Gabapentin is a medication prescribed to treat postherpetic neuralgia, a condition that involves epileptic seizures and pain that can occur after shingles, according to Mayo Clinic. Gabapentin is also used off-label in the treatment of addiction, often to manage withdrawal symptoms during detox.
Also known by the brand name Neurontin, gabapentin works in the brain and along the central nervous system to relieve specific types of pain and to control seizures. It may have a similar mechanism of action as a benzodiazepine drug. Benzodiazepines work by interacting with GABA (gamma-aminobutyric acid) levels in the brain. While gabapentin does not directly influence GABA, it is similar in action to the inhibitory neurotransmitter that acts to slow down the central nervous system and decrease the “fight-or-flight” anxiety response. In this sense, gabapentin then likely interacts with overactive nerve firings to manage neuropathic pain and act as an anticonvulsant.
Just like benzodiazepine medications, gabapentin can lead to physical dependence. The American Journal of Health-System Pharmacy publishes that gabapentin withdrawal symptoms can be similar to those associated with alcohol or benzodiazepine drugs.
Gabapentin withdrawal can be risky, so medical supervision is recommended during the withdrawal process.
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Specifics of Gabapentin Withdrawal
Withdrawal symptoms occur when the brain becomes dependent on a drug after regular use and begins to rely on it to keep its chemical “balance.” If the drug is suddenly stopped, especially if a person stops taking it “cold turkey” rather than tapering off it, withdrawal symptoms can result.
Since gabapentin suppresses the central nervous system, dampening things like blood pressure, heart rate, and other functions related to the stress response, a kind of “rebound” effect can occur if the medication is suddenly stopped. The FDA warns that stopping Neurontin (gabapentin) suddenly can cause an increase in seizures. These seizures may be potentially life-threatening. Other potential symptoms of gabapentin withdrawal include:
- Mental confusion
- Rapid heart rate
- Appetite fluctuations
- Increased blood pressure
- Elevated body temperature
- Possible suicidal thoughts
Due to the possible risks of gabapentin withdrawal symptoms, it is not recommended to stop the medication suddenly. Mood swings, uncomfortable and even potentially dangerous physical side effects, cognitive issues, and sleep difficulties all make gabapentin a medication that should be slowly weaned off over a set period of time through a controlled taper, generally through a medical detox program.
Factors Impacting Gabapentin Withdrawal Duration and Severity
In general, withdrawal symptoms will typically begin when a drug is no longer active in the bloodstream. The average half-life of gabapentin is 5–7 hours, so this means that withdrawal symptoms will likely start 10–14 hours after the last dose of the drug.
Withdrawal symptoms will usually peak within the first 2–3 days and start to taper off after about 7–10 days. Sleep and mental difficulties, trouble feeling pleasure, mood swings, and drug cravings can continue for a few weeks to a few months.
As published by MedPage Today, gabapentin abuse does occur and can be especially dangerous if the medication is mixed with alcohol or other central nervous system depressants like benzodiazepines, opioids, or alcohol. The combination of these drugs can cause a potentially fatal overdose by suppressing autonomic life-sustaining functions, such as breathing, heart rate, and blood pressure.
Using gabapentin outside of a doctor’s supervision and direction can increase the odds for an adverse reaction to the medication, including intensified withdrawal symptoms. Taking the medication in a way other than it was intended—such as chewing it, or crushing it and then smoking, injecting, or snorting the powder—can also more rapidly increase physical dependence and therefore the significance of withdrawal symptoms.
The more significantly dependent on gabapentin a person is, the more intense withdrawal is. Dependence is influenced by how long a person has been using the drug and how high the dosage is. Family history of addiction and other genetic and biological factors can play a role in drug dependence and abuse. Individual metabolism, age, and gender can all be involved as well.
If a person struggles with a co-occurring medical and/or mental health condition, withdrawal symptoms can be further complicated, and the timeline may also be impacted. Environmental aspects, such as how much stress is in a person’s daily life, how much support they have at home, and how chaotic or stable their everyday surroundings are, can also influence the severity, intensity, and duration of gabapentin withdrawal.
The withdrawal syndrome for gabapentin is highly individual and can therefore vary quite a bit from person to person.
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Benefits of Medical Detox for Gabapentin Withdrawal
The U.S. National Library of Medicine (NLM) warns that increased suicidal thoughts are a potential side effect of gabapentin use. During withdrawal, mood swings and depression are common, and suicidal inclinations may be stronger.
Medical detox can provide a secure environment that is monitored around the clock to ensure that a person remains safe from self-harm. Medications can be used to manage difficult emotions and the physical side effects of gabapentin withdrawal. There are no specific medications for gabapentin detox, but mood stabilizers, sleep aids, nonsteroidal pain medications, and gastrointestinal medications may help with specific symptoms.
Gabapentin may be slowly tapered off on a strict and set schedule to minimize the potential for significant withdrawal symptoms like seizures, heart and blood pressure irregularities, and other central nervous system reactions that can occur if the medication is stopped suddenly. Gabapentin may also be substituted with a longer-acting benzodiazepine medication during detox that can then be tapered off.
During medical detox, set sleep schedules, proper nutrition, and a stable and calm environment can all help the brain and body heal from gabapentin dependence. Nutritional supplements may be helpful as can holistic measures such as massage therapy or yoga. Vital signs can be monitored 24/7 by licensed professionals to make sure that clients remain safe and comfortable during medical detox.
A comprehensive addiction treatment program should directly follow detox. Medical detox programs generally last 5–7 days on average. When a person is physically stable, they can often go directly into a complete addiction treatment program.
In treatment, behavioral therapies and relapse prevention programs can offer tools and techniques to manage stress and anxiety, and to cope with potential triggers and drug cravings. Medical detox and ongoing therapy provide time and space for the brain to heal while alleviating withdrawal symptoms and minimizing the potential for episodes of relapse.