Why is Gabapentin Prescribed?

Gabapentin capsules, tablets, and oral solution are used 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.

How should Gabapentin be used?

Gabapentin comes as a capsule, a tablet, an extended-release (long-acting) tablet, and an oral solution (liquid) to take by mouth. Gabapentin capsules, tablets, and oral solution are usually taken with a full glass of water (8 ounces [240 milliliters]), with or without food, three times a day.

These medications should be taken at evenly spaced times throughout the day and night; no more than 12 hours should pass between doses. The extended-release tablet (Horizant) is taken with food once daily at about 5 PM. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take gabapentin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Gabapentin extended-release tablets cannot be substituted for another type of gabapentin product. Be sure that you receive only the type of gabapentin that was prescribed by your doctor. Ask your pharmacist if you have any questions about the type of gabapentin you were given.

Swallow the extended-release tablets whole; do not cut, chew, or crush them.

If your doctor tells you to take one-half of a regular tablet as part of your dose, carefully split the tablet along the score mark. Use the other half-tablet as part of your next dose. Properly throw away any half-tablets that you have not used within several days of breaking them.

If you are taking gabapentin to control seizures or PHN, your doctor will probably start you on a low dose of gabapentin and gradually increase your dose as needed to treat your condition. If you are taking gabapentin to treat PHN, tell your doctor if your symptoms do not improve during your treatment.

Gabapentin may help to control your condition but will not cure it. Continue to take gabapentin even if you feel well. Do not stop taking gabapentin without talking to your doctor, even if you experience side effects such as unusual changes in behavior or mood.

If you suddenly stop taking gabapentin tablets, capsules, or oral solution, you may experience withdrawal symptoms such as anxiety, difficulty falling asleep or staying asleep, nausea, pain, and sweating. If you are taking gabapentin to treat seizures and you suddenly stop taking the medication, you may experience seizures more often. Your doctor may decrease your dose gradually over at least a week.

Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with gabapentin and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs) or the manufacturer’s website to obtain the Medication Guide.

Off-Label Usages of Gabapentin ?

Gabapentin is frequently prescribed off-label for a variety of conditions outside its primary approvals for epilepsy and nerve pain. Here is a list of some of the common off-label uses:

1. Anxiety Disorders: Gabapentin is sometimes used to manage generalized anxiety disorder (GAD) and social anxiety, especially in patients who don’t respond well to traditional anti-anxiety medications.
2. Bipolar Disorder: While not a first-line treatment, gabapentin may be used as an adjunct to stabilize mood in patients with bipolar disorder, particularly those who have difficulty tolerating other mood stabilizers.
3. Insomnia: Due to its sedative effects, gabapentin is occasionally prescribed to help with sleep disorders, especially for those who struggle with sleep due to chronic pain or anxiety.
4. Alcohol Dependence and Withdrawal: Gabapentin is used to help reduce cravings and manage withdrawal symptoms in patients with alcohol use disorder, as it can help alleviate anxiety, tremors, and insomnia associated with withdrawal.
5. Migraine Prevention: Gabapentin is sometimes used off-label to prevent migraines, especially in cases where traditional migraine medications are ineffective or not tolerated.
6. Hot Flashes: Particularly for postmenopausal women or breast cancer patients, gabapentin can be prescribed to help reduce the frequency and intensity of hot flashes.
7. Restless Legs Syndrome (RLS): Gabapentin can help alleviate symptoms of RLS, a condition that causes uncomfortable sensations and an urge to move the legs.
8. Pruritus (Chronic Itching): Gabapentin has shown effectiveness in managing severe itching related to conditions like kidney disease, liver disease, or certain types of neuropathy.
9. Chronic Cough: Some cases of refractory chronic cough, where traditional treatments are ineffective, have responded to gabapentin.
10. Multiple Sclerosis (MS)-Related Symptoms: Gabapentin can help alleviate nerve pain, spasticity, and certain types of tremors associated with MS.
11. Temporomandibular Joint (TMJ) Disorders: In cases of chronic TMJ-related pain, gabapentin may be used to reduce discomfort.
12. Post-Traumatic Stress Disorder (PTSD): It is sometimes prescribed to help manage PTSD symptoms, particularly anxiety, sleep disturbances, and hyperarousal.
13. Vulvodynia: Gabapentin can help reduce pain in patients with vulvodynia, a chronic pain condition affecting the vulvar region.
14. Phantom Limb Pain: After amputation, some patients experience pain in the “phantom” limb, and gabapentin may be used to help relieve these sensations.
15. Chronic Pelvic Pain: Gabapentin is sometimes prescribed to help manage chronic pelvic pain, especially when associated with nerve involvement.
16. Trigeminal Neuralgia: Although more commonly used for postherpetic neuralgia, gabapentin can also help with trigeminal neuralgia, a painful nerve condition affecting the face.

These off-label uses are based on clinical observations, smaller studies, or anecdotal evidence, so efficacy may vary. Always consult with a healthcare provider for guidance on using gabapentin for any off-label purpose.

Why is Gabapentin Prescribed Off-Label?

• Versatility: Gabapentin affects the nervous system broadly by calming overactive nerves, making it useful for a wide range of conditions.
• Low Abuse Potential: Unlike opioids, gabapentin has a lower potential for abuse, making it a safer alternative for chronic pain management.
• Safety Profile: Generally, gabapentin is well-tolerated and considered safe when used properly, encouraging doctors to explore its benefits for other conditions.

What special precautions should I follow?

Before taking gabapentin,

• tell your doctor and pharmacist if you are allergic to gabapentin, any other medications, or any of the inactive ingredients in the type of gabapentin you plan to take. Ask your pharmacist for a list of the inactive ingredients.
• you should know that gabapentin is available in different forms that may be prescribed for different uses. Ask your doctor to be sure that you are not taking more than one product that contains gabapentin.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: hydrocodone (in Hydrocet, in Vicodin, others), medications that make you feel dizzy or drowsy, morphine (Avinza, Kadian, MSIR, others), and naproxen (Aleve, Anaprox, Naprosyn, others). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• if you are taking antacids such as Maalox or Mylanta, take them at least 2 hours before you take gabapentin tablets, capsules, or solution.
• tell your doctor if you have or have ever had kidney disease. If you will be taking the extended-release tablets, also tell your doctor if you need to sleep during the day and stay awake at night.
  tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking gabapentin, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking gabapentin.
• you should know that this medication may make you drowsy or dizzy, may slow your thinking, and may cause loss of coordination. Do not drive a car or operate machinery until you know how this medication affects you, and your doctor agrees that it is safe for you to begin these activities.
  if you are giving gabapentin to your child, you should know that your child’s behavior and mental abilities may change while he or she is taking gabapentin. Your child may have sudden changes in mood, become hostile or hyperactive, have difficulty concentrating or paying attention, or be drowsy or clumsy. Have your child avoid activities that could be dangerous, such as riding a bicycle, until you know how gabapentin affects him or her.
• remember that alcohol can add to the drowsiness caused by this medication.
  you should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking gabapentin for the treatment of epilepsy, mental illness, or other conditions. A small number of adults and children 5 years of age and older (about 1 in 500 people) who took anticonvulsants such as gabapentin to treat various conditions during clinical studies became suicidal during their treatment. Some of these people developed suicidal thoughts and behavior as early as one week after they started taking the medication.
• There is a risk that you may experience changes in your mental health if you take an anticonvulsant medication such as gabapentin, but there may also be a risk that you will experience changes in your mental health if your condition is not treated. You and your doctor will decide whether the risks of taking an anticonvulsant medication are greater than the risks of not taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood); talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; giving away prized possessions; or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If you forget to take gabapentin capsules, tablets, or oral solution, take the missed dose as soon as you remember it. However, if it is almost time for the next dose or if you forget to take gabapentin extended-release tablets, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What Side Effects Can Gabapentin Cause?

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. shortness of breath
11. sore throat
12. sores, ulcers, or white spots on the lips or in the mouth
13. swollen glands
14. unusual bleeding or bruising
15. 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. dizziness
11. fast or irregular heartbeat
12. headache
13. increased thirst
14. itching or skin rash
15. joint pain
16. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
17. loss of appetite
18. muscle ache or pain
19. nausea
20. red skin lesions, often with a purple center
21. red, irritated eyes
22. unpleasant breath odor
23. vomiting of blood
24. 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

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. difficulty with breathing
15. dryness of the mouth or throat
16. earache
17. excess air or gas in the stomach or intestines
18. excessive tearing
19. eye discharge
20. feeling faint, dizzy, or lightheadedness
21. feeling of warmth or heat
22. flushed, dry skin
23. flushing or redness of the skin, especially on the face and neck
24. frequent urination
25. fruit-like breath odor
26. impaired vision
27. incoordination
28. increased hunger
29. increased sensitivity to pain
30. increased sensitivity to touch
31. increased thirst
32. indigestion
33. noise in the ears
34. pain, redness, rash, swelling, or bleeding where the skin is rubbed off
35. passing gas
36. redness or swelling in the ear
37. redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
38. runny nose
39. sneezing
40. sweating
41. tender, swollen glands in the neck
42. tightness in the chest
43. tingling in the hands and feet
44. trouble sleeping
45. trouble swallowing
46. trouble thinking
47. twitching
48. unexplained weight loss
49. voice changes
50. vomiting
51. weakness or loss of strength
52. 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 should I know about storage and disposal of this medication?

Keep Gabapentin in the container it came in, tightly closed, and out of reach of children. Store the tablets, extended-release tablets, and capsules at room temperature, away from excess heat and moisture (not in the bathroom). Store the oral solution in the refrigerator. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include the following:

• double vision
• slurred speech
• drowsiness
• diarrhea

What other information should I know?

Keep all appointments with your doctor.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking gabapentin.

If you use a dipstick to test your urine for protein, ask your doctor which product you should use while taking this medication.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names

Horizant®
Neurontin®

Fioricet contains a combination of acetaminophen, butalbital, and caffeine Acetaminophen is a pain reliever and fever reducer. Butalbital is in a group of drugs called barbiturates. It relaxes muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.

Fioricet is a prescription medicine given to people who suffer from tension headaches and migraines. It is a combination of three primary ingredients which are butalbital, acetaminophen, and caffeine. Butalbital is the component of the drug that can cause a Fioricet high, as it’s a barbiturate. Barbiturates act as a central nervous system depressant, much like drugs like opioids and other muscle relaxants.

The acetaminophen works to relieve pain in a different way for the butalbital, and the caffeine is included to help improve blood flow that can reduce the symptoms of migraines and headaches.

While in general Fioricet is thought of as a headache medicine, regarding FDA approval, it’s intended for three specific types of headaches. These are muscle contraction, tension, and post-dural puncture headaches. The FDA does not necessarily approve it as a treatment for migraines, but many doctors do prescribe it for this.

While there are risks and an abuse potential with Fioricet, people who suffer from headaches can find tremendous relief in the use of this drug.