Gabapentin is a medication that is prescribed for partial seizures, postherpetic neuralgia, and other neuropathic pain conditions. In more recent years, there has been a growing concern that the medication (which is marketed under several brand names, including Neurontin) has more abuse potential than previously believed and is sometimes mixed with illegal drugs for recreational consumption.
People who develop dependence on the drug—something that may occur even in those who use the medication according to prescription—may experience withdrawal symptoms when they stop or reduce their dose. The timeline for gabapentin withdrawal may be influenced by several factors. However, symptoms can be expected to develop over the course of 12 hours to 7 days and can last up to 10 days or more. Symptoms include anxiety, heart palpitations, sweating, confusion, and agitation.
Because of the potential for some significantly troublesome withdrawal effects, the safest way to go off the drug is to work with a physician on a tapering schedule.
How Does Gabapentin Work?
Gabapentin is an anticonvulsant medication given to patients with certain seizure disorders. Gabapentin is also prescribed for pain associated with an active herpes zoster infection (shingles),1 It has several additional, off-label uses, including for the management of neuropathic pain (i.e., diabetic neuropathy), restless leg syndrome, migraine headache, and peri-menopausal hot flashes.2,3
Gabapentin’s precise mechanism of action isn’t well understood. It is thought to help manage seizures by decreasing abnormal electrical activity in the brain, and it may decrease neurogenic or nerve pain by interfering with the transit of pain signaling through the brain and down the spine.2
Is Gabapentin Commonly Abused?
Even though gabapentin is generally considered a safe drug, its abuse potential is becoming increasingly clear.
People who misuse the drug may take higher doses than recommended to achieve a high or to supplement the intoxicating effects of another drug. People may also use gabapentin to relieve symptoms of withdrawal from other substances.4
In many cases, recreational users of gabapentin combine it with other drugs, particularly opioids. Users claim they can enhance the high of heroin or can cause a marijuana-like buzz if they take the drug by itself in high doses.5 A 2015 study of people in Kentucky who abused opioids found that 15% also abused gabapentin in the past 6 months to get high.6
Gabapentin has been increasingly involved in overdose deaths.
In 2017, a study published in the journal Addiction noted that users who abuse heroin with gabapentin are at an increased risk of lethal overdose.7 A pain and addiction specialist told the Louisville Courier-Journal that while gabapentin is unlikely to cause problems on its own, it could cause respiratory depression and death if mixed with opioids like illicit fentanyl and heroin.8
In certain states, gabapentin has been increasingly involved in overdose deaths. In 2017, it was a factor in more than a third of drug overdose deaths in Kentucky. And in 2015, it was involved in 109 overdose fatalities in West Virginia.5,6
Gabapentin use is associated with physiological dependence and a potentially risky withdrawal syndrome. Even people who have been taking it as prescribed should seek the support of their physician prior to stopping its use. However, those who have been taking larger than prescribed doses or otherwise misusing the drug should absolutely not stop using it suddenly, as this can bring on a potentially complicated withdrawal. Symptoms have been reported in people taking between 400mg to 8000mg a day for periods as short as 3 weeks up through 5 years.9
As with the precise mechanism of action, the biochemical changes that underlie the development of gabapentin withdrawal are not fully clear. Gabapentin is similar in structure to gamma-aminobutyric acid, or GABA, a neurotransmitter that inhibits excitability in the brain. One of the theories is that it may supplement GABA’s normal activity.3
Through their influence on a specific protein structure, benzodiazepines (Xanax, Klonopin, Valium) and alcohol are able to amplify the effects of GABA at its receptor. So, it may be unsurprising that gabapentin’s withdrawal symptoms resemble certain symptoms associated with the discontinuation of these substances. Additionally, gabapentin has been used with some success in managing alcohol withdrawal, which further supports some overlap in pharmacologic mechanisms.3
Both the length and severity of gabapentin withdrawal depend on a number of different factors. These include:
- The average dose being used.
- Length of time the person used the medication.
- Medical or psychiatric conditions.
- Any concurrent use of other drugs or alcohol.
Gabapentin Withdrawal Symptoms and Timeline
Withdrawal symptoms usually begin within 12 hours to 7 days of stopping the drug.10
The timeline of symptoms, based on case studies, is as follows:
- Itchy skin
Days 4 and 5
- Increasing confusion, agitation, and anxiety
- Light sensitivity
There is little information on how long gabapentin withdrawal lasts. Some studies have noted symptoms for up to 10 days, at which point person may develop severe changes in mental status, chest pain, and high blood pressure.13 However, it’s possible that people could continue to have symptoms beyond this point.
People who wish to quit gabapentin should work with a physician to taper off the medication. Going “cold turkey” can lead to severe complications. One example of this stems from the fact that gabapentin is commonly prescribed for the treatment of seizures. If someone prone to seizures suddenly stops taking gabapentin, they may begin to have seizures that do not stop (status epilepticus).2 This condition is life-threatening and requires hospitalization.
Undergoing a gradual taper as part of a supervised medical detox can minimize the risk of these complications as well as facilitate the management of any medical problems that you may experience during withdrawal.
How To Safely Withdraw From Gabapentin?
The key for safely withdrawing from gabapentin is to not completely stop taking the drug, but to slowly wean off it (a taper). Consulting with a doctor, or seeking the services of a treatment center, will help individuals consistently stick to gradually diminishing doses of gabapentin. This will create the best possible circumstances for withdrawal while ensuring that the other conditions that the gabapentin treated receive appropriate attention.
According to Pfizer, a drug company that makes gabapentin, gabapentin should be tapered over a minimum of one week. The exact tapering schedule will depend on the individual’s medical and mental health status, their likelihood of adhering to the tapering instructions, and factors such as:14
- The condition for which gabapentin was prescribed.
- The current dose and regimen.
There may also be other factors that affect the taper, which is why you should always work with a doctor to determine the right schedule for you. For instance, some people may not respond well to the typical timeline and may need to adjust the dose.
If you have been prescribed gabapentin and would like to stop using it, talk to your doctor about a taper. If you are abusing gabapentin and want to quit, consider medical detox and substance rehabilitation—especially if you are abusing other drugs and/or alcohol. These programs can help you taper off gabapentin and teach you skills to change your lifestyle and prevent a relapse.
- University of Michigan Medicine. Gabapentin.
- National Health Service. (2018). Gabapentin.
- Norton, J. (2001). Gabapentin Withdrawal Syndrome. Clinical Neuropharmacology, 24(4), 245-246.
- Melton, S. (2014). Has Gabapentin Become a Drug of Abuse? Medscape.
- Vestal, C. (2018). Growing Abuse of Gabapentin. Pain News Network.
- Rodriguez, C.H. (2017). New on the streets: Gabapentin, a drug for nerve pain, and a new target of misuse. STAT.
- Lyndon, A. et al. (2017). Risk to heroin users of poly-drug use of pregabalin or gabapentin. Addiction, 112(9), 1580-1589.
- Warren, B. (2018). Drug touted as safe alternative to painkillers has been found in more Louisville deaths. Louisville Courier Journal.
- See, S., Hendriks, E. & Hsiung, L. (2011). Akathisia Induced by Gabapentin Withdrawal.Annals of Pharmacotherapy, 45(6), e31.
- Mersfelder, T.L., and Nichols, W.H. (2016). Gabapentin: Abuse, Dependence, and Withdrawal. Annals of Pharmacotherapy, 50(3), 229-233.
- Yesil, B., and Elbozan, B. (2016). Gabapentin withdrawal in a depressed patient: A case report. Anatolian Journal of Psychiatry, 17(3), 61-63.
- Hellwig, T.R., Hammerquist, R. & Termaat, J. (2010). Withdrawal symptoms after Gabapentin discontinuation. American Journal of Health-System Pharmacy, 67(11), 910-912.
- Tran, K.T., Hranicky, D., Lark, T., and Jacob, N.J. (2005). Gabapentin withdrawal syndrome in the presence of a taper. Bipolar Disorders, 7(3), 302-304.
- Sussex Partnership, National Health Service. Protocol for the management of Pregabalin and Gabapentin use in HMP Lewes.