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The Mild and Serious Side Effects of Gabapentin

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Gabapentin is a popular medication for treating multiple conditions, particularly to reduce seizures and mitigate nerve pain.1 Physicians also prescribe gabapentin for off-label situations to treat various physical and mental ailments, with varying levels of success.2 However, gabapentin side effects do occur and can be mild to severe, depending on your usage and condition.

Table of Contents

Common Side Effects of Gabapentin

As with all medications, there are some side effects of gabapentin use, including:

  • Gastrointestinal upset
  • Diarrhea 6
  • Fever
  • Somnolence
  • Ataxia
  • Dizziness
  • Fatigue

These side effects are oftentimes mild and usually subside as the body adjusts to the medication, but if they continue beyond the adjustment period for your body, a simple adjustment in dosage and/or timing of consumption can help alleviate them.4

Neurological Gabapentin Side Effects

Besides the above-mentioned mild side effects, other rare gabapentin side effects have been reported, such as:

  • Chorea
  • Increased symptoms of Myasthenia Garvis
  • Hypoventilation
  • Respiratory failure
  • Mitochondrial toxicity

Chorea

In one small study, chorea was noted as a possible side effect, where a man taking gabapentin experienced a sudden onset of involuntary and jerky muscle movements.11

After the complete discontinuation of medication, the chorea fully resolved and the man was able to return to normal neurological function without any long-term side effects. However, this side effect did prompt further study into the possible negative relationship between gabapentin and those with other muscular disorders.

Myasthenia Gravis

If you have myasthenia gravis, a neuromuscular disorder that causes weakness in the skeletal muscles, gabapentin may worsen your symptoms of the disorder. Studies have found a correlation between gabapentin and worsening symptoms of myasthenia gravis. Similar to chorea, the worsening of symptoms abated after the discontinuation of gabapentin therapy.

Hypoventilation and Respiratory Failure

Another small study reports central hypoventilation and respiratory failure as rare but serious side effects of gabapentin. Mitochondrial toxicity has also been noted as a rare side effect with gabapentin.

With this side effect, you may experience damage to the mitochondria in your cells, eventually leading to myopathy or muscle weakness. Your doctor will assess any possible underlying health conditions that may increase your risk of these serious side effects and most likely not prescribe you gabapentin if a true risk is there.6

Cognitive and Behavioral Side Effects

Altered mental status is also sometimes reported as a side effect of gabapentin. These side effects can include:

  • Increased risk for those with kidney disease
  • Suicidal ideation
  • Self-harm
  • Intrusive thoughts

The range of mental impairment varies by person. It is possible that higher doses of gabapentin, especially if you have chronic kidney disease, have a higher propensity to result in hospitalization due to an altered mental status. This is due to gabapentin being filtered almost exclusively through the kidneys, placing an extra burden on that organ.

As such, doctors take extra care when prescribing gabapentin to the older population, who may be more at risk of this side effect. If you are concerned about this side effect, please speak with your doctor before beginning the medication. In addition to disease management, your comfort in accepting gabapentin therapy is also crucial to your well-being. 12

Suicidal Thoughts and Self-Harm

Additional discussions should be had around the risk of developing or progressing in suicidal ideation and/or thoughts of self-harm while taking gabapentin. If you, or a loved one, are beginning gabapentin therapy, it is often recommended to seek out additional support with a psychotherapist or psychologist while on the medication to help safeguard the individual taking gabapentin and monitor for any suicidal thoughts or self-harm.

These side effects can be serious yet treatable and manageable with proper care and support by family, loved ones and mental health professionals.

Gabapentin Side Effects in Children

Some side effects are specific to children. Most significant is the change in behavior, such as:

  • Increased tantrums
  • Intensified baseline behaviors
  • New and challenging behaviors
  • Aggressive actions
  • Hyperactivity
  • Defiance

Some children taking gabapentin have shown an increased level of intensified baseline behaviors, as well as the development of new and challenging behavioral problems, such as:

  • Increased severity of tantrums
  • Aggression toward self and others
  • Hyperactivity
  • Defiance

If your child is experiencing gabapentin side effects, you will notice this personality change and that their behaviors are inconsistent with their age and social and emotional development.

This shift in behavior can oftentimes be managed through dosage changes. However, if severe enough, discontinuation of gabapentin may be in the best interest of the child. Studies have shown that once gabapentin was discontinued, the child’s behaviors returned to normal without any long-term side effects.13

Visual Side Effects of Gabapentin

A vision change is another possible side effect of gabapentin, particularly a binasal field loss of vision. If you are experiencing this side effect, you will see vision loss on the inner half of both the right and left visual fields, resulting in a loss of central vision.

You may also lose the retinal nerve fiber layer. Studies are still being conducted on this side effect to determine the significance of vision loss and whether it is reversible once gabapentin is discontinued. If you feel nervous about this risk, please speak with your doctor, as he or she may have additional insight into the risks versus benefits for your particular situation.14

Gabapentin and Pregnancy

If you’re pregnant and looking to begin taking gabapentin, there is positive news in that the medication shows promising results for pregnancy. Current studies on pregnant mice and rats showed gabapentin did not appear to harm the developing fetus. However, some concern remains over possible preterm delivery and low birth weight, but there has yet to be a study confirming these concerns.

If you are currently pregnant or looking to become pregnant soon, certainly speak with your doctor before beginning gabapentin therapy. You may also consider speaking with your OB-GYN or midwife about the medication further to clarify any possible risk of gabapentin during pregnancy.6

How Is Gabapentin Used?

Gabapentin effectively treats patients dealing with seizure disorders, such as epilepsy,3 reducing seizures in patients by at least 50%.4 You may also be prescribed gabapentin for pain management, especially nerve pain stemming from spinal injuries, diabetic neuropathy, and arthritis.5

Seniors

If you’re in the older population, your doctor may have prescribed gabapentin to help reduce aggression associated with dementia.2 It can improve psychomotor function and memory, adding another benefit to the older population in particular.3

Mental Health Conditions

If the above conditions don’t apply to your situation, then perhaps your physician is prescribing gabapentin to help manage a mental health condition. Gabapentin now shows promise for the treatment of major depressive disorder (MDD), bipolar disorder (BPD), and post-traumatic stress disorder (PTSD).

If you’re taking gabapentin for MDD, it has the potential to assist in your mood, as studies show the medication increases activity and gregariousness while also decreasing inhibitions.6

With PTSD, gabapentin shows promise in reducing the severity of symptoms, such as sleep disturbances, insomnia, and nightmares. The reduction of these symptoms with gabapentin is great progress, as the commonly prescribed antidepressants for PTSD show limited ability to mitigate those symptoms, which can arguably be the most challenging aspect of the diagnosis.7

Gabapentin also shows some, although limited, benefit for anxiety disorders.8 Overall, gabapentin can benefit from more studies evaluating its effectiveness in treating mental health conditions, yet the current results are promising and offer hope to many struggling.9

Alcoholism Treatment

Notably, gabapentin is also commonly used to help individuals recovering from alcoholism, as the medication helps reduce withdrawal symptoms and alcohol cravings.9 If you are currently taking or considering taking gabapentin to begin recovery from alcoholism, then gabapentin is an excellent treatment option for those experiencing mild withdrawal symptoms.10

How Addictive Is Gabapentin?

Arguably the most severe of possible gabapentin side effects is the risk of developing a new or secondary addiction. Although not in the same class of drugs that traditionally carry the risk of addiction, such as benzodiazepines and opioids, gabapentin has a strong reputation for creating chemical and physical addiction in the patient, medication-seeking behaviors, and even withdrawal symptoms once the medication is discontinued.

It has become such a popular drug of choice among those with addiction that physicians (52%) and drug dealers (36%) are the two major distribution sources.6 The main reason behind the development of addiction is that gabapentin can induce a sense of euphoria when taken at high doses, such as those given to patients with chronic pain,2 as well as sedative and psychedelic effects similar to taking an amphetamine.

Gabapentin can also induce dissociations, similar to those found with dextromethorphan, which is another desirable feeling to many, resulting in addictive tendencies and addiction itself.6

This side effect is severe and should not be easily overlooked by either you or your doctor. If you are looking to begin recovery from an addiction or are currently in recovery for addiction and/or alcoholism, please speak openly with your doctor about gabapentin’s addiction risk.

The risk of secondary addiction is significantly higher among those suffering from one addiction. Therefore, accepting a medication with a strong potential to create a secondary addiction must be carefully considered.

Importance of Patient Screening

Doctors should screen their patients’ risks before prescribing gabapentin. These screenings can help you and your doctor assess potential risk factors, such as addiction history, time in recovery, coping skills, support networks, and resiliency. If your loved one is taking gabapentin and showing possible signs of addiction, consider speaking with them and their doctor to discuss the next best steps.

If you show a risk of secondary addiction, you should still be considered for gabapentin if the medication benefits outweigh the risk of secondary addiction. In these circumstances, please seek additional time and support to create a safety plan for accepting and managing the medication treatment while minimizing secondary addiction risk.

While on the medication, you can seek recovery support and therapy to help you maintain your sobriety and watch for any possible signs of developing an addiction to gabapentin.

If a possible addiction to gabapentin is developing, then altering the drug dosage or frequency may be helpful, but discontinuation of the mediation altogether is advisable. Yet, extra care and medical oversight might be considered when gabapentin is discontinued, as withdrawal symptoms are possible.

References

  1. U.S. Food and Drug Administration. (2019). FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR).
  2. McPherson, D., & Wick, J. (2019). Gabapentin: Change is in the Wind. Sr Care Pharm, 1:38(8), 490-498.
  3. Goa, L., & Sorkin, E. (2012). Gabapentin: A Review of its Pharmacological Properties.
  4. Epilepsy Foundation. (n.d.). Gabapentin.
  5. Jainren, M., & Lucy, C. (2000). Gabapentin in Pain Management. Anasthesia & Analgesia, 91(3), 680-687.
  6. Quintero, G. (2017). Review about Gabapentin misuse, Interactions, Contraindications, and Side Effects. J Exp Pharmcol, 9, 13-21.
  7. Hamner, M., Brodrick, P., & Labbate, L. (2001). Gabapentin in PTSD: A Retrospective, Clinical Series of Adjunctive Therapy. Annals of Clinical Psychiatry, 13, 141-146.
  8. Yasmin, S., Carpenter, L., Leon, Z., Siniscalchi, M., & Price, L. (2001). Adjunctive Gabapentin in Treatment- Resistant Depression: A Retrospective Chart Review. Journal of Affective Disorders, 63(1-3), 243-247.
  9. Berlin, R., Butler, P., & Perloff, M. (2015). Gabapentin Therapy in Psychiatric Disorders: A Systematic Review. Prim Care Companion, 17(5).
  10. Leung, J., Hall-Flavin, D., Nelson, S., Schmidt, K., & Schak, K. (2015). The Role of Gabapentin in the Management of Alcohol Withdrawal and Dependence. Ann Pharmacother, 49(8), 897-906.
  11. Attupurath, R., Aziz, R., Wollman, D., Muralee, S., & Tampi, R. (2009). Chorea Associated with Gabapentin Use in an Elderly Man. Am J Geriatr Pharmocather, 7(4), 220-224.
  12. Fleet, J., Dixon, S., Kuwornu, P., Dev, V., Montero-Odasso, M., Bureno, J., & Garg, A. (2018). Gabapentin Dose and the 30- day Risk of Altered Mental Status in Older Adults: A Retrospective Population Based Study. Plos One, 3(14).
  13. Steingard, L., Cesena, M., Helmers, S., Riviello, J., & Mikati, M. (1996). Behavioral Side Effects of Gabapentin in Children. Epilepsia, 7(3).

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