Gabapentin has been shown to lead to dependence, addiction and withdrawal in some people, although when it was first approved in 1993 this risk was thought to be minimal. Gabapentin has been increasingly associated with drug abuse, particularly in people who mix it with opioids, alcohol or other substances. Illegal diversion of gabapentin has led to its illicit availability on the streets, as well.

Using gabapentin with opioids can be dangerous. When combined with opioids or sedatives, the risk of respiratory depression (slowed or stopped breathing) and opioid-related death increases significantly. Withdrawal symptoms, especially when used at higher dosages, have also been reported.

Combined abuse of gabapentin and opioids can lead to a 4-fold higher risk of respiratory depression and opioid-related overdose and death. Serious breathing problems can also occur when gabapentin is taken with other medicines that can cause severe sleepiness or decreased awareness and by someone who already has breathing problems.

How common is gabapentin addiction?

In the general population, around 1% of people are estimated to misuse gabapentin, but in those who abuse opioids, one study has noted that 15% to 20% of people abuse the drug. In drug abuse treatment centers, up to 22% of people were reported to be misusing gabapentin. People who abuse opioids use gabapentin to further boost the euphoric “high” feeling with opioid abuse.

Gabapentin has been reported to be used by patients in substance use disorder treatment programs, as it is not typically screened for during treatment. Even though gabapentin may be used as a treatment option for alcohol and substance abuse, it is important to monitor for all drug-seeking behaviors in patients.

What are the signs of gabapentin addiction?

Signs that you may be misusing or becoming addicted to gabapentin include:

• Taking larger doses or using this medicine more frequently than prescribed by your doctor.
• Experiencing withdrawal symptoms when you try to stop using gabapentin.
• You are having strong cravings to use gabapentin.
• It is interfering with your ability at work, school or home-related activities.
• Seeing multiple doctors to obtain gabapentin prescriptions.
• Trying to stop use of gabapentin without success, even though you want to.
• Spending too much time trying to get gabapentin

Reports note that gabapentin is often used by people abusing other medicines, such as opioid painkillers like oxycodone, muscle relaxants, and anxiety medications such as Valium and Xanax to boost the high.

What are the most common gabapentin withdrawal symptoms?

Withdrawal symptoms after abruptly stopping gabapentin may include:

• agitation
• anxiety
• inability to remain still, restlessness (akathisia)
• disorientation
• headaches
• dizziness
• excessive sweating (diaphoresis)
• confusion
• trouble sleeping
• nausea
• fast or abnormal heart rate
• seizures (possibly severe)

In general, prescription gabapentin should be withdrawn gradually to help lower the risk for significant withdrawal symptoms. If you have epilepsy, stopping gabapentin suddenly can cause serious seizures that will not stop, known as status epilepticus.

In a survey, documented cases of withdrawal symptoms were reported in people who took daily doses between 400 mg to 8000 mg for at least 3 weeks.

• High doses, such as those used during substance abuse, may be associated with tolerance, addiction and even greater withdrawal symptoms.
• According to the manufacturer, there are also reports of people experiencing withdrawal symptoms after stopping higher off-label doses of gabapentin.

In a survey looking at abuse of gabapentin, it was found that patients were taking on average 3,000 mg/day, ranging from 600 mg to 8,000 mg/day. Withdrawal, when reported, occurred within 12 hours to 7 days of discontinuation of the medication.

There is no approved medication to treat gabapentin withdrawal. Slow discontinuation, as directed by healthcare professional, can help to relieve symptoms. Behavioral and supportive medical care, such as treatments for nausea, anxiety or insomnia can help to support the withdrawal. Treatment for any other substance use disorder should be initiated (for example, opioid or alcohol use) if this accompanies gabapentin misuse.

Is gabapentin a controlled substance in all 50 states?

No, as of September 2022, the following states have reported reclassification of gabapentin as Schedule C-V controlled substance:

• Alabama
• Kentucky
• Michigan
• North Dakota
• Tennessee
• Virginia
• West Virginia

The federal government does not classify gabapentin as a controlled substance, but several states have changed its status to help curb abuse.

What is gabapentin used for?

Gabapentin is a prescription anticonvulsant medicine approved to treat partial seizures and for the management of postherpetic neuralgia (shingles nerve pain) in adults.

• Postherpetic neuralgia is pain from damaged nerves that follows healing of shingles (a painful rash that comes after a herpes zoster infection) in adults.
• Partial seizures when taken together with other medicines in adults and children 3 years of age and older with seizures.

It has also been used “off-label” to treat other conditions like fibromyalgia, anxiety, alcoholism or other types of nerve pain. Gabapentin may also be used as an alternative to opioid medications to help manage pain. “Off-label" use means it may be prescribed by your doctor for a generally accepted use not specifically approved by the FDA or listed in the package labeling.

Related: Is gabapentin considered a painkiller?

The brand name treatments Horizant and Gralise are extended-release formulations of gabapentin, but are not approved for the treatment of epilepsy.

• Gabapentin enacarbil (brand name: Horizant) is the only gabapentin product approved for treatment of Restless Legs Syndrome (RLS). It is also approved to treat nerve pain (postherpetic neuralgia) caused by herpes virus or shingles (herpes zoster).
• Gabapentin (brand name: Gralise) is only indicated for the management of postherpetic neuralgia. Gralise is an extended-release formulation given once a day.

Use only the brand and form of gabapentin your doctor has prescribed. Different forms and brand names of gabapentin are not interchangeable.

Gabapentin Mechanism of Action

Gabapentin works by affecting chemicals and nerves in the body that are involved in the cause of seizures and in some types of nerve pain.

• It is a structural analog of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, but has no effect on GABA binding, uptake, or degradation.
• Experts are not exactly sure how gabapentin works, but it is thought to bind to calcium-channels within the nerve cells, improving the response to GABA in the brain.
• It is not structurally related to opioids and does not occupy opioid receptors.