The People's Perspective on Medicine

New Concerns About Gabapentin and Pregabalin (Lyrica) for Nerve Pain

Over 10 million people take GABA agonists for nerve pain. A recent report raises new concerns about gabapentin and pregabalin. What are the pros and cons?

A recent review of the FDA’s Adverse Event Reporting System (FAERS) reveals some disconcerting data about commonly prescribed drugs for nerve pain (ISMP QuarterWatch Reports (March 27, 2019). This independent publication provides insights on emerging drug risks based on information submitted to the Food and Drug Administration. GABA agonists like gabapentin (Neurontin) and pregabalin (Lyrica) are prescribed primarily for neuropathic (nerve) pain. Lyrica is also prescribed for fibromyalgia. The latest ISMP report raises safety concerns about gabapentin and pregabalin that deserve some careful consideration by physicians, patients and FDA safety officers. 

Gabapentin and Pregabalin and the Brain

No doubt you have heard of the neurotransmitter called serotonin. One of the most widely prescribed antidepressants, fluoxetine (Prozac), became a household name because it was a selective serotonin re-uptake inhibitor (SSRI).

You have probably read about dopamine. It has been described as the “feel-good” neurotransmitter. Think of it as the reward neurochemical. If you experience something wonderful, the pleasurable feelings are probably impacted by dopamine.

Have you ever heard of a neurotransmitter called GABA (gamma-aminobutyric acid)? We didn’t think so. Whereas most neurotransmitters stimulate neurons, GABA is more like a brake on the brain. Neuroscientists refer to this as an inhibitory action. Not surprisingly, drugs that “calm” the brain often attach themselves to GABA receptors and/or enhance the activity of GABA. Think booze, barbiturates, benzodiazepines such as diazepam (Valium) or even sleeping pills like zolpidem (Ambien).

Gabapentin and pregabalin (Lyrica) are considered GABA analogs or gabapentinoids. In addition to being prescribed for nerve pain, they sometimes are used to treat “partial onset seizures.” You get the picture: brain brakes for epilepsy or sensations of pain.

Why Are GABA Drug Prescriptions Skyrocketing?

Prescriptions for these powerful brain modulating meds are way up. An article in JAMA Internal Medicine (Feb. 2018) notes that:

“The use of gabapentinoids more than tripled between 2002 and 2015.”

According to our calculations, over 10 million Americans are now taking either gabapentin or pregabalin. That represents more than 50 million prescriptions annually!

We suspect that many physicians have become worried about prescribing opioids to patients suffering from chronic pain. They have either reduced the dose of opioids and added a drug like gabapentin or substituted a GABA analog entirely for the more powerful pain relievers. That’s not just our opinion. An article published in the New England Journal of Medicine (Aug. 3, 2017) stated: 

“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.”

The report from the March 27, 2019 ISMP QuarterWatch reveals: 

“Gabapentin is so widely used that it is reported taken by more adults than any other psychoactive drug except the opioid combination acetaminophen/hydrocodone (Vicodin). It is so widely abused that a study of overdose deaths showed 32% had included it in a cocktail of lethal drugs that mostly included potent opioids.”

You can read more about the rise in gabapentin and pregabalin prescriptions at this link.

Are Doctors Overprescribing Gabapentin and Pregabalin (Lyrica) for Pain?

Why Are There Concerns About Gabapentin and Pregabalin?

The latest analysis from the ISMP QuarterWatch reveals some disconcerting data:

• “Risky polypharmacy. Nearly one-half of GABA analog patients were also taking 10 or more other drugs, increasing the risk of interactions, overdose, or inhibiting effects on other needed drugs.

• “CNS depression and overdose. 35% were also sustained users of opioids; another 18% were regularly taking an additional drug that activated GABA receptors such as alprazolam (Xanax) and zolpidem (Ambien).

• “Untested psychiatric combinations. 44% of GABA analog drug patients were also in sustained use of various antidepressant drugs. This suggests that doctors observing poor responses to antidepressant drugs were adding GABA analog drugs in untested and unapproved combination therapy.”

Are There Concerns About Gabapentin and Pregabalin Dependence?

The QuarterWatch also notes that:

• “Withdrawal symptoms/dependence. More than 1,200 reports described withdrawal syndromes, drug abuse, intentional misuse, or overdose.

• Mental impairment. Patients complained of memory loss, memory impairment, confusion, dizziness, and falls.”

We suspect that many health professionals are unaware of concerns about gabapentin and pregabalin dependence. They assume that such drugs can be discontinued at any time without problems. That is not what we are hearing from visitors to this website.

Ivy was not told she would need to wean herself off gabapentin slowly:

“I have taken 3600mg/day of Neurontin (gabapentin) for about 15 years for small and large fiber neuropathy and other neuropathic pain all caused by Lyme disease. I never had any side effects…in fact, I tell people gabapentin has no side effects!

“The only problem I had was when a doctor told me to stop taking it and to take GABA supplements instead because they are the same thing. They are not. I had withdrawal symptoms that made me feel like I was going insane. I cried all the time, etc. I’m surprised I didn’t have seizures. I didn’t realize why it was happening but went back on the gabapentin…and they went away.”

Jay wasn’t warned about a discontinuation syndrome:

“I was prescribed gabapentin after lower back surgery. Not sure it helped with the nerve pain. I developed a canker sore on my lip after a couple weeks. I also experienced night sweats (and unusual body odor).

“The doctor didn’t say anything about side effects upon stopping gabapentin suddenly. I found out what they were when I ran out and didn’t refill–anxiety, insomnia, feeling ‘crazy.’ It’s been 5 days and I finally got a decent night’s sleep. Even with the withdrawal symptoms I’m not going back on gabapentin!”

Judy had problems with Lyrica (pregabalin):

“I am currently tapering Lyrica from 225 mg daily to 200 mg. It has been almost a month. I have been on Lyrica for 15 months. I suffer from severe chest and spinal pain due to a rare condition. The nerve pain has returned with a vengeance, but I am determined to taper to 150 mg daily. The brain fog, lack of concentration, drowsiness, etc. was ruining my life. Withdrawal has been a nightmare.”

Side Effects of GABA Analogs:

Gabapentin can cause symptoms of depression, drowsiness, dizziness, fatigue, brain fog, balance problems and visual difficulties. Patients should be warned about the possibility of suicidal thoughts. If such occur, people should contact the prescriber immediately.

Pregabalin can also lead to cognitive difficulties, unsteadiness and dizziness. Some people develop coordination problems, fatigue, confusion, blurred vision, fluid buildup (edema) and dry mouth. If depression or suicidal thoughts occur, the prescribing physician should be notified immediately!

You can learn more about the side effects of GABA analogs at this link. There are over 800 comments so you can read about the experiences of many other patients.

Surprising Gabapentin Side Effects

Some People Get Relief from Nerve Pain:

We do not want to paint a grim picture about gabapentinoids. We hear from many people that concerns about gabapentin and pregabalin are overblown and that such drugs do help relieve nerve pain. Here are just a few examples:

Gin in Granby, Connecticut, reports positive results:

“Tingling and numbness are relieved with gabapentin. I am not depressed taking it. Rather I am thrilled to not have to experience neuropathy. I don’t have any side effects to speak of. If I do, they are minimal.”

Janet in Virginia is also a fan of gabapentin:

“It took two years to finally get a diagnosis of peripheral neuropathy in my feet that has come up my legs. I’ve been on Neurontin (now gabapentin) for over 25 years. That medicine has helped me live!

“Early mornings are bad until 8:30 when the pills kick in. I was also put on tramadol. These meds have allowed me to get around, even drive some. Yes, I am sleepy and off balance but these side effects are worth it.”

Lyn reports that gabapentin helps her:

“I have very debilitating polyneuropathy. I have been on gabapentin for about 8 years. It does help with the pain in my feet. I have bad loss of balance, fuzzy head and have fallen twice. People with neuropathy will take and do anything to relieve the jabbing, burning pains. Gabapentin is the only help I have found. I have tried everything, except Marijuana.”

Final Concerns About Gabapentin and Pregabalin:

We suspect that there is a lot of off-label prescribing of gabapentin. That may stem in part from the aggressive marketing of Neurontin for which the company was fined a huge amount of money. You can learn about this sad saga in the history of gabapentin at this link:

Gabapentin for Pain Drove Patient to Brink of Suicide

We agree with the conclusions of Quarter Watch:

“Substantial action is needed to reduce inappropriate use of GABA analog drugs… Further, treatment guidelines are needed to discourage incidental off-label use without careful monitoring and patient assessment. Other risks—notably possible harmful effects of long-term use—have not been adequately assessed in drugs almost exclusively tested in short-term trials. With the exception of opioid misuse, it would be hard to find a drug safety issue today affecting so many million adults where neither risks nor benefits have been adequately established.”

Reader Response, Please:

Share your own experience with gabapentin or pregabalin in the comment section below. You can read the full FREE report from ISMP’s QuarterWatch at this link.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Citations
  • "Gabapentinoid Use in the United States 2002 Through 2015," JAMA Internal Medicine, Feb. 2018, doi:10.1001/jamainternmed.2017.7856
  • "Gabapentin and Pregabalin for Pain — Is Increased Prescribing a Cause for Concern?" New England Journal of Medicine, Aug. 3, 2017, DOI: 10.1056/NEJMp1704633
  • "Focus on 3 Psychoactive Drugs," ISMP QuarterWatch, March 27, 2019.
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I am on a 1000 mg of gabapentin for severe nerve pain. I only take an occasional pain pill now. The gabapentin has relived the debilitating pain in my legs. The worst side effect has been drowsiness which seems to be going away.

I had been taking gabapentin since 2010 to relieve symptoms of severe nerve pain following a microdiscectomy during which the surgeon tore the dura (the membrane surrounding the spinal cord).

I had taken as much as 2700 mg. per day, and for 8 of those years I was also taking morphine and hydrocodone. A year ago I graduated from the Mayo Clinic’s 3-week “Pain Rehabilitation Program” and am now off of: morphine, hydrocodone, xanax, clonazepam and methylphenidate.
Last month I returned to Mayo’s Pain Clinic and received a recommendation for Lyrica, starting at 150 mg per day and titrating up to 600 mg per day. I am currently at 400 mg per day. I find the Lyrica is more effective at controlling my pain. That said, I also am experiencing cognitive deficits: short-term memory impairments and with longer term memories I find I can remember images, e.g., people’s faces and images from movies, but I cannot retrieve the NAME of the person or the movie. Very strange experience. The other night “Tooty Fruity” was on the jukebox and I could see Little Richard’s face but couldn’t remember his name. This kind of thing keeps happening; picture is there but word isn’t.

On a different note. Regarding Balance Issues caused by Neuropathy, do you see anything on the horizon that can help us with this type of Neuropathy?

What is the difference between these prescription drugs and over-the-counter GABA supplements? A couple of the comments would indicate there are significant differences; I would like more information.

I was recently told I am not a candidate for HRT in spite of early menopause symptoms that are severe. Instead of hormones, the OB/GYN stated I should take Neurontin, which I disagreed with vehemently. Are there studies supporting the reduction of vasovagal symptoms with Neurontin? Yes. Does it provide relief for some according to these studies? Yes. So would Valium or Xanax and nobody would think about making that a first line treatment for menopause. I took Neurontin for a week when I had shingles and experienced discontinuation symptoms that were severe in spite of tapering myself off. As a therapist, I see a lot of substance abuse clients who take Neurontin in combination with other drugs.

I have been taking a low dose of gabapentin (200mg) at bedtime for several years because a sleep study confirmed that I was waking up many times a night, meaning that I would get up in the morning and feel like I did not sleep at all. This was to replace the clonazepam I took for several years for this problem, because I was getting scared about reports of that drug contributing to dementia.

I follow all of the standard advice about getting a good night’s sleep, but none of that prevents these frequent wakenings. Whenever I forget to take the gabapentin I wake up at least hourly all night long and feel horrible the next day. I hope that at this low dose it is safer than one of the “z” drugs. Besides, lack of sleep also degrades one’s memory, mental sharpness and overall health, so what’s a person to do?

Almost four yeats ago I was suffering from right sided low back and sciatica. Found out I had right sided synovial cyst! Was the largest neurosurgeon had ever removed. Surgery went well. Followed up with physical therapy. Unfortunately left with pain. Bottom line after two years on different pain meds which made me loopy I was placed on Gabapentin 600mg three times a day to total 2400 mg.
Eventually weaned myself off. Need to take 300 mg only once daily as needed. It’s a godsend! Side effects weight gain and constipaton.

While I was in the hospital recovering from lower back surgery I was prescribed gabapentin for leg pain. Soon after taking it my blood pressure rose. I asked the nurse if it could be from the gabapentin. She looked it up on her phone and it was a side effect. I stopped taking it and my blood pressure went back to normal

I have taken gabapentin since 2008. It is true that abruptly stopping The medication is harmful, may cause seizures, this is clearly stated in the patient pamphlet. However the risk of falls in my opinion is due mostly to the perpherial neuropathy. The foot/leg and the nerves supplying the leg for ambulation are not functioning properly, and the person is looking down to see where the feet are. This then makes the person more apt to fall first by gravity pulling downward, and second by poor perception of the nerves to make the balance adjustments. This seems like another way to just increase the suffering of chronic pain patients, by taking away what little relief we are able to find. If you don’t need it you will know, if you need it you will know. There is nothing like being eaten alive from your toes on up by fire ants.

I came down with a severe case of shingles. I suffered from the pain of the rash and then, weeks later, realized I had the severe lingering nerve pain known as postherpetic neuralgia. My doctor and I discussed the best way to treat this debilitating condition and decided that “off” label use of Lyrica was worth trying on a limited basis. I was given a one month prescription. Relief started within about 36 hours of beginning. My pain diminished to a level where I could sleep and function again. I took warnings about the drug to heart, but fortunately had none of the possible side effects. Near the end of my pill supply, on doctor’s suggestion, I started to taper off, reducing my dosage. By the time I was out of medication, I was fine, symptom free with no after effects.

I have been taking Gabapentin for 17 years. The brain fog it creates is horrible. I know what I want to say but can’t find the words. I feel like it has cost me my intelligence. I have severe short term memory problems.

In 1986, I was infected with a virus in my spinal chord which resulted in complete paralysis from the Chet down. The infection I had is transverse myelitis. After 9 months of physical therapy, I could finally walk without crutches or cane. However, I was left with peripheral neuropathy in my legs and, especially, my feet. The pain was and is excruciating. It wasn’t until 2004 that I found out about lyrica. I used lyrica for 11 years until going on Medicare. Medicare wouldn’t cover lyrica because it wasn’t generic. So I was prescribed gabapentin. Gabapentin is not as effective as lyrica for me but I still cannot imagine my life without it. These drugs have been life changing for me. I may be a little unstable on my feet but I was worse before the drugs. I am more tired than before TM but being in chronic pain can do that to a person. For me, I have 3 periods in my life, before TM, after TM and after gabapentin and lyrica.

Gabapentin was prescribed for me 10 or so years ago. I have Nueropathy, “restless legs” syndrome, my legs would ache, jump and twitch at night and disturb my sleep.
I was prescribed 100mg Gabapentin once a day at bedtime and have had relief ever since. Recently, I forgot to take the pill and the symptoms immediately returned.
At 80yrs old I am grateful and have never attributed any other ageing symptoms, such as memory loss and balance, to the drug.
If I forget names they will normally come back to me. I just say they are in files – and my brain will sort through them and find them.

I am grateful for People’s Pharmacy and the common sense health information that you give us. So many times I have followed your good advice and have also shown my Doctor.
Thank you

This article mentions lots of bad side effects and withdrawal problems with Gabapentin, so I thought I’d express a different opinion. I had excruciating sciatic for over 15 years. I’m a very athletic, energetic person, but even walking to my mailbox often forced me to sit down on the dirt and cry from the pain. My doctor prescribed Gabapentin. He stupidly started me on a very high dose: 900mg. 3xday. It did wonders for my sciatic pain, but it also put me in an overly-ecstatic la-la land where I felt like I was the essence of joy. I quickly realized that was too high a dose, and I asked to have it lowered. I had no problems at all with withdrawal.

I am now on 300mg only once a day. My sciatica is very minor at this dosage, and I notice no side effects whatsoever. I have stayed on Gabapentin at 300mg/day for about 3 years, and will be happy to stay on it at this level for the rest of my life. It works miracles for me. I have no dizziness, no balance issues, no brain fog, and none of the other symptoms others have mentioned. For me, Gabapentin has been a life saver.

By the way, the article did not mention the fact that Gabapentin is also a “mood enhancer” which explains my euphoria at the very high dosage. My opinion is that patients’ nerve pain might be helped by Gabapentin and may or may not be accompanied by side effects. It makes sense to start on a low dose and increase slowly to see what the pluses and minuses are for you. Then, decide with your doctor if you want to stay on it. My quality of life has improved tremendously with Gabapentin.

After using Gabapentin for a few years I ran out and forgot to order more. A few days later I ended up really sick. One of my caregivers researched it and found out you need to be weaned off of it. Anyhow I ended up at the emergency room, they administered a dose and by the time I got home I felt better. Needless to say I won’t go “cold turkey” again…

I’m so glad I was able to wean off Gabapentin which I was prescribed for back & leg pain. I didn’t really have any ill effects from taking 300 mg 3 times a day. But after I had my hip replaced after discovering it was bone on bone, all back & leg pain disappeared. So it was then that I thankfully was able to eliminate the medication.

I have been on Lyrica 7 yrs and otherwise o would have diet from nerve damage pain from neck surgery bone spurs and also a Fibromyalgia. Here’s my ? to everyone: I have tried all types of Medical Cannabis and they all made me hurt a lot more. It kept me awake all night in worse pain. So now I’m just on Baclophen at bedtime, Lyrica 75 mgs 4 times in 24 hrs, Melatonin and 3/4ths mg of Valium at 4 am out of desperation to calm the pulsing burning nerve pain in my left neck. I feel my great beating there and it keeps me awake too. My ? is- have any of you also experienced M Cannabis conflicting with Lyrica?

I have been on gabapentin for 2 months now for the pain of knee replacement surgery.i was on 1200mgs a day now up to 1800mgs a day.It doesnt help with the pain at all

I was experiencing nerve inpingmemt on lumber disc L5 on my right side. I was given low doses of a steriod for about 2 months and my doctor stopped them. I went on gabapentin in hopes of getting some relief because I had to wait 2 months to see a pain management specialist. I don’t like taking drugs that are alterations of natural alternatives so I went on straight GABA and by the third week I felt back to normal! I was taking 2200mg’s of GABA a day with no side effects.

I’ve been taking Gabapentin at bedtime since Sept., 2018 for PLMS (Periodic Limb Movements of Sleep). This was diagnosed after a sleep study. For me the Gabapentin has been a blessing. Before I would wake up after about 4 hours of sleep and it would usually take 3-4 hours to get back to sleep. Too often I had to get up and try to go with only the 4 hours of sleep. Not good at all. The only side effect I have had is a rather dry mouth when I first wake up. I manage that by putting a glass of water by my bed and chugging it 1st thing in the AM. And I’m sleeping 7-8 hours /night!!

I took GABA drugs, both gabapentin and pregabalin for severe back pain. After some months i noticed very foggy thinking. Couldn’t remember simple things, sleepy all the time. I had a much slower rate of processing information. I even ran off the road in my car a couple of times, something i’ve never done before. When I asked the doc about it he said, “Oh yeah, that’s a known side affect. We don’t mention it because not everyone has it.” I stopped the meds right away, knowing from my research that there would be hell to pay, and there was. At least I was prepared for it and my husband was very supportive and understanding during this time. He was also glad I was off the meds because he said he did not recognize the person I had become. I have since found relief through chiropractic care. Not 100 percent but pain free most days and when I have pain, it’s much less severe.

I hope to find some natural remedies and get off gabapentin (Neurontin) entirely, though I only take a low dose (even that affects me negatively).

I have lots of nerve issues and some pain due to fibromyalgia and a separate neuro condition, as yet non-specified, but looking rather like cerebral palsy. Would appreciate any suggestions. Perhaps The People’s Pharmacy could do a column on healthier alternatives.

I don’t do yoga or related because of my religious beliefs. Also can’t do deep massage or chiro because my neuro condition causes the muscles to cramp and spasm easily, and they can (very!) easily “lock” on me, which is extremely painful and makes even stretching difficult. I can sometimes do gentle stretching when at my best.

Magnesium, calcium, and alpha lipoic acid help a bit, as does applying heat or taking a warm bath, and using magnesium oil, but during flares, I need more help. Thanks for any ideas.

GABAPENTIN is to me a horrid drug due to side effects.

I’d rather endure crazy nerve pain than have a drug mess with my mind this much. Due severe RA and severe osteoporosis there are irreparable nerve pains in neck, shooting into head.

Anyway I am stunned as to what I hear and read that the FDA doesn’t have the means to actually test drugs. Companies can use private so called inspectors. Who cares about the ill? No one. It’s all about pharma industries getting richer.

There are drugs on the market in the USA that will never be allowed in Europe due to strict QUALITY checking and control. No one seems to care about the suffering here.

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