Gabapentin Review: The Best Seizure Medication?

Gabapentin Review: The Best Seizure Medication?


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Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.

Gabapentin is one of the most commonly-prescribed medications in the world, and is FDA-approved to treat seizures and relieve pain.

But is the drug actually proven in research trials to reduce seizures, treat conditions like epilepsy and reduce pain? Does gabapentin have any concerning side effects? Can it relieve anxiety? And how do real users rate and describe the effects of gabapentin?

In this article we’ll answer all of these questions and more as we review clinical studies on gabapentin to determine whether or not the drug is effective, document its side effects, explain whether it can be used to treat anxiety and whether it's addictive and share real, unsponsored user reviews of gabapentin.

Does Gabapentin Decrease Seizures and Pain?

Gabapentin has been studied extensively in clinical trials for both seizures and pain.

clinical trial from 2003 examined the efficacy of gabapentin for the treatment of epilepsy, which is a condition that causes seizures. 

Patients were prescribed either gabapentin at 1,200 milligrams (mg) per day, gabapentin at 1,800 mg per day or a placebo pill. Over 20% of patients in the higher-dose group responded to the drug, which means they experienced a clinically significant reduction in seizures.

A separate medical trial tested whether gabapentin was effective for treating seizures in children. A group of children who experienced regular seizures were prescribed gabapentin. Around 50% of the children taking gabapentin experienced a 25% or greater reduction in seizures.

By the end of the trial, two of the children (out of 32 total) taking gabapentin had a total reduction in their symptoms and were seizure-free, and four of them were only experiencing seizures once every few months (categorized as “almost seizure-free”).

A medical review published in the JAMA journal examined data from various clinical trials on gabapentin for pain relief. The study authors documented that at a minimum daily dose of 1,200 mg, 32% of patients reported "substantial benefit" in terms of pain reduction.

We will conclude from the available research that gabapentin is effective for treating seizures and pain.

Gabapentin Side Effects

Gabapentin does cause side effects in some patients.

In 2019 the FDA published a warning letter about gabapentin side effects, indicating to patients that the medication may cause serious breathing problems. The letter detailed that patients with “respiratory risk factors” such as chronic obstructive pulmonary disease (COPD) were at risk of this side effect. 

A medical review published in the American Journal of Geriatric Psychiatry documented the most common side effects from pooled clinical trials.

20.2% of patients at a dose under 1,800 mg experienced dizziness, and 14.9% of patients in that dosing range experienced drowsiness. 7.5% of patients taking gabapentin at a dose at or above 1,800 mg experienced peripheral edema (swelling of the extremities).

Another side effect reported in a separate medical review of gabapentin is myoclonus. This is the medical term for muscle jerking. The researchers report that 1.9% of patients taking gabapentin experienced this side effect, but that it was resolved when medication was stopped, suggesting this effect is reversible.

Clearly gabapentin confers the risk of some serious side effects, but the drug's FDA label is free of a "black box" warning, which is notable because this is the most severe type of warning issued by the FDA that indicates life-threatening side effects.

Real, Unsponsored User Review of Gabapentin

One of the most popular YouTube reviews of gabapentin comes from a creator named "NicoleForReal" who documents her experience taking the drug for pain, and explains the benefits and side effects she experienced:

Can Gabapentin Treat Anxiety?

Gabapentin has been studied for the treatment of anxiety disorders.

clinical trial from 2012 tested the efficacy of gabapentin for anxiety reduction in breast cancer survivors. Patients taking either 300 mg or 900 mg of gabapentin daily experienced significant reductions in anxiety after four weeks, and the reductions were even greater between weeks four to eight.

A separate case study published in the Case Reports for Psychiatry medical journal documented a 59 year old woman who was prescribed gabapentin for anxiety. The drug was effective in treating her generalized anxiety disorder (GAD) symptoms.

We do not recommend taking gabapentin for anxiety alone, as the drug is not approved for the treatment of anxiety disorders. However, this early research suggests that gabapentin may be especially effective for patients with seizures and anxiety or pain and anxiety, because the potential for anxiety reductions could be seen as a secondary benefit of the drug.

Gabapentin Dosage

Gabapentin is prescribed at a wide range of doses depending on condition and severity of condition. StatPearls, which is a free medical database lists the dosing for seizure to range between 300 mg and 1,200 mg taken three times per day, which results in a cumulative daily dose between 900 mg and 3,600 mg.

The dose is lower for those prescribed gabapentin for fibromyalgia, ranging 400 mg to 800 mg taken three times daily, resulting in a cumulative daily dose between 1,200 and 2,400 mg.

Gabapentin is also prescribed for neuropathic pain, which is the medical term for nerve pain which can affect nerves throughout the body. The dose range for this condition is the same as the dose range for seizures: between 900 mg and 3,600 mg per day, divided into three oral doses.

A medical study documents that gabapentin is cleared via renal (kidney) excretion, so dosage is typically lower for patients with kidney disease, so as not to overburden the kidneys.

Gabapentin Interactions

Gabapentin may interact with various other drugs, as detailed on its FDA label.

The label contains a “Drug Interactions” section which indicates that gabapentin may interact with hydrocodone and morphine, which are both opioids. This suggests that patients taking gabapentin should be sure to indicate such if they receive treatment in urgent care or an emergency room, because both opioids listed can be used in these settings.

Gabapentin also interacts with an over-the-counter (OTC) antacid called Maalox. The antacid reduces the bioavailability of gabapentin by 20%, which may make the drug less effective.

Gabapentin may also interact with urinary protein tests. The gabapentin label states that the drug can cause false positive readings on a specific dipstick test for urinary protein levels, which suggests that patients taking gabapentin should be sure to notify their doctor before taking any test for urinary protein to ensure accurate results.

Is Gabapentin Addictive?

Whether or not a drug is addictive is a complex medical issue, because it can vary so much patient-to-patient. An extremely thorough medical review analyzed the addictive potential of gabapentin by examining results from 106 clinical trials on the drug.

The researchers concluded the following: 

We did not find convincing evidence of a vigorous addictive power of gabapentinoids which is primarily suggested from their limited rewarding properties, marginal notes on relapses, and the very few cases with gabapentinoid-related behavioral dependence symptoms (ICD-10) in patients without a prior abuse history.”

A separate study suggested that gabapentin could induce drug-seeking behavior due to its effects on dopamine, which is a neurotransmitter associated with pleasure and reward seeking. However, this study used an animal model so the quality of evidence is lower than the previous study which examined human data.

We recommend that patients with a history of addiction speak with their doctor about the risks of gabapentin’s addictive potential, because the risk seems higher in those who are genetically predisposed to addiction.

Can Gabapentin Cause Withdrawal Symptoms?

Gabapentin can cause withdrawal symptoms, and is documented to do so in some patients. A case report published in the Annals of Pharmacotherapy journal documents a 76 year old woman who developed akathisia while withdrawing from gabapentin. This condition refers to the inability to remain still, and can be quite uncomfortable. The condition eventually resolved itself after 3 days.

Another medical review documents 18 case reports of patients who experienced addiction to or withdrawal symptoms from use of gabapentin. The study authors listed “a history of alcohol or substance abuse” as a risk factor for dependence issues.

Withdrawal symptoms varied, but the most common were confusion and disorientation (experienced in 45% of withdrawal cases), excessive sweating (36%) and gastrointestinal symptoms (23%).

Because gabapentin can cause discomforting withdrawal symptoms, it’s important for patients considering stopping use of the medication to speak with their doctor first, because tapering off according to medical standards can make the quitting process safer and less painful. 

A YouTube channel called "Veterans With Anxiety" published a review of gabapentin withdrawals that they personally experienced:

Does Gabapentin Cause Weight Gain?

Use of gabapentin is associated with weight gain on average. A medical review titled “Drugs Commonly Associated With Weight Change” which was published in the well-respected JECM journal documents that gabapentin is associated with average weight gain of 4.85 pounds after 1.5 months of use.

It’s unclear what causes this association, and whether gabapentin is directly the cause of weight gain or if it causes downstream biological effects which cause weight gain.

This data suggests that overweight and obese patients may wish to speak with their doctor about alternative seizure or pain medications that are not associated with weight gain in clinical research.

Can I Drink Alcohol While Using Gabapentin?

Gabapentin’s FDA label, which we linked to earlier, also notes there are contraindications of using alcohol while on the drug. Alcohol should not be used while taking gabapentin unless approved otherwise by a doctor.

Gabapentin is sometimes prescribed for reducing alcohol cravings and ameliorating dependence on alcohol. A clinical study on gabapentin for treating alcohol dependence found that the drug was effective.

Only 4.1% of alcoholic patients on a placebo pill were able to fully abstain from alcohol use during the trial, while 11.1% of patients taking 900 mg gabapentin and 17% of patients taking 1,800 mg gabapentin were able to fully abstain.

This research suggests that for patients who are able to abstain from alcohol use while on gabapentin, the drug may reduce alcohol cravings which can aid sobriety efforts. However, it's important that patients have an honest discussion with their doctor about whether they will be able to totally refrain from alcohol use while taking gabapentin, since there is a negative interaction between the two substances that can be dangerous.

Is The Branded Version of Gabapentin More Effective?

Gabapentin is the generic version of the drug, and the brand-name version is called Neurontin. These two drugs have the exact same active drug ingredient.

We typically recommend that patients speak with their doctor about the generic version of drugs.

A medical study examined whether gabapentin or Neurontin was more effective, and the researchers determined that the drugs were equally effective. 

At the time of updating this article, the retail price of Neurontin according to SingleCare is $489.87, while the retail price of generic gabapentin is as low as $11 according to GoodRx.

Is Gabapentin a Controlled Substance?

Gabapentin has a unique legality for a pharmaceutical medication. A controlled substance means a substance with federal restrictions on how it can be prescribed and handled.

Gabapentin is not a controlled substance federally, according to the Drug and Enforcement Agency (DEA). However, the medication is a controlled substance in an increasing number of states.

A Pharmacy Today review indicates that gabapentin is a controlled substance in the following states: Alaska, Kentucky, Michigan, North Dakota, Tennessee, Virginia and West Virginia.

There’s also been a recent push by both the FDA and the DEA to make gabapentin a federally controlled substance due to potential for abuse and misuse.

We recommend that patients in states where gabapentin is a controlled substance speak with their doctor about their state's laws regarding the drug, to ensure that they are not at risk of any legal action based on the quantity of gabapentin they may possess at any given time.

Can Gabapentin Be Used For Dogs?

Because older dogs often suffer from seizures and nerve pain, people are often curious about whether gabapentin can be used in dogs.

It can be difficult to measure pain in animals, but a clinical trial on gabapentin for post-operative pain management in dogs attempted to do so. The researchers used morphine administration as a proxy for the dogs’ pain: more morphine required suggested more pain, and less morphine required suggested less pain.

The dogs in the study were given morphine based on whether they were agitated and in visible distress, which is how the vets qualified pain. The dogs receiving gabapentin required significantly less morphine, suggesting that gabapentin may be effective for reducing pain in dogs.

A separate clinical trial evaluated the effects of gabapentin on dogs with seizures. 6 of the 11 dogs studied experienced a positive response to the drug, with the average number of seizures per week and the average number of days without a seizure per week decreasing by the end of the study.

These medical results suggest that gabapentin may be effective for treating seizures and pain in dogs, but we strongly recommend only giving gabapentin to a dog if the medication is prescribed by a veterinarian. Dosage differs between humans and dogs, and there may be other medical considerations that would put an animal’s life at risk if their owner were to give the animal a human dose of gabapentin.

A YouTube video published by a veterinarian explained the uses of gabapentin for dogs as well as the drug's safety:

How Does Gabapentin Work?

Researchers don’t understand exactly how gabapentin works. Even StatPearls describes gabapentin’s mechanism of action in the following way: “The exact mechanism of action with the GABA receptors is unknown.”

Sometimes pharmaceutical compounds can be found effective based on clinical trials without scientists knowing their exact biochemical effect. If a drug causes patients’ mood to improve by 30%, it may qualify for approval to treat depression even if researchers are unclear how it works.

The brain is incredibly complex, and there are millions of synergies and interactions between different chemicals and electrical signals, and sometimes it can be challenging to parse out exactly what downstream effects a medication causes.

A separate medical review suggested that gabapentin may work by modifying the function of voltage-sensitive calcium channels in the brain, but this is not conclusively proven.

Stay up-to-date on our research reviews

Conclusion

Gabapentin is effective for treating seizures and pain. The medication may also be effective for reducing anxiety and reducing desire to drink alcohol, but these are potential secondary benefits of the drug that are not approved by the FDA for standalone treatment.

Gabapentin causes side effects including sleepiness and swelling of the extremities in some patients. It also may cause breathing problems in patients predisposed to respiratory illness.

The drug may be effective for treating seizures in dogs, but should only be used in dogs if prescribed by a vet.

We recommend that patients speak with their doctor about generic gabapentin over its branded alternatives like Neurontin, because the two drugs should be equally effective but gabapentin may be significantly cheaper.




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