Gabapentin, which is most commonly marketed under the brand name Neurontin, has central nervous system depressant effects. The drug was originally produced to be a synthetic analog to the inhibitory neurotransmitter GABA (gamma-aminobutyric acid), and its medicinal uses are designed to mimic the effects of GABA although it does not work on the same neurotransmitter receptors in the brain as GABA. The actual mechanism of action associated with gabapentin is not fully understood.
The drug has numerous medicinal uses including as an anticonvulsant and to address pain in some individuals. Other purposes include:
The drug is not listed as a controlled substance by the DEA (Drug Enforcement Administration) and not covered in the yearly reports of use and misuse of drugs by the Substance Abuse and Mental Health Services Administration (SAMHSA). Its abuse potential has been considered to be low because use of the drug is not associated with euphoria, significant sedation, or other effects that most drug abusers seek.
Abuse of Gabapentin
Dosages of gabapentin vary depending on what it is being used for and the group of individuals the drug is being used to treat. Elderly individuals and children respond to lower doses than healthy adults do. It is believed that there is a ceiling effect to its effectiveness for treating pain, and using doses of over 1800 mg are not considered to be effective for pain management. Although gabapentin is not considered to be a controlled substance by the DEA, there are drugs with very similar chemical structures, such as pregabalin (Lyrica), that are controlled substances.
There are scattered reports in the research literature that suggest that gabapentin may be abused rarely; however, it is not a primary drug of abuse, and it is most often abused in conjunction with other drugs or by individuals who are desperate to achieve psychoactive effects from any drug, such as prison inmates. The important point to understand is that many chronic drug abusers will attempt to abuse any drug they can get their hands on. As a result, though gabapentin is not considered to be a significant drug of abuse, but in some cases, the drug may be misused or abused.
The greatest potential for overdose occurs in elderly individuals with a prescription for the drug who forget how much of the drug they have taken or in individuals who combine gabapentin with other drugs.
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Potential Overdose Effects
There are some scattered reports of individuals overdosing on gabapentin, and there are a few case reports of fatalities associated with gabapentin overdose; however, these fatalities appear to be very rare. The primary danger of gabapentin overdose appears when individuals use gabapentin in conjunction with other drugs, such as alcohol.
Mixing drugs with central nervous system depressant effects results in an enhancement of the effects of the drugs and can lead to significant issues, including overdose. For instance, individuals using gabapentin in conjunction with alcohol can have enhanced side effects, enhanced lethargy, and an enhanced potential to overdose (the overdose would be more likely to occur due to alcohol but could occur for both drugs).
In 2011, a review of the effects of gabapentin overdose was published in a case study of what was believed to be the first published case of a fatality due to gabapentin overdose in the Journal of Forensic Science. It appears the effects of an overdose on gabapentin are most likely:
- Double vision
- Slurred speech
- Problems with motor coordination
- Labored breathing
- Possible unconsciousness or coma
Standard treatment for an overdose on gabapentin would most likely include:
- Keeping the individual quiet and still
- The administration of activated charcoal or some other substance
- Attempts to get the individual to regurgitate medications
- The administration of IV fluids
- Symptom management
Although there are some scattered cases of potentially fatal overdoses of gabapentin, this appears to be extremely rare, and overdoses are typically addressed by physicians without significant complications. Nonetheless, overdose on any drug can be very serious, and individuals can have specific reactions to an overdose that may be atypical. For instance, children and elderly individuals would be far more sensitive to the effects of an overdose than healthy adults.
Individuals who overdose on a combination of gabapentin and some other central nervous system depressant (e.g., alcohol, prescription medications, etc.) are at serious risk for significant organ or brain damage, and these individuals need immediate attention. The effects of a central nervous system depressant overdose are most dangerous as a result of oxygen deprivation (hypoxia) or total oxygen cutoff (anoxia) to the brain. Depending on the severity of the oxygen deprivation and the length of time that this occurs, there can be significant and even lasting brain damage. This can include:
- Development of problems with attention and concentration
- Problems remembering new information
- Problems with judgment and problem-solving
- Problems with inhibiting impulses
- Problems with emotional control and the development of severe issues with depression
- Potential fatal effects due to massive brain damage in extreme cases
Even though an overdose on gabapentin alone is rare and the symptoms can be treated, anyone exhibiting any signs of an overdose or other toxic reaction to any medication should receive immediate treatment because this always represents a potentially dangerous situation. Anyone who thinks they, or someone else, have overdosed on gabapentin should immediately contact emergency medical services (911), keep the person quiet, do not administer any medications or fluids unless instructed to do so, and wait for help. Individuals who are trained in CPR can administer CPR if it is necessary.