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Gabapentin is a medication prescribed to treat postherpetic neuralgia, a condition that involves epileptic seizures and pain that can occur after shingles.1 Gabapentin is also used off-label in the treatment of addiction, often to prevent seizures during during drug and alcohol detox.2

Also known by the brand name Neurontin, gabapentin alleviates certain types of pain and helps to prevent seizures; however, its specific mechanism of action is unknown. It is structurally similar to GABA, the inhibitory neurotransmitter that acts to slow down the central nervous system and decrease the “fight-or-flight” anxiety response, but it does not appear to affect it in the way that do.3

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.

Gabapentin use can lead to physical dependence. Gabapentin withdrawal symptoms may occur in an individual who abruptly discontinues the drug.

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 seizure acitivity in those who were being treated with the drug for seizures. Other potential symptoms of gabapentin withdrawal include:4

  • Sweating
  • Insomnia
  • Pain
  • Nausea
  • Anxiety

Due to the possible risks of gabapentin withdrawal symptoms, it is not recommended to stop the medication suddenly. With medical supervision and potentially a controlled taper, you can withdraw safely and comfortably from gabapentin.

Factors Impacting Withdrawal Duration and Severity

Withdrawal symptoms will typically begin in a gabapentin-dependent person when the drug dose is lowered or when the drug is discontinued entirely. The severity of withdrawal symptoms may vary from person to person. The timeline may vary widely as well. WIthdrawal may begin as soon as 12 hours or as late as 7 days after discontinuing the drug.5

The more significantly dependent on gabapentin a person is, the more intense withdrawal may be. 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

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The U.S. National Library of Medicine (NLM) warns that increased suicidal thoughts are a potential side effect of gabapentin use.4 Withdrawal may also affect mood adversely and someone who already suffers from suicidal thoughts may be safest in an inpatient environment.

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. In general, a gradual reduction in the gabapentin dose is recommended to prevent or minimize symptoms.4

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. Holistic approaches such as yoga and massage therapy can also help you regain a sense of calm and physical stability. 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 more comprehenisve 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.

Sources

  1. Pfizer. Highlights of Prescribing Information, Neurontin.
  2. Mack, A. (2003). Examination of the evidence for off-label use of gabapentin. Journal of Managed Care Pharmacy, 9(6), 559-568.
  3. Food and Drug Administration. (2011). Neurontin.
  4. U.S. National Library of Medicine. (2017). Gabapentin.
  5. Mersfelder, TL, Nichols, WH. Gabapentin: Abuse, Dependence, and Withdrawal. (2016). Ann Pharmacother, 50(3), 229-33.