What is the Side Effects and Interaction of Gabapentin (Neurontin ) ?

Gabapentin is a prescription medicine that’s used to treat partial seizures in adults and children who are at least 3 years old.

More commonly, it’s prescribed for nerve pain that’s caused by herpes-family viruses (for which it is approved by the U.S. Food and Drug Administration) or other causes for which it is prescribed “off-label.”

Gabapentin is in a class of drugs called anticonvulsants. The medicine works by calming excitement in the brain and changing the way your body senses pain.

Different brands of gabapentin are given for specific medical conditions. It’s important that you only take the brand name that your doctor prescribes.

The FDA approved this medicine in 1993.

What is the Side Effects of Gabapentin ?

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

      1. Clumsiness or unsteadiness
      2. continuous, uncontrolled, back-and-forth, or rolling eye movements

More common in children

      1. Aggressive behavior or other behavior problems
      2. anxiety
      3. concentration problems and change in school performance
      4. crying
      5. depression
      6. false sense of well-being
      7. hyperactivity or increase in body movements
      8. rapidly changing moods
      9. reacting too quickly, too emotional, or overreacting
      10. restlessness
      11. suspiciousness or distrust

Less common

      1. Black, tarry stools
      2. chest pain
      3. chills
      4. cough
      5. depression, irritability, or other mood or mental changes
      6. fever
      7. loss of memory
      8. pain or swelling in the arms or legs
      9. painful or difficult urination
      10. sore throat
      11. sores, ulcers, or white spots on the lips or in the mouth
      12. swollen glands
      13. unusual bleeding or bruising
      14. unusual tiredness or weakness

Incidence not known

      1. Abdominal or stomach pain
      2. blistering, peeling, or loosening of the skin
      3. clay-colored stools
      4. coma
      5. confusion
      6. convulsions
      7. dark urine
      8. decreased urine output
      9. diarrhea
      10. difficult or troubled breathing
      11. dizziness
      12. fast or irregular heartbeat
      13. headache
      14. increased thirst
      15. irregular, fast or slow, or shallow breathing
      16. itching or skin rash
      17. joint pain
      18. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
      19. loss of appetite
      20. muscle ache or pain
      21. nausea
      22. pale or blue lips, fingernails, or skin
      23. red skin lesions, often with a purple center
      24. red, irritated eyes
      25. unpleasant breath odor
      26. vomiting of blood
      27. yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common Side Effects of Gabapentin

      1. Blurred vision
      2. cold or flu-like symptoms
      3. delusions
      4. dementia
      5. hoarseness
      6. lack or loss of strength
      7. lower back or side pain
      8. swelling of the hands, feet, or lower legs
      9. trembling or shaking

Less common or rare

        1. Accidental injury
        2. appetite increased
        3. back pain
        4. bloated or full feeling
        5. body aches or pain
        6. burning, dry, or itching eyes
        7. change in vision
        8. change in walking and balance
        9. clumsiness or unsteadiness
        10. congestion
        11. constipation
        12. cough producing mucus
        13. decrease in sexual desire or ability
        14. dryness of the mouth or throat
        15. earache
        16. excess air or gas in the stomach or intestines
        17. excessive tearing
        18. eye discharge
        19. feeling faint, dizzy, or lightheadedness
        20. feeling of warmth or heat
        21. flushed, dry skin
        22. flushing or redness of the skin, especially on the face and neck
        23. frequent urination
        24. fruit-like breath odor
        25. impaired vision
        26. incoordination
        27. increased hunger
        28. increased sensitivity to pain
        29. increased sensitivity to touch
        30. increased thirst
        31. indigestion
        32. noise in the ears
        33. pain, redness, rash, swelling, or bleeding where the skin is rubbed off
        34. passing gas
        35. redness or swelling in the ear
        36. redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
        37. runny nose
        38. sneezing
        39. sweating
        40. tender, swollen glands in the neck
        41. tightness in the chest
        42. tingling in the hands and feet
        43. trouble sleeping
        44. trouble swallowing
        45. trouble thinking
        46. twitching
        47. unexplained weight loss
        48. voice changes
        49. vomiting
        50. weakness or loss of strength
        51. weight gain

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

What You Should Know Before You Take Gabapentin Online ?

It is very important that your doctor check your progress at regular visits, especially in the first few months if you have epilepsy. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

Check with your doctor right away if you have a fever, rash, swollen, painful, or tender lymph glands in the neck, armpit, or groin, unusual bleeding or bruising, or yellow eyes or skin. These may be symptoms of a serious and life-threatening allergic reaction called drug reaction with eosinophilia and systemic symptoms (DRESS) or multiorgan hypersensitivity.

This medicine may cause serious allergic reactions, including anaphylaxis and angioedema. These can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Gabapentin may cause vision changes, clumsiness, unsteadiness, dizziness, drowsiness, sleepiness, or trouble with thinking. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert, well-coordinated, or able to think or see well. If these side effects are especially bothersome, check with your doctor.

This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors, such as feeling sad or hopeless, getting upset easily, or feeling nervous, restless, or hostile. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, tell your doctor right away.

Gabapentin will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicine or narcotics, other medicines for seizures (eg, barbiturates), muscle relaxants, or anesthetics, including some dental anesthetics. Check with your medical doctor or dentist before taking any of the above while you or your child are using gabapentin.

This medicine may cause respiratory depression, a serious breathing problem that can be life-threatening, when used together with narcotic pain medicines. Check with your doctor right away if you have pale or blue lips, fingernails, or skin, difficult or troubled breathing, or irregular, fast or slow, or shallow breathing.

Do not stop using gabapentin without checking with your doctor. Stopping the medicine suddenly may cause seizures. Your doctor may want you or your child to gradually reduce the amount you are taking before stopping it completely.

Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

This medicine comes with a Medication Guide. Read and follow the instructions carefully. Ask your doctor if you have any questions.

If you are using Gralise® tablets:

  • These should be taken with the evening meal.
  • Swallow the tablet whole. Do not crush, break, or chew it.

For patients with epilepsy who take gabapentin three times per day, do not allow more than 12 hours to pass between any 2 doses. The medicine works best if a constant amount is in the blood.

Neurontin® capsules, tablets, and solution may be taken with or without food.

You may break the scored Neurontin® tablets into two pieces, but make sure you use the second half of the tablet as the next dose. Do not use the half-tablet if the whole tablet has been cut or broken after 28 days. Ask your doctor or pharmacist if you have any questions.

Swallow the capsule whole with plenty of water. Do not open, crush, or chew it.

Measure the oral liquid using a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

If you take an antacid that contains aluminum or magnesium, wait at least 2 hours before taking gabapentin. Some examples of these antacids are Di-Gel®, Gaviscon®, Gelusil®, Maalox® and Mylanta®.

Only use the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

What is Gabapentin and What It is Used for ?

US Brand Name

      1. FusePaq Fanatrex
      2. Gabarone
      3. Gralise
      4. Neurontin

Descriptions

Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.

Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles.

Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

      • Capsule
      • Tablet
      • Solution
      • Suspension

Gabapentin capsules, tablets, and oral solution are used along with other medications to help control certain types of seizures in people who have epilepsy. Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down).

Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.

The off-lable use of Gabapentin for migraine

Neurontin is prescribed for the treatment of the following conditions in adults and children over 3 years:

Various forms of epilepsy. When used for controlling epilepsy, it is usually used in conjunction with another anti-epileptic drug.   Usually doctors prescribe prescribe Neurontin for patients to help them to treat your epilepsy when a current treatment is not fully controlling his/her condition. Neurontin is used as addition to the main treatment of epilepsy.

Peripheral neuropathic pain (long lasting pain caused by damaged nerves). This disease can occur and develop in various conditions: injury, diabetes, shingles, and others.

Your doctor may prescribe you Neurontin for the treatment of other diseases, if he thinks that it is a right medicine for your case which is offl-label use of Neurontin.

It is also widely used to treat Anxiety and Migraine prevention.

Gabapentin Off-Label Usage

One of Gabapentin “off-label” usage is for migraine prevention and treatment, including migraines with or without aura, vestibular migraines. It can reduce the frequency of headaches, pain intensity, and the use of symptomatic medications. Gabapentin is a good preventive therapy for migraines refractory to standard medications.

The chemical structure of gabapentin is related that of gamma-aminobutyric acid (GABA) which is a neurotransmitter in the brain. The exact mechanism as to how gabapentin controls epilepsy and relieves pain is unknown, but it probably acts like the neurotransmitter GABA.

The effective dose of gabapentin varies greatly. Some persons need only 200-300 mg a day whereas others may need 3000 mg or more a day. It may take several weeks to become effective, so it is important to stay on it for an adequate length of time.

The Efficacy of gabapentin in migraine prophylaxis experiment shows  gabapentin is an effective prophylactic agent for patients with migraine.

In the Clinical trials143 patients evaluated gabapentin for migraine prophylaxis.  After 3 months the patients taking gabapentin had a reduction of the migraine frequency by 1.5 migraines per month (or by 35.7%) compared with a reduction of 0.6 migraines per month for the placebo group. Also, gabapentin reduced the headache frequency by 50% or greater in 45% patients compared with only 16% patients on placebo. The most frequently reported adverse events  were asthenia, dizziness, somnolence, and infection.

Gabapentin Tips

The Neurontin brand of gabapentin can be taken with or without food. If you break a 600mg or 800mg Neurontin tablet in half, be sure to take the other half at your next dose or within 28 days.

The Gralise brand of gabapentin cannot be substituted for other gabapentin products due to differing administration requirements (once daily versus three times daily for other products).

Gralise should be taken with food at the evening meal. Gralise tablets should be swallowed whole; do not cut, crush, or chew.

Horizant (gabapentin enacarbil) tablets should be swallowed whole and taken with food. For restless leg syndrome, take at roughly 5 PM in the evening. Do not cut, crush, or chew the tablet. Do not interchange Horizant with other gabapentin products.

Use a manufacturer-provided or pharmacist-provided measuring cup calibrated for liquid formulations when measuring liquid doses of gabapentin. Do not use a kitchen measuring device or teaspoon because these may be inaccurate.

For dosage schedules of three times daily do not allow more than 12 hours between doses.

Monitor for mood changes and report any evidence of new or worsening mood or depression to the prescribing doctor.

Do not take gabapentin at the same time as antacids such as Maalox or Gaviscon. Separate administration by at least two hours. Take exactly as directed by your doctor, do not increase or decrease the dose without his or her advice.

Avoid operating machinery, driving, or performing tasks that require mental alertness if gabapentin makes your drowsy or impairs your judgment.

The side effects of gabapentin, such as dizziness or drowsiness, may increase your risk of falling. Remove any fall hazards from your home if possible (such as loose rugs), and be careful when ascending or descending stairs.

Talk to your doctor if you experience any worsening of your mood or if you develop any suicidal thoughts.

Do not stop taking gabapentin without your doctor’s advice as it may precipitate a withdrawal reaction (symptoms include agitation, disorientation, confusion). When the time comes to discontinue gabapentin your doctor will tell you how to taper it off.

Seek urgent medical advice if you develop a rash, fever, difficulty breathing or facial swelling while taking gabapentin.

The drug has been dubbed an “emerging threat” in the opioid epidemic in a national bulletin provided to narcotics officers.

It’s sold under the brand names:

      • Neurontin
      • Gralise
      • Horizant

It’s been available as a generic in the United States since 2004.