Gabapentin Withdrawal: What It Takes To End Gabapentin Addiction

Last Updated 9/16/2020

Gabapentin isn’t a household name but perhaps it should be. The amount of people taking the drug is staggering. Out of a population of 321 million people in the United States, an amazing 57 million prescriptions were prescribed by physicians. While any drug may do what it is supposed to if taken properly, Gabapentin has the propensity for causing issues when trying to stop the drug. Withdrawal symptoms associated with neurotonin (Gabapentin/Gabbies) addiction include anxiety, cravings, dysphoria, and insomnia. Withdrawal symptoms usually occur within 1-7 days of stopping the drug.

Before we dive into Gabapentin withdrawal syndrome, we need to clarify some information about the prescription drug itself.

What Is Gabapentin?

Gabapentin is available as an oral solution, tablets, and capsules, and it works to help manage symptoms from a variety of issues that usually relate to alcohol abuse. Keep in mind though, it doesn’t treat the underlying condition it’s prescribed for – just the symptoms or pain. This medication is available in immediate-release and extended-release versions, and it’s usually taken several times a day at evenly spaced times. Low doses are typically prescribed and the dosage may be increased by the doctor as needed.

The family of medicines, known as gabapentinoids, includes Gabapentin (Neurontin, Gralise, Horizant) and pregabalin.

What Is It Used For?

Gabapentin is a legitimately helpful medication. It helps with a variety of issues even though it is mainly prescribed as an anticonvulsant. The reason it works the way it does is perhaps by balancing electrical impulses in the central nervous system. The reason this is important is that these problems are what cause discomfort and pain. Gabapentin may alter the calming neurotransmitter in the brain, called GABA – and hence, the drug’s name. It may also work to reduce a contributor to seizures from epilepsy known as glutamate. By slowing the production of this component, it can reduce seizures and help with other painful issues it is otherwise prescribed for. These include things like:

• Shingles pain
• Anxiety
• Other pain symptoms
• Restless leg syndrome
• Tremors
• Hot flashes
• Psychiatric issues

Help with cocaine withdrawal As you can see, there are quite a few things that this drug is used to help. The uses for Gabapentin that are not as an anticonvulsant are called off-label uses. This does not mean that these are not legitimate causes to use the drug, it just means that they are not the original uses it was created for.

Your doctor may prescribe it for any number of reasons listed or its original use – for seizures. With that said, it is imperative that you know the dangers, drug interactions, and have an overall idea of how this drug works.

Related medications to Gabapentin include:

Pregabalin (Lyrica), Amitriptyline / Chlordiazepoxide (Limbitrol), Duloxetine (Cymbalta), Clomipramine (Anafranil), and Doxepin (Silenor).

It is important to know that even though this drug is highly prescribed, its effectiveness rating is quite low. This isn’t trying to minimize its effectiveness as a brand, just a simple fact that bears mentioning. The effectiveness of Gabapentin is only around 15 to 20 percent in helping with symptoms from the conditions mentioned.

How Is It Taken?

How this drug is taken depends on a lot of factors but there are a few constants in its instructions.

The doctor may start you off on a lower dosage until it is seen how your body and health concerns adjust and react to it. It is a drug that works it’s magic best when kept at a constant level. So, it is important not to miss doses, double up on doses, split pills, or take it in a way that is different from how it was prescribed.

With that said, no more than 12 hours in between uses is recommended and it should be taken with food.

It does interact with antacids so wait two hours after taking one so that it is absorbed well. Otherwise, magnesium and aluminum in the antacid interferes with it and it may not be as effective.

There are different kinds like sustained release, immediate release, and enacarbil sustained-release. The one you take depends on what your doctor feels is best. It is important not to switch the form without speaking to your doctor first.

As with any drug, your doctor should know your full medical history before taking this one. It is crucial to mention anything like depression, breathing problems, and kidney disease. Any alcohol or marijuana use should be mentioned since it can interact with those too.

How Many People Use Gabapentin?

It may seem surprising at just how much of a part of our society this drug is. It’s not one you hear about on the news and you don’t see specials on the rise of deaths from this drug. Most people would consider it mild or not a drug that we should worry about. This is simply not true. Instead, it is a drug that seems to have a slow burn when it comes to tolerance and risks. Take it right, it may be helpful. Start abusing it and it can lead to fatal results when mixed with opioids. It’s as simple as that, regardless of how often you’ve heard of it.

According to Pew Gabapentin is now one of the most popular prescription drugs in the United States, according to the New England Journal of Medicine. It was the 10th-most-prescribed medication in 2016. Its more expensive cousin, pregabalin, sold as Lyrica and also made by Pfizer, was the eighth best-selling.

And the statistics continue to be alarming.

According to Stat News in Ohio, it was the most prescribed medication in December of 2018. This was 9 million doses more than the next popular drug, oxycodone. But this is a widespread issue, not just in Ohio.

Gabapentin’s ability to tackle multiple ailments has helped make it one of the most popular medications in the U.S. In May, it was the fifth-most prescribed drug in the nation, according to GoodRx.

It doesn’t have the same risks as opioids as far as overdoses, but that doesn’t mean it can’t be harmful. Plus, some people may use it to intensify the use of opioids. One study found that 22 percent of people addicted to opioids had a Gabapentin prescription, and 40 percent of those who had a Gabapentin prescription reported using more Gabapentin than prescribed.

Another group of statistics according to Stat News A literature review published in 2016 in the journal Addiction found about a fifth of those who abuse opiates misuse Gabapentin.

A separate 2015 study of adults in Appalachian Kentucky who abused opiates found 15 percent of participants also misused Gabapentin in the past six months “to get high.” In the same year, the drug was involved in 109 overdose deaths in West Virginia, the Charleston Gazette-Mail reported.

It has caused deaths through other drug interactions yet it is highly prescribed by doctors. In fact, out of a population of 321 million people in the United States, an overwhelming 57 million prescriptions were written for this drug. Ironically, it is often used to help treat withdrawal symptoms from opioids since it helps with restless leg syndrome and nerve pain – two side effects were commonly seen in patients with withdrawal symptoms from opioids.

With around one percent of the entire population using Gabapentin, it is important to look at the risk factors. Physiological dependence is not entirely uncommon.  Withdrawals from gabapentin make the drug something people should discuss with their doctor. Withdrawal symptoms vary from one person to the next.

Why Is It Taken For Recreational Use?

It is illegal to use this drug for recreational use but that doesn’t stop people from doing it. One of the reasons is how it makes them feel. The high from Gabapentin is similar to marijuana. It gives the user a sense of calm, a feeling of euphoria, and helps manage pain. It helps create a relaxed state of mind and body, it enhances social skills, and even works as a sedative and gives a buzz similar to opioids, without a “coming down” feeling.

Just the searches on Google alone show that this is a popular drug. There are nearly 420,000 people searching for Gabapentin high or seeking the recreational uses for this drug every month.

And since many places do not have legal recreational marijuana, some may want to mimic the effects of marijuana without risking legal problems, without having to pay a lot, and without inconvenience.

Another reason for its popularity is its low cost. When a bottle of 90 pills can cost as little as $10, it is something that can easily be misused. Plus, it is not a narcotic so that can cause some to be complacent about the risks. They may think that since it’s not a narcotic or opioid that it is safe – when it is not 100 percent safe and little is known about the risks. And since it is not considered a controlled substance, it is easy to get in large quantities – making it easier to abuse.

Some users have reported that the high from snorted Gabapentin can be similar to taking a stimulant. It can also enhance the euphoric effects of other drugs, like opiates, and is likely to increase the risks when taken in this way. This is where it can become dangerous, especially when mixed with things like heroin or fentanyl. In fact, mixing Gabapentin with opioids does increase the risk of a fatal overdose. In 2017, 1/3 of drug overdose deaths were related to gabapentin.

Lastly, it may be more popular as a recreational drug due to how it is perceived. Since it is not a narcotic or opioid, some may be under the false impression that it is perfectly safe. It is relatively safe if taken correctly. Yet as we know, when it is abused, this is where it has risks, including addiction. But to some people, it is not viewed as a risk simply because it’s not a traditional pain killer or something you have to show ID for at the pharmacy. No one is watching over your shoulder at how many you get and it is not on the news media’s radar. This sometimes creates a sense of complacency.

Is It Addictive?

First, let’s look at the difference in addiction and dependence because this is important when it comes to Gabapentin. Suffice it to say, addiction treatment exists specifically for the drug. Substance abuse is common with gabbies.

Dependence vs Addiction

A dependence is physical, where the body feels that it needs the drug. The difference in that and addiction is that there is a change in behavior where there is a physical and mental need for the drug. People who are addicted or develop a physical dependence to a drug may take part in behaviors that are not what someone would usually do. Their focus is the need for the drug. While these are similar, the dependence is physical and the addiction is mental and physical. Both are extremely similar and sometimes hard to differentiate.

Physical dependence means that the body adapts to the drug’s effects. This can and often leads to a need for more and more of the drug to get the same effects. This also notates withdrawal symptoms when the drug is stopped or not enough is given to the tolerance level of the person.

Whereas addiction is similar and does include some of the physical dependence traits, it also includes others. It is when the person cannot stop the use of the drug. This is the very definition of drug abuse. This affects things like their family obligations, their social life, and including their work life. Of course, tolerance and withdrawal also becomes a part of the addiction.

What About Gabapentin?

With that said, it is not addictive in the traditional sense. Yet a person may feel a dependence for it and this is what makes it more hazardous.

One issue that is disturbing is that the medical community does not consider this drug to be physically addictive. This only means that for this particular drug, it’s potential for addiction and dependence is complicated to determine. Many patients shared that they experienced withdrawal effects after stopping the use of it. And of course, anything can cause a psychological addiction.

The body can become tolerant to this drug and often, the doctor will increase the dosage. This too leads to it being harder to stop when needed.

What Are the Side Effects?

Gabapentin has mental and physical side effects including:

• Dizziness
• Double vision
• Fatigue
• Fever
• Lack of coordination
• Memory loss
• Nystagmus (involuntary eye movement)
• Sleepiness
• Tremors
• Viral infections
• Unsteadiness
• Shortness of breath
• Mouth ulcers
• Dry mouth
• Urinary problems
• Eye-rolling
• Water retention
• Red and itchy eyes
• Weight gain
• Heartburn

There are also a few mental health side effects that include:

Agitation, Decreased libido, Depersonalization, Increased libido, Mania, and Paranoia.

These are a few of the side effects. While it is fairly safe if taken correctly, there are many effects that can arise regardless and even more so when taken in an abusive way. The most disturbing side effect that is possible is suicidal thoughts. The FDA lists some incredible numbers. They showcase that one if 500 people taking this drug will have suicidal thoughts. Now, while that is 1 in 500 odds, use the same math when realizing that there are almost 60 million prescriptions written for this drug and around 1 percent of the population on it. Then you realize how big the number of people with suicidal thoughts.

This is why using it how the doctor prescribed it is imperative. Your doctor determines the dosage according to a few factors that are unique to every patient. These include things like the weight of the patient, the patient’s age, and the patient’s overall health. Yet, there are other factors too. From the brand of the drug to the type of Gabapentin – they are also factors. Even the very condition being treated is important.

For example, someone being treated for restless leg syndrome will most likely have a very different prescription than someone being treated for convulsions. And someone who weighs over 250lbs will probably have a different dosage from someone who is 100lbs. Every variance is a factor in how it is prescribed and taking it different from how it is prescribed is what gets some people in trouble to where they either have adverse side effects or risk their health and life.

Someone who starts altering their prescription doesn’t have the same background knowledge as a doctor. They can easily take too many drugs, mix it with the wrong drugs, or start building up a tolerance that can not be sated eventually. They may start to shop doctors or find the drug elsewhere just to get the same feeling they had in the past before their tolerance was raised.

Withdrawal Symptoms of Gabapentin

Most of the side effects occur when the drug has been abruptly stopped or is abused. These side effects mentioned don’t normally occur often in a situation where the patient is taking the drug correctly under a physician’s care. These include:

1. Mood swings such as depression, crying, and even suicidal thoughts.
2. Heart palpitations that occur even if the person isn’t doing physical activity.
3. Dizziness can be extremely severe and interrupt normal activities.
4. Headaches can be severe or mild depending on the person.
5. Muscle spasms and cramps.
6. Anxiety even when you have not experienced it in the past or being anxious about things that never bothered you before.
7. Convulsions or seizures in people who were taking this drug for relief from seizures.
8. Insomnia can affect a person’s way of life.
9. Increased pain.
10. Personality changes like agitation and irritability.
11. Excessive sweating and perspiration.
12. Stomach problems like pain, nausea, diarrhea, and changes in the appetite.
13. Flu-like symptoms include body aches, fatigue, and fever.
14. Nerve Pain

Gabapentin withdrawal syndrome resembles many symptoms of benzo withdrawal and alcohol withdrawal. Withdrawal usually occurs after quitting cold turkey.

Sometimes Help Is Needed

By itself, Gabapentin isn’t a scary or bad drug. So much so that it won’t even show up on a drug screen test. But the difference is when it is combined with other drugs. This opens up a whole new world where the risks are amplified and the potential for harm is heightened.

The problem, or one of them, is that there isn’t an antidote for an overdose. It has been found to have been used as a cutting agent for other drugs too, such as heroin. Some people use it with alcohol too. Any kind of other drug mixed with this one has the potential for both abuse and misuse.

If you are planning to stop taking gabapentin, you will want to make an appointment with your prescribing doctor or a primary care doctor who can help see you through the tapering process.

What Are the Signs of Gabapentin Abuse?

While Gabapentin is a drug with the potential for abuse, recognizing the signs isn’t always quite so easy. This is because the symptoms seem the same as when taking it as you should versus abusing it. For example, one of the side effects of Gabapentin is disorientation. Yet, it is also a side effect of someone abusing it. See how confusing and hard to determine it can be?

Here are more of the signs that a person may be abusing Gabapentin. Of course keep in mind, as stated, that the signs are the same – abuse or prescribed dosage.

Anxiety

Disorientation

Depression

Struggling to stay awake or drowsiness

Slurred speech

Impaired memory

Noticeable and frequent eye problems

Extreme loss of coordination

Jerking or shaking uncontrollably

Extreme loss of coordination

Now just because a person is taking a high dosage, this does not mean the drug is being abused. In fact, often a high dosage simply signifies that the doctor has prescribed an amount that is helpful for the person’s issue that caused it to be prescribed in the first place.

One thing to keep in mind is that the signs of Gabapentin abuse are less physical and more behavioral and psychological.

Here are a few of the signs that may be indicative for someone who is abusing Gabapentin.

• Symptoms of withdrawal when doing without the prescription for too long in between doses.
• Telling doctors exaggerated descriptions of symptoms. This is to gain more of the medication.
• Not being able to quit
• Refusing to stop taking the prescription
• Medical Doctor shopping in order to get more medication or to hide the amount of use.
• Becoming irate or upset if the medication is not available.
• Changes in grooming or hygiene habits.
• Talks about the medication frequently or shows obsessive behavior.
• Changes in friends with distancing themselves from family. There may be an entirely new type of group of friends and often long-term friends and family are sacrificed.

The shocking news is that there are more deaths being reported that are linked to Gabapentin use. It is interesting to know that with the general population, the abuse of this drug is fairly low. In fact, as low as 1 percent. But, there is another number that is important to know. If you take the population percentage that takes opioids and look at their rates of Gabapentin use, that number goes up to 22 percent. The last number to be aware of, and perhaps the most surprising, is that if you take all users of this drug, the addiction rate is around 65 percent.

We Can Help You Make the Transition

If you need help with Gabapentin use, we provide professional addiction treatment help. Since this drug should never be stopped abruptly, people often need help getting off of it. Yet, it has to be done the right way – slowly tapering off of it is important.

Some rehabilitation centers do not yet fully understand all there is to know about this drug and do not offer a plan for those who have trouble getting off of it. Yet, there is help with this drug, just like other types of drugs that a person may need help with.

Withdrawal from Gabapentin can take a while for a person. This may take weeks or even months depending on how long the medication was used, the dosage, and each person’s individual body physiology. A physician or the staff at a rehabilitation facility can help ease you through the withdrawal process so that you are much more comfortable. Some of the ways they do this are by suggesting effective tapering off schedules, providing you with supplements, or other helpful ways to decrease the debilitating side effects of withdrawal.

In fact, the treatment for Gabapentin withdrawal can be quite similar to treatment from other drugs like opioids. Once the detoxification is complete, it is a good plan to go on alternative medications. These include drugs like Lyrica, Cymbalta, and pregabalin. Yet, it is imperative to realize that these are also drugs that have the potential for addiction. That is why a customized plan is needed for each individual. Some patients may even be addicted to other drugs as well or have what is known as co-occurring disorders. These are all treated accordingly.

The point is to find caring, compassionate professionals who treat everyone as an individual – no matter what their needs. We tailor your treatment and help you live life without the need for Gabapentin.

Sources

American Journal of Health-System Pharmacy, 67(11), 910-912

Smith, R., Havens, J., and Walsh, S. (2016)

Mersfelder, T.L., and Nichols, W.H. (2016)

Hellwig, T.R., Hammerquist, R. & Termaat, J. (2010)