. Karla
    Reply

    Gabapentin helps with my sciatica pain in two ways: 1. it reduces the pain itself, and 2. it reduces anxiety so I get less stressed by the pain I feel.

  13. Kate
    Ossining NY
    Reply

    I’ve been on gabapentin since 2005- I have the condition known as trigeminal neuralgia. I truly didn’t want meds. After awhile I chose to have brain surgery to repair the nerve—to no avail. Back on the gabapentin. In years following I had 2 gamma knife procedures. Despite having some pain relief after the second GK the pain came back and I had to go back on gab. At least I’ve gone from 2700 mg down to 1800 mg . I have attempted to Lee myself off the gabapentin but the pain comes raging back ! Prayers for pain free days ahead for EVERYONE!

    • Sylvia
      Reply

      Order some ProGest progesterone cream from Emerita.com. Put a dime-size dab on your finger and massage it into your jaw where you have the pain.
      Progesterone is a neurosteroid made in your brain from cholesterol. It is also a hormone that both females and males have. It is mostly associated with females during pregnancy.
      It is wonderful for any neurological pain including diabetic neuropathy and sometimes migraine headache. It’s worth a try.

  14. Oreosgrammie
    Indiana
    Reply

    I was prescribed gabapentin for shingles pain. I took it (300 mg every eight hours around the clock). It helped with the pain and my ability to sleep, but completely took away my ability to experience orgasm–that was the only side-effect i could identify, but a huge problem nonetheless). I had no thoughts of suicide, but gradually tapered myself off it after five months. I have non-diabetic neuropathy, and unless it gets way worse, I have no desire to go back on this product.

  15. Marie
    Texas USA
    Reply

    I started taking gabapentin when I had shingles, then noticed it helped the fibromyalgia so I’ve continued taking it. I do experience some sleepiness and balance problems and would like to stop taking it – but there seems to be no alternative.

    • Fred
      NC
      Reply

      Agree with your conclusions. I am taking 600 mg, 4 tabs a day due to nerve pain and damage brought on by Parsonage Turner Syndrome, a very rare nerve disorder that can last for years. I am right now trying to come off this stuff.

  16. Charles
    NJ
    Reply

    I was on Neurontin for 5 years, 2004-2009, had some of the side effects; drowsiness, fatigue and lack of concentration. I began Lyrica in Oct 2009 (very expensive at first, even more so now) and those side effects disappeared completely.You have to start at a low dose (25 mg) and gradually work up to the full prescription dose, in my case 100 mg twice a day. Accidentally missing a dose is a big deal, lots of nerve pain returns in about 15 hours. If you are ever taken off either drug, you have to go through a reverse dosing to prevent the withdrawal symptoms listed above.

    What is most aggravating is the preferential treatment that Parke Davis received from the FDA after its patent expired (I think in 2014). FDA approved a generic version, but then extended the P-D protective monopoly, still in effect today, that would have drastically reduced the price. I pay $664 for a 90 day supply right now. Outrageous!

    And why does Voltaren 1% gel still require a prescription today? When friends travel anywhere in Europe I ask them to pick up a tube, because it is OTC there. Same price or less than in the US, same packaging, always by a major drug company.

  17. David
    Wisconsin
    Reply

    I take gabapentin for restless leg syndrome and it helps a lot. I am concerned about side effects like dizziness. Thanks for the information about withdrawal, I will not stop suddenly. Keep me posted on any other emerging issues.

  18. DR SUSAN
    Reply

    Similarly, 25% of drugs are based on plants/herbs, the GABApentinoids are based on the amino acid GABA. GABApentinoids are derivatives of the chief inhibitory neurotransmitter gamma-Aminobutyric acid (GABA). GABApentinoids increase the available amount of GABA, typically have relaxing, anti-anxiety, and anti-convulsive effects. People can increase their own GABA naturally with Nutrition. It is synthesized in the brain from glutamate, using the enzyme glutamate decarboxylase (GAD) and pyridoxal phosphate (which is the active form of vitamin B6) as a cofactor. This process converts glutamate, the principal excitatory neurotransmitter, into the principal inhibitory neurotransmitter (GABA}. L-Glutamine and vitamin B6 are endogenous precursors of GABA.

    The biochemical basis for these drugs are actually nutrients. Again, a contributing solution to reducing pain is Nutrition. Other contributing solutions for correcting the causes of pain vs. covering up the pain are again not part of Big Pharma: Acupuncture, Chiropractic, Exercise, Meditation, etc., but are important cofactors of a healthy lifestyle.

    It is important to remind your readers that legally prescribed drugs are the 3rd leading cause of death in US [JAMA, 1998]. Legally prescribed drugs like opioids, many of which are prescribed by dentists, may become the 2nd leading cause of death in US, if people continue to obediently follow their drug doctors’ orders and swallow their prescriptions. Or they can take back their health, and correct the causes of pain.

    • Carole
      Sydney, Australia
      Reply

      Thanks DrSusan, that explains why B6 is so good for tingling nerves in hands and feet. I’ll add in L-glutamine.

  19. Mickie
    Reply

    I was prescribed Neurontin. As dosage was increased so did side effects.Burning tongue was first. Then waking up in strange places.I was told to stop it then 3 weeks later start it again.I would have unexplained injuries. The last time I took it I woke up on my porch outside.

    My doctor didn’t believe it was the Neurontin but didn’t push me to resume it. Don’t take it if you are alone. You need to have someone be there to see what happens to you while you think you are asleep.

  20. Diane
    FL
    Reply

    I took gabapentin for nerve pain due to Spinal Stenosis. I heighten my pain. My mood was awful and I was crying in the morning. Went off of it after 3 weeks and so much better. Side effects not worth it for me. On Facebook there is a group of Spinal Stenosis and some of the people that were on it were taken off too quickly after a high dose. One women had a video of herself as she started seizures. It also makes you gain weight rapidly. One person said they gained 50 lbs. in a year. I myself gained 10 lbs. in 4 weeks.

  21. Alicia
    Sarasota, Fl
    Reply

    I was taking three 100mg capsules of Gabapentin for several months, graduating from 1 capsule to three. I thought I saw improvement in the nerve pain in my feet, but really haven’t. So I called my physician’s assistant and told him I was not renewing the prescription. He said that would be okay. I don’t think the pain has worsened, but not enough time has passed yet.

  22. Deborah
    NC
    Reply

    A month on Gabapentin and I was a different person – and not a nice one! Generally, I am a quiet, gentle, easy going person. Along with the drowsiness and fatigue, I had become angry and impatient – very angry. When I started yelling at my two year old granddaughter and a couple of store clerks I knew something was wrong. I cut down immediately and within two weeks of stopping completely I was back to normal. It did help with pain but so not worth my sanity. I went back and apologized to the clerks.

  23. Brooke
    Reply

    I took it for a short time for a nerve pain issue. It didn’t help at all and caused a bizarre side effect of severe chills. I tapered off and never looked back.

  24. Deb
    Saginaw, Michigan
    Reply

    My regular physician prescribed gabapentin to help alleviate the pain of severe back problems and the resulting peripheral neuropathy. Initially I couldn’t sleep through the night and felt very irritable. Within a month I felt “stupid” ~ I couldn’t think straight, I kept forgetting and losing things, and started experiencing brain “zaps.” My doctor laughed it off and a month later when she laughed it off again I told her I would be discontinuing the drug. I did my research and weaned myself off over a few weeks. Problems vanished.

  25. Paula
    NM
    Reply

    I have been taking 200 mg of gabapentin at night for several years to help me sleep. I have a condition similar to restless leg syndrome that causes me to wake up every 30-60 minutes during the night. I had been taking clonazepam but several years, but became concerned about possible long term risks such as damage to cognitive processes and Alzheimer’s, so my doctors said this would be a safe and effective alternative. I have noticed absolutely no side effects and it is very effective.

  26. Avaline
    Reply

    I was prescribed gabapentin by a sleep specialist for “lower limb movement disorder”, a precursor to restless leg syndrome. After less than a week, I became severely constipated and reported this to the physician, who told me that this was impossible, as gabapentin does not cause constipation. Three days after I stopped taking the drug, I was no longer constipated. Needless to say, I no longer see that sleep specialist.

  27. Elizabeth
    Buffalo, NY
    Reply

    I was recently given a prescription for gabapentin due to sciatia. The script was for 900mg. I read all the side effects and decided that possible suicidial thoughts were not something I needed, nor any of the other side effects. Several years ago I was given oxycotin for nerve pain. I did take this for almost 2 years until I worked to find relief from the pain. Then my pain management doctor began reducing my dose until I no longer needed it. The oxycotin was a life saver. Right now I would rather have the oxycontin. I never got “high” from the opioid nor did I abuse it. I feel it saved my life from suicidal thoughts because of constant pain.

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