Category: Gabapentin

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.

Indigestion remedies (antacids) containing aluminium or magnesium may reduce the absorption of gabapentin from the gut. Indigestion remedies should therefore not be taken at the same time as a dose of gabapentin, or in the two hours before a dose.

It is recommended that people who are taking any antiepileptic medicines should avoid taking the herbal remedy St John’s wort (Hypericum perforatum). This is because St John’s wort may affect the level of antiepileptic medicines in the blood and could increase the risk of seizures.

This medicine is not known to interact significantly with other medicines. However, if it makes you feel sleepy or dizzy, this effect is likely to be increased if you take it in combination with other medicines that can cause drowsiness, in particular morphine, or with alcohol. If you are prescribed morphine in combination with gabapentin you should let your doctor know if it makes you feel sleepy, or if any drowsiness gets worse.

This medicine does not affect hormonal contraceptives such as the pill.

Other medicines containing the same active ingredient

Gabapentin tablets and capsules are also available without a brand name, ie as thegeneric medicine.

Gabapentin has been recommended as a possible treatment for migraines by the National Institute for Health and Care Excellence (NICE), but recent research has suggested it may not be effective in preventing attacks and concerns have been raised about the quality of earlier research into the medication.

 

Neuropathic pain is a common and potentially treatable cause of considerable lifelong morbidity. Effective pharmacological treatments are scarce, but one group of drugs that has shown promise is the antiepileptics.

Gabapentin has become popular as a first-line treatment for neuropathic pain because of its efficacy as an antineuropathic agent and relatively benign side-effect profile. However, its mechanism of action is far from clear.

Neuropathic pain is pain coming from damaged nerves. It differs from pain messages carried along healthy nerves from damaged tissue (a fall, cut, or arthritic knee). Neuropathic pain is treated by different medicines than pain from damagedtissue. Medicines like paracetamol or ibuprofen are not effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain. Our understanding of fibromyalgia (a condition of persistent, widespread pain and tenderness, sleep problems, and fatigue) is poor, but fibromyalgia can respond to the same medicines as neuropathic pain.

Glutamate is also involved in transmitting pain signals in the brain and nervous system. As gabapentin reduces the release of this neurotransmitter it can also be used to treat nerve pain occuring as a result of damage to or a disturbance in the function of nerves (neuropathic pain)

The way in which gabapentin works is not fully understood. It is thought to work by binding to calcium channels found on nerve cells in the brain and spinal cord. This is thought to affect the release of various neurotransmitters from these nerve cells.

Neurotransmitters are natural body chemicals that are stored in nerve cells. They are involved in transmitting messages between the nerve cells. Gabapentin is thought to reduce the release of a neurotransmitter called glutamate.

Glutamate is a neurotransmitter that acts as a natural ‘nerve-exciting’ agent. It is released when electrical signals build up in nerve cells and subsequently excites more nerve cells. It is thought to play a key role in causing epileptic seizures. Reducing the release of glutamate from the nerve cells in the brain is thought to help stabilise the electrical activity in the brain and prevent epileptic fits.

Gabapentin is used to prevent partial seizures, and partial seizures that spread to secondary generalised seizures.

Glutamate is also involved in transmitting pain signals in the brain and nervous system. As gabapentin reduces the release of this neurotransmitter it can also be used to treat nerve pain occuring as a result of damage to or a disturbance in the function of nerves (neuropathic pain). It probably works in other ways in this area as well.

Gabapentin may also be used to treat other nerve pain conditions (such as diabetic neuropathy, peripheral neuropathy, trigeminal neuralgia) and restless legs syndrome.

Diabetes can harm your nerves. That damage, called neuropathy, may be painful. It can happen in several ways, and they all seem to be related to blood sugar levels being too high for too long. To prevent it, work with your doctor to manage your blood sugar.  You may hear your doctor mention the four types of diabetes-related neuropathy: peripheral, autonomic, proximal, and focal.

Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials.

BACKGROUND:

Pain is one of the most common reasons for seeking medical attention, and neuropathic pain is among the most common types of pain. Despite its prevalence, neuropathic pain is often underrecognized and inadequately treated. Many cases are refractory to the medications traditionally used for pain, such as nonsteroidal anti-inflammatory drugs. Tricyclic antidepressants are considered first-line agents for neuropathic pain, but their use is limited by unwanted side effects and a risk of cardiovascular mortality.

OBJECTIVES:
The goals of this article were to review data on the efficacy and tolerability of gabapentin in the treatment of neuropathic pain in adults and to determine the optimal dosing schedule.

METHODS:
Randomized controlled studies of gabapentin for neuropathic pain were identified through a search of PubMed and MEDLINE from 1966 to the present using the search terms gabapentin, randomized, placebo, and pain. Abstracts of identified articles were screened for study size (>100 patients per treatment arm) and use of appropriate efficacy measures. A separate review based on information provided by the manufacturer of gabapentinaand clinical trial Web sites was conducted to ascertain whether there had been any other relevant industry- or government-sponsored trials. The manufacturer provided additional unpublshed study data.

RESULTS:
Data from 5 randomized, placebo-controlled trials were included in the review, 1 of which has not yet been published. Gabapentin was effective in the treatment of painful diabetic neuropathy, postherpetic neuralgia, and other neuropathic pain syndromes. It relieved symptoms of allodynia, burning pain, shooting pain, and hyperesthesia. Adverse effects were typically mild to moderate and usually subsided within approximately 10 days from the initiation of treatment. Based on available data, it appears that treatment should be started at a dose of 900 mg/d (300 mg/d on day 1, 600 mg/d on day 2, and 900 mg/d on day 3). Additional titration to 1800 mg/d is recommended for greater efficacy. Doses up to 3600 mg/d may be needed in some patients. The effective dose should be individualized according to patient response and tolerability.

CONCLUSION:
At doses of 1800 to 3600 mg/d, gabapentin was effective and well tolerated in the treatment of adults with neuropathic pain.

Restless legs syndrome (RLS) symptoms include an unpleasant feeling or sensation when going to sleep and a strong urge to move. The movement makes it hard or impossible to get enough sleep.

There are no cures for primary restless legs syndrome, or RLS, although various treatments often can help relieve symptoms. Treatment for secondary restless legs syndrome (RLS caused by another medical problem) involves treating the underlying cause.

The following medications are the most widely prescribed to treat RLS. They may be given alone or, in certain cases, in combination. Your doctor will prescribe the best treatment plan for you.

• Dopamine agonists: These are most often the first medicines used to treat RLS. These drugs, including pramipexole (Mirapex),rotigotine (Neupro), and ropinirole (Requip), act like the neurotransmitter dopamine in the brain. Side effects include daytime sleepiness, nausea, and lightheadedness.
• Dopaminergic agents: These drugs, including Sinemet — a combination of levodopa and carbidopa — increase the level of dopamine in the brain and may improve leg sensations in RLS. However, they may cause a worsening of symptoms for some people after daily use. Side effects can also include nausea, vomiting, hallucinations, and involuntary movements (dyskinesias).
• Benzodiazepines: Benzodiazepines, such as alprazolam (Xanax),clonazepam (Klonopin), and temazepam (Restoril), are sedatives. They do not so much relieve symptoms as help you sleep through the symptoms.
• Opiates: These drugs are most often used to treat pain, but they can also relieve RLS symptoms. Because opiates are very addictive, they are usually used only when other drugs don’t work. Hydrocodone(Vicodin, Norco) is one example.
• Anticonvulsants: These agents, such as gabapentin (Neurontin) and gabapentin enacarbil (Horizant), may help relieve the symptoms of RLS as well as any chronic pain or nerve pain.
• Alpha2 agonists: These agents stimulate alpha2 receptors in thebrain stem. This activates nerve cells (neurons) that “turn down” the part of the nervous system that controls muscle involuntary movements and sensations. The drug clonidine (Catapres) is an example.

To provide information regarding the effects of in utero exposure to gabapentin, physicians are advised to recommend that pregnant patients taking gabapentin enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry.

This can be done by calling the toll free number 1-888-233-2334, and must be done by patients themselves. Information on the registry can also be found at the website http://www.aedpregnancyregistry.org/. Limited observations have suggested an active transplacental transport of gabapentin, with accumulation in the fetus as a consequence.

Gabapentin has been assigned to pregnancy category C. Animal studies have revealed evidence of fetotoxicity involving delayed ossification in several bones of the skull, vertebrae, forelimbs and hindlimbs. Hydroureter and hydronephrosis have also been reported in animal studies. There are no controlled data in human pregnancy. Gabapentin should only be given in pregnancy when benefit outweighs risk.

Gabapentin Breastfeeding Warnings

Gabapentin is secreted into human milk following oral administration. A nursing infant may be exposed to a maximum dose of approximately 1 mg/kg/day of gabapentin. Because the effect on the nursing infant is unknown, gabapentin should be used in women who are nursing only if the benefits clearly outweigh the risks.

No. Gabapentin use and abuse is not associated with compulsive, drug-seeking behavior or strong cravings that indicates addiction. But what can you expect if you are physically dependent on gabapentin? What kind of withdrawal symptoms occur when you stop taking this medication?

Questions About Gabapentin Dependency

If you concerned about the long-term effects of taking gabapentin, talk to your doctor about reducing your dose on a tapered schedule so that you can avoid withdrawal symptoms. Common withdrawal symptoms can occur during acute detoxification and include:

• anxiety
• insomnia
• nausea
• pain
• sweating
• temporary increase in seizure symptoms

How Do You Develop A Dependence On Gabapentin?

Taking gabapentin long-term is enough to develop a physical dependence on this type of medication. If you are taking gabapentin for a chronic condition such as epilepsy, your doctor can help you judge whether the potential for a physical dependence outweighs the symptoms it treats.

What Does Gabapentin Do In The Body?

Gabapentin decreases abnormal excitement of the brain and changes how the body feels pain. No one is exactly sure how gabapentin produces analgesic or anticonvulsant effects on the body. It’s possible that it interacts with receptor sites in the brain, but none have yet been found. While the mechanism of action is not known, studies have shown it to be effective in treating a variety of illnesses.

Gabapentin is an anti-epileptic medication, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain.

Gabapentin is used in adults to treat nerve pain caused by herpes virus or shingles (herpes zoster).

The Horizant brand of gabapentin is also used to treat restless legs syndrome (RLS).

The Neurontin brand of gabapentin is also used to treatseizures in adults and children who are at least 3 years old.

Gabapentin is not a narcotic, it is actually an anticonvulsant that can also help with certain forms of nerve pain.

It may cause side effects, such as nausea, dizziness and weight changes.

To determine whether Neurontin is a narcotic, let’s decipher the informal definition of “narcotic.”  According to a general dictionary, a “narcotic” is considered:

A drug or substance affecting mood or behavior and sold for nonmedical purposes – especially an illegal one. 

Does Neurontin affect mood or behavior and is it sold for nonmedical purposes (e.g. intoxication)?  Let’s break it down.

• Neurontin (Gabapentin) and mood: Many users report that Gabapentin has a “mood boosting” effect. Due to its mechanism of action, most people report feeling noticeably more calm and relaxed upon ingestion of Gabapentin.  Though relaxation may not be interpreted as a mood change per se, the act of physiological relaxation can certainly influence or alter mood.  Recreational users taking the drug at doses exceeding 600 mg report noticing a subtle degree of euphoria.
• Neurontin (Gabapentin) and behavior: While Gabapentin may not have a noticeable effect on behavior, many individuals report that the drug lowers inhibitions, making them more social. This may result in riskier behavior when taken at high, supratherapeutic doses.  An individual may become noticeably more calm in their demeanor and actions upon ingestion of Gabapentin.
• Sold for nonmedical purposes: The majority of Gabapentin sales are for medical purposes such as neuropathic pain and epilepsy. That said, the drug may be attained by an individual for an off-label condition and sold to friends, family members, or strangers.  The selling of the drug is done by individuals to make money, and the buyer purchases the drug often with the intention of getting “high.”
• Legal status: Although Gabapentin is considered a “legal” prescription drug when attained via doctor’s prescription, it is considered illegal to possess without a prescription. That said, it isn’t considered a “controlled-substance” and is therefore easier to obtain.  It is even easier to obtain than its successor Lyrica; a similar drug with greater potency and a Schedule V classification.

Based on the informal dictionary definition, Neurontin (Gabapentin) could be interpreted as fitting the criteria of a “narcotic.”  The drug is certainly capable of altering both mood and behavior, and is commonly sold for nonmedical purposes (e.g. intoxication).  When the drug is attained via a doctor’s prescription and used correctly, it is not regarded as a “narcotic.”

Gabapentin does not fit the necessary legal criteria to be classified as a “narcotic” in the United States.  The legal criteria for “narcotic drugs” in the United States are: any substances totally prohibited or used in violation of governmental regulation (e.g. morphine).  For example, morphine can be used under medical supervision and considered legal.

In a hospital setting, morphine would be considered a legal narcotic.  When obtained and administered outside of a formal hospital setting without medical consent, morphine would be regarded as an illicit narcotic. Unlike morphine, Gabapentin is not regarded in the United States as a “controlled-substance.”

Therefore it should NOT be regarded as a “narcotic” according to the legal definition.  The penalties associated with unauthorized possession and/or sale of a narcotic substance are far more harsh than those associated with the unauthorized possession and/or sale of a prescription drug.

 

Restless legs syndrome (RLS) is a disorder of the nervous system (the system consisting of your brain, spinal cord, and nerves).  Currently, there is no cure for RLS.  However, lifestyle changes, nonmedicine treatments, and medicines may relieve symptoms and help you sleep better.

Several types of medicines have been used to treat RLS, including those listed below.

• Dopamine agonists: These medicines work by affecting the level of a chemical called dopamine in your brain. Dopamine agonists studied in the research for this summary include:
  • Pramipexole (Mirapex^®)*
  • Ropinirole (Requip^®)*
  • Rotigotine (Neupro^®) skin patch*
• Antiseizure medicines: These medicines are usually used to stop seizures and nerve pain. You do not have to have seizures to take this type of medicine. Antiseizure medicines studied in the research for this summary include:
  • Pregabalin (Lyrica^®)
  • Gabapentin (Neurontin^®)
    
  • Gabapentin enacarbil (Horizant^®)*
• Iron: Iron is usually given to people who have too little iron in their body. Iron can be taken as a pill or given through an intravenous (IV) tube in your arm.
  • Taking too much iron can be dangerous, so it is important to talk with your doctor before taking iron.