Overview Of Gabapentin

Gabapentin is an anticonvulsant that is mainly used to prevent partial seizures in children and adults. Some brands are specifically formulated to treat pain associated with neuropathy caused by shingles. Gabapentin can be taken as a liquid or as an immediate-release or extended-release tablet. It first became available in the United States in 1993, and the generic form was first available in 2004. A standard adult dosage of gabapentin for the treatment of epilepsy varies between nine hundred and 1800 milligrams, and the maximum recommended daily dosage is 3600 milligrams. For the treatment of neuropathy, the maximum recommended dosage is 1800 milligrams per day, and individuals who use gabapentin for restless legs syndrome typically take one dose of six hundred milligrams each evening.

Class Of Medication

Gabapentin belongs to the anticonvulsant class of medication. As an anticonvulsant, it works by calming the hyperactivity in the brain that occurs with epilepsy, restless legs syndrome, migraines, and nerve damage that results from shingles. Gabapentin is available in various formulations. Some of these are intended specifically for use in the treatment of pediatric and adult seizures, and other forms are used to treat restless legs syndrome and nerve pain. Patients should ensure they use the form of gabapentin their doctor has prescribed, and this should be rechecked at each prescription refill.

Common Uses

Gabapentin is approved for the treatment of partial-onset seizures in adults and children over three years old. The medication is effective in treating both focal seizures and mixed seizures, but there is insufficient evidence to support its use as a treatment for generalized epilepsy. Gabapentin is available in several different brand names, and some of these are specifically intended to treat restless legs syndrome and shingles-related neuropathy.

Doctors will prescribe the appropriate brand of gabapentin for the patient's specific condition. Brands of gabapentin are not interchangeable with each other, and patients should ask their doctor whether they need to take their tablets with or without food. When used for epilepsy treatment, patients transitioning from gabapentin to another drug will need to taper off their dose over at least one week to avoid withdrawal symptoms. This should only be done under medical supervision.

Uncommon Uses

According to current estimates, approximately ninety percent of gabapentin prescriptions are used for uncommon, 'off-label' purposes. For example, it is sometimes prescribed for central pain, pain associated with diabetic neuropathy, and neuropathic pain related to cancer. In the past, it has been used as a treatment for chronic low back pain, and it was also prescribed for complex regional pain syndrome and pain relief for post-surgical joint replacements. It was also used to prevent migraines in adults. However, evidence suggests using gabapentin for these conditions is largely ineffective.

Currently, off-label uses of gabapentin that have shown some benefit include its use in the relief of itching, including itching caused by kidney failure. It is often considered as an option in the treatment of essential tremor, and it may be prescribed to help ease symptoms of alcohol withdrawal. In the area of mental health, gabapentin is used for treating anxiety disorders and borderline personality disorder.

Common Side Effects

Commonly reported side effects of gabapentin include fever, viral infection, nausea, and vomiting. Patients have also frequently reported dizziness, ataxia (clumsiness), jerky movements, and trouble speaking. Uncontrolled, continuous eye movements have occurred as well. Children who use gabapentin are more likely to experience anxiety, aggressive behavior, emotional overreaction, and hyperactivity. They may develop rapidly changing moods, distrust, and restlessness, and changes in school performance might be present. Drowsiness, sedation, and fatigue are very common in both children and adults.

Since these side effects could be troubling, patients are advised to talk to their healthcare provider about any issues that arise. It may be necessary to take additional medication to treat the mental health side effects associated with gabapentin, and doctors might also recommend counseling. Since gabapentin can affect the movement of the eyes in various ways, patients might also want to have regular eye exams while taking this medicine.

Rare Side Effects

Gabapentin can cause suicidal thoughts, and patients and their families should be vigilant for any signs of mood changes, anxiety, thoughts of dying, or suicidal actions. Patients having suicidal thoughts should seek support from a counselor, and it may be necessary to seek emergency treatment. In addition to this side effect, other rare side effects of gabapentin include chest pain, cough, chills, black or tarry stools, and painful urination. Patients have reported loss of memory, shortness of breath, swollen glands, and unusual bleeding as well.

Some individuals who take gabapentin could develop sores or ulcers on the lips or the inside of the mouth. The arms and legs could ache or swell while on this medicine. Patients should consult a doctor if they notice pain in the lower back or side, loss of strength, dementia, hoarseness, or delusions while on gabapentin. They should also check with a physician if they observe an increased sensitivity to touch or pain.

Precautions To Remember

Patients who use gabapentin for the treatment of epilepsy will often need to start on a low dose and gradually work up to a higher dose. This process should be done with medical guidance. Patients who take gabapentin tablets will need to swallow it whole for it to be effective. The dizziness and drowsiness that can occur with gabapentin may increase a patient's risk for falls and serious injuries. While using this medicine, individuals should be very careful when going up and down stairs, and any loose rugs or other potential fall hazards should be removed from the home.

Patients who take antacids will need to take these at least two hours before or after taking gabapentin. Alcohol should not be consumed during treatment because it could worsen the drowsiness and dizziness. Gabapentin is known to interact with narcotic pain relievers, antihistamines, antidepressants, anti-anxiety medicines, sedatives, and antipsychotics. Patients should let their doctor know about all of the medicines they take before gabapentin is prescribed, and the doctor should check for any potential drug interactions.

Who Shouldn't Take Gabapentin

Gabapentin is not safe for everyone. Before prescribing this medication, doctors will need to know if the patient has a history of cardiovascular disease, liver disease, or kidney disease, and the patient should inform the physician if they are on dialysis. Patients should also let their doctor know if they have ever experienced a seizure and if they have any type of diabetes. Gabapentin triggers suicidal thoughts in some who take it, and patients should tell their doctor if they have previously experienced suicidal thoughts or suicide attempts.

The doctors need to know if the patient has had depression or any type of mood disorder as well. Patients may not be able to take gabapentin with antidepressants or with medicines that cause sedation, and they should tell their physician about all of the medicines they use. Individuals who have restless legs syndrome need to inform their doctor if they work the night shift or if they sleep during the daytime. Patients who are pregnant or breastfeeding should let their doctor know as this information is crucial in the decision to prescribe gabapentin. Gabapentin is not recommended for use in children under three years old, and elderly patients may need to use it with caution.

Medication Interactions

Gabapentin can interact with more than one hundred medications. It has particularly strong medication interactions with opiate pain relievers such as morphine and hydrocodone-acetaminophen. It also has severe interactions with sodium oxybate and medicines that depress the respiratory system. If these medicines are taken together, patients could experience loss of coordination, and they might become confused or agitated. They could become excessively sleepy, and they might start sleeping longer than they normally would at night. The patient's respiratory rate could slow too.

Moderate interactions are known to exist between gabapentin and medicines containing aluminum or magnesium. Aluminum and magnesium both decrease the amount of gabapentin absorbed by the body. If these medicines are taken with gabapentin, patients could have an increase in seizures. To reduce this risk, patients who use gabapentin are typically advised to take antacids and other products containing aluminum or magnesium at least two hours before taking gabapentin. Patients who take naproxen sodium with gabapentin could experience excessive sleepiness and gastrointestinal issues, and they should speak to their physician before using these medicines together.

Commonly Prescribed Alternatives

If gabapentin is not an option, doctors may consider prescribing other medications to treat the patient's condition. Commonly prescribed alternatives for nerve pain include duloxetine and pregabalin. When gabapentin cannot be used for the prevention and control of seizures, neurologists may choose to prescribe other anticonvulsants such as levetiracetam, Divalproex, lamotrigine, or carbamazepine. Patients may need to take a combination of several medicines to control their symptoms, and they might have to try several different combinations of anticonvulsants to find one that is effective and tolerable.

Patients should always ask their doctor about all of the possible medication options for their particular health situation. They should ensure they are informed about potential benefits and side effects for each of the medications. If a medicine causes side effects that significantly affect the patient's quality of life, they should speak to the neurologist about the possibility of trying alternatives.

Dosage Factors

The proper dose of gabapentin will vary for each patient. Factors such as the patient's weight and age, as well as the severity of the condition being treated will all be considered. Patients typically begin this medication with a lower dose for the first few weeks, and the dose is gradually increased over time until the recommended maintenance dose is reached. For example, adults with epilepsy will usually begin by taking three hundred milligrams of gabapentin on the first day of their treatment. On the second day, they will take six hundred milligrams, and the third day will include nine hundred milligrams of gabapentin. After this time, the normal maintenance dose will be set somewhere between nine hundred to 1,800 milligrams per day.

Patients will typically take the maintenance amount in several doses throughout the day. Each dose will be between three to six hundred milligrams. Individuals who use gabapentin for restless legs syndrome generally take six hundred milligrams per day, and this is taken at around 6 p.m. Patients with renal dysfunction will need to have their dose adjusted based on their CrCL levels. When discontinuing this drug, the patient may need to taper the dose over at least one week to avoid potential side effects.