Gabapentin: Withdrawal Symptoms, Abuse & Use in Drug & Alcohol Detox
Gabapentin is a prescription anticonvulsant used to treat epileptic seizures, postherpetic neuralgia, and restless legs syndrome. Postherpetic neuralgia is pain caused by shingles, which can last many months after having the illness.
While the exact mechanism of action of gabapentin is not fully understood, it may work by decreasing excitatory brain signaling. This can prevent seizures and change the way the brain responds to pain signals. This medication can be found as a capsule, tablet, or oral solution.
As an Addiction Treatment Medication
The medical research community has made great strides in synthesizing thousands of drugs over the years to treat physical ailments, mental illness, and other health conditions.
Addiction is just one of the many conditions that can be treated with specific medications. And while there are presently only a handful of FDA-approved medications used to manage substance dependence, gabapentin has been considered for off-label use for as an addiction treatment drug.
Different companies, including Parke-Davis, Greenstone, and Teva, manufacture several varieties of the generic drug. Other drugs that have been used to treat the symptoms of addiction withdrawal, for specific substances, include:
- Other anticonvulsants, such as Tegretol and Depakote
- Methadone and buprenorphine
Doses range from 100 mg to 800 mg. The frequency of administration may be based on various factors such as withdrawal symptom severity and withdrawal progress. The drug’s half-life is around 5-7 hours.
Gabapentin has been evaluated for use during medical detox and throughout subsequent treatment modalities to support relapse prevention while clients adjust to their new sober lifestyles.
Treating Substance Abuse
According to Medscape, gabapentin can inflict users with suicidal thoughts and abrupt changes in behavior. For this reason, it should only be used under medical supervision. It can also cause elevated blood pressure, fever, sleep problems, appetite changes, and chest pain.
While it has been used to treat addictions to other substances, gabapentin is most often used to treat alcoholism — an addiction some 16.6 million adults suffered from in 2013, per the National Institute on Alcohol Abuse and Alcoholism.
During withdrawal from alcohol abuse or dependency, clients may experience anxiety, tremors, agitation, and irritability. In order to understand how gabapentin works, there must be a basic understanding of how the brain works first. A balance of excitatory and inhibitory nervous system activity is, in part, mediated by neurotransmitters known as GABA and glutamate. Gabapentin may work by potentiating the inhibitory signaling of GABA and reducing the neural excitation associated with glutamate activity. As a result, signals for pain, agitation, and anxiety are reduced, too.
An American Journal of Psychiatry study showed impressive results during the 16-week treatment of 150 people who were dependent on alcohol, noting better results among those who were treated with both gabapentin and naltrexone than the latter alone. The Journal of Clinical Psychiatry reported on another study in which individuals treated for alcoholism with gabapentin showed a significant reduction in how much they drank and a greater rate of abstinence than those in the placebo group.
Gabapentin may have a similar calming effect on individuals who are detoxing from marijuana and benzodiazepines. Despite claims from fans of the plant-based drug, marijuana is indeed addictive. In 2012, 305,560 people checked into rehab citing cannabis as their primary drug of abuse, per the Substance Abuse and Mental Health Services Administration. One Neuropsychopharmacology study that analyzed the use of gabapentin in the treatment of marijuana addiction and withdrawal noted individuals in the gabapentin treatment group used less marijuana, had fewer withdrawal symptoms, and experienced improvements in cognitive functioning, compared to the placebo group.
While not quite as prevalent as a substance of abuse, benzodiazepines still accounted for 17,019 admissions to treatment in 2012, per SAMHSA. Individuals who have been abusing marijuana or benzodiazepines for a long period of time may have difficulty achieving a state of relaxation without those drugs, and gabapentin can help individuals remain calm while they’re recovering from addiction.
Gabapentin As An Addictive Drug
Many people use gabapentin for legitimate medical conditions, but some people become addicted to the drug and may misuse it.Frequent use of gabapentin can lead to physical dependence on the drug. This occurs when the body becomes accustomed to the substance and requires it in order to function normally. Physical dependence is a normal bodily response when taking a drug regularly. If you become physically dependent on gabapentin, you will experience a withdrawal syndrome whenever lessening or stopping its use.
The symptoms of withdrawal can be managed in various ways, including by slowly tapering the dosage of the drug or treating the symptoms with other medications. Quitting “cold turkey,” or all at once, can cause symptoms of withdrawal to be much more severe. Quitting gabapentin requires medical supervision and should only be done with a doctor’s approval.
Effects of Abuse
The use of gabapentin should be closely monitored by a doctor, in order to monitor side effects. Some people experience a rush of euphoria or “high” when using this drug, which can lead them to use it in higher doses or in ways other than how it was prescribed. Abusing this medication can lead to more severe side effects and increases the risk of overdose and physical dependence.
A study published by The Annals of Pharmacotherapy reported that addiction to and abuse of gabapentin were most likely to occur in individuals who had a history of addiction to other substances, including alcohol, cocaine, and opioids. Rates of gabapentin misuse were 1.1 percent in the general population and 22 percent in drug abuse treatment centers. People who abuse gabapentin often take extremely high doses of the drug or combine it with illicit substances to enhance its effects.
The National Library of Medicine (NLM) lists the following side effects of gabapentin:
- Shaking in one part of the body
- Blurry or doubled vision
- Difficulty with memory
- Strange or unusual thoughts
- Uncontrolled eye movement
- Nausea and vomiting
- Dry mouth
- Increased appetite and weight gain
- Swelling in the extremities
- Back or joint pain
- Ear pain
- Red, itchy eyes
Other more serious side effects include rash, itching, swelling of the face or mouth, hoarseness, difficulty swallowing or breathing, and seizures. These side effects indicate a serious reaction to the drug and require immediate medical attention.
Symptoms of overdose according to NLM include:
- Double vision
- Slurred speech
If too much gabapentin is taken accidentally, or if the drug is abused, it is possible to overdose and experience adverse effects. Risk of overdose increases after withdrawal, if the individual returns to gabapentin use and does not increase the dosage gradually. Dosages of gabapentin should always be increased and decreased by small amounts over a period of at least several days. An overdose of any substance requires immediate medical attention. Overdose can cause lasting damage to internal organs, including the heart, liver, and kidneys.
Gabapentin withdrawal occurs when stopping use of the drug after becoming physically dependent on it. It is possible to become physically dependent on gabapentin even when using the medication only as prescribed, particularly if it is used on a long-term basis.
NLM lists the following symptoms of gabapentin withdrawal:
- Difficulty sleeping
Symptoms of withdrawal typically begin within 12 hours of the last drug use and may last up to a week. If gabapentin is being used to treat a seizure disorder, stopping use of the drug too suddenly can cause the frequency of seizures to increase.
Gabapentin can cause changes in mood and may trigger depressive episodes, as well as compulsive thoughts. Withdrawal can also trigger mood episodes and other mental health problems, including anxiety and suicidal ideation. This is more likely in young adults and children. These symptoms of gabapentin withdrawal can last longer than acute physical symptoms, sometimes lasting weeks or months.
There are currently no FDA-approved medications for the treatment of gabapentin withdrawal. Some withdrawal symptoms, such as nausea and pain, may be treated with medications specifically for those symptoms. The main treatment for gabapentin withdrawal is supportive medical care and behavioral interventions. If an addiction is present, withdrawal may be the first step in the recovery process from a substance use disorder.