Healthy Living

Gabapentin: Abuse, Withdrawal, and Overdose

Gabapentin: Abuse, Withdrawal, and Overdose

Key Takeaways

  • Gabapentin is an anticonvulsant drug often used to treat epilepsy, postherpetic neuralgia, and restless legs syndrome (RLS).
  • The drug has also been used to treat various addictions and is usually included as a part of the detox process.
  • There are a lot of reported cases of gabapentin abuse and withdrawal, especially in patients with a history of alcohol or drug abuse.

Most holistic addiction centers use gabapentin in one form or another to help their patients deal with addiction. However, many patients have started to abuse this drug after prolonged exposure during the course of their rehab process.

Gabapentin is usually available in the form of tablets and has been found to have a great and positive impact on addiction patients. For this reason, it is one of the core medications utilized by a number of rehab centers in mainland US. While there are other drug variants that are often used to help patients deal with withdrawal symptoms, Gabapentin is one of those few drugs that actually help regulate, limit, and inhibit unusual brainwave activity. In fact, the drug alters the brain similar to how the brain processes pain stimuli. That is why it is so effective in enabling addicts to overcome their withdrawal symptoms.

Gabapentin is an anti-epileptic medicine. It is also called as an anticonvulsant. It is used to treat post-herpetic neuralgia, which is the pain that follows an episode of shingles. It also prevents seizures. The Horizant brand is used to treat restless legs syndrome whereas the Neurontin brand is used to treat seizures in adults and three-year-old children. Use the brand and form prescribed by your doctor. Each time you get a refill, check the medicine to make sure you have received the correct one.

The brand names available are Neurontin and Gralise in the US. Fanatrex FusePaq Kit and Gabarone in the US have been discontinued.

Packaging

Gabapentin comes in the form of tablets and liquid with dosages that can vary between 100 mg to 800 mg. The drug is widely available and comes in other generic variants as well. The drug’s half-life is about a few hours only, six hours to be specific, and the dosage to be given depends more on the patient and the severity of his or her withdrawal symptoms.

It also depends on the person’s weight and height, wherein a higher dosage would be provided to large-sized patients to increase the efficacy of the drug. The drug is often used to treat substance abuse and is often used by various detox centers to help their in-house patients to deal with their withdrawal symptoms. It is also now used as an active drug by these rehab centers to prevent relapse among their patients once they are released. This drug may be taken with or without food.

What are the uses of gabapentin?

Gabapentin is used for treating seizure disorders and nerve damage from herpes zoster.

The non-approved uses are:

Gabapentin Abuse and Side Effects

Gabapentin is actively used to help users kick their addiction. The drug is quite effective as it changes the way the brain processes certain stimuli. The drug, apart from being used during the initial stages of the detox process to help patients overcome their withdrawal symptoms, is also used to prevent relapse among those released from detox centers. This drug has had a very positive impact on addicts even to the extent of managing them from relapsing any further. Gabapentin has a similar effect on those hooked on marijuana and benzodiazepines. The key thing about this drug is the calming effect it induces among various patients, enabling them to remain calm while dealing with their withdrawal symptoms.

Some of the side effects associated with this drug are known to sometimes cause suicidal thoughts, loss of concentration or focus, elevated blood pressure, and changes in behavior. That is why it is important to use this drug only after consulting a healthcare professional and with a doctor’s prescription. The drug is mostly used to treat alcoholism more than any other addictive habit and has shown itself to be quite effective in preventing people from regularly binging on alcohol. The fact that this drug is equally effective against other forms of addiction is indeed a welcoming news, allowing most rehab centers to start using gabapentin to treat other forms of addiction.

Gabapentin Addiction

Some people use this drug for legitimate medical conditions but some may get addicted to it and misuse it. If this drug is frequently used, it can cause physical dependence on it. The reason is that the body gets accustomed to it and requires it for normal functioning. People who lessen or stop its use experience withdrawal symptoms.

Since this drug manages to change the brain's chemistry and induces a calming effect, it has resulted in many of the addicts being hooked on this drug. Most patients who are released from various rehab centers are highly encouraged to take gabapentin to prevent them from relapsing back to their old habits. However, after prolonged exposure to gabapentin, patients tend to get hooked on the drug so much that they cannot imagine living without it anymore. Moreover, substance abuse can be more severe in patients who have been using this drug to fight off temptation and relapsing into their addiction. The withdrawal symptoms of this drug are also more severe resulting in symptoms flaring up even if there is a small drop in the level of the drug consumed over the last few hours.

In other words, those addicted to gabapentin often have to face acute withdrawal symptoms. In this case, most patients would require an active medical treatment and rehab process, so they can be weaned off the drug under controlled situations. While some claim to be able to quit all at once, the fact remains that with highly addictive substances, quitting cold turkey is not an option and not in any way possible.

Effects of Gabapentin Abuse

Patients addicted to gabapentin often report hearing voices, feeling really "high", being able to fly, and so on. While the full effects of this drug abuse are yet to be studied in detail, the fact remains that gabapentin is addictive over prolonged periods and has resulted in various rehab centers changing their treatment modalities to limit exposure to this drug over a long period of time. Moreover, the feeling of being "high" often causes these patients to increase their dosage in the quest for an even greater high, thereby getting pulled back into the circle of addiction and highs. The fact that this drug comes with various side effects does not seem to discourage addicts. For this reason, some have started to use this drug in combination with other addictive substances in search of that ever elusive greater high. The sad truth is that it often leads several addicts to a drug overdose that leads to death.

Abusing this medication may cause more severe side effects. It can also increase the risk of an overdose and physical dependence. A study published by the Annals of Pharmacotherapy reported that individuals who had a history of addiction to other substances such as alcohol, cocaine, and opioids, were most likely to get addicted to this drug. In the general population, the misuse of gabapentin was 1.1 percent and in drug abuse treatment centers, it was 22 percent.

Side Effects

Some side effects of gabapentin abuse are listed below:

Patients who have started taking this drug should be closely observed for clinical worsening or unusual changes in behavior. Some more serious side effects include itching, rash, swelling of the face and mouth, difficulty in swallowing or breathing, hoarseness, and seizures. These are serious side effects due to dangerous drug reactions and need immediate medical care.

Overdose

There is no specific antidote for its overdose. It is often easy for addicts to overdose on this drug, given how addictive it is within a short period of time. At times, an addict may take a higher dosage by mistake, which is why it is always a good idea to monitor patients who are on gabapentin round the clock.

Some of the symptoms of gabapentin overdose may include loss of coordination, slurred speech, blurry vision, diarrhea, and drowsiness. The nature of this drug is that any sudden increase in its dosage can lead the patient to experience withdrawal symptoms. Thus, gabapentin dosage must only be gradually increased and under strict medical supervision.

Other signs and symptoms of withdrawal include double vision, drowsiness, lethargy, and diarrhea. Possibly, it can lead to death if a very high amount is combined with alcohol. If the person uses gabapentin again and does not increase the dosage gradually, then the risk of an overdose after withdrawal increases. Lasting damage can be caused to the kidneys, heart, and liver due to overdose.

Hence, over a period of several days, the dosages should be increased and decreased by small amounts. Supportive care should be immediately given in such cases. Since gabapentin cannot be eliminated by the kidneys, hemodialysis can be done to remove the drug from the system of the patient. Serum gabapentin may be measured to confirm an overdose.

It goes without saying that given the addictive nature of this drug, the patients' parents and loved ones need to form an intervention, to get the patient realize what they are doing to all those around them and to their loved ones. Moreover, they should list various risks of substance abuse and be aware of the risks of a gabapentin overdose.

The patient should be monitored for any evidence of overdose such as diarrhea, dysarthria, lethargy, and diplopia. Suicide precautions should be taken according to the facility's policy and anticipate psychiatric re-evaluation.

Withdrawal Symptoms

After becoming physically dependent on the drug, and if its use is suddenly stopped, then gabapentin withdrawal occurs. Even when the medication is used only as prescribed, there are still chances of becoming physically dependent on it, especially if it is used on a long–term basis.

The withdrawal symptoms of this drug can be quite severe, leading to severe bouts of nausea, pain, anxiety, difficulty in sleeping, and sweating. Symptoms may occur within 12 hours of its last use and these symptoms may last up to a week. If this drug is used to treat seizure disorders and it is stopped suddenly, then the frequency of seizures may increase. Gabapentin may also trigger depressive episodes, compulsive thoughts, and mood changes. It can also trigger mood episodes and other mental health problems such as anxiety and suicidal ideation. Young adults and children are more at risk. The withdrawal symptoms can last longer than the acute physical symptoms. They might even last for weeks or months. Some of the common withdrawal symptoms include the following:

  • Change in appetite - there might be an increase or loss of appetite.
  • Anxiety - Gabapentin is prescribed to treat anxiety. However, during withdrawal, the feeling of anxiety is triggered.
  • Crying spells - the emotional stability is affected. For no apparent reason, the person may feel the urge to cry. However, these symptoms eventually cease.
  • Dizziness - while withdrawing from this drug, the person may experience dizziness, which will eventually diminish.
  • Depression - the only reason why people end up using gabapentin recreationally is that they may experience the feeling of depression during the withdrawal stage.
  • Feeling of fatigue - there are some complaints of a feeling of lethargy or fatigue during the withdrawal stage.
  • Insomnia - the initial complaint is severe insomnia, where the person normally experiences a difficulty in falling asleep.
  • Itchiness - it is another withdrawal symptom, which the person may feel all over the body.
  • Irritabilitythe signs of irritability is experienced at this stage.
  • Muscle pain - muscle pain may return or begin to be more noticeable after quitting the drug.
  • Seizures - if going “cold turkey” to quit, episodes of seizures may occur.
  • Restlessness - many users complain of restlessness. The ability to concentrate is affected due to the feeling of anxiety.
  • Spasms - spasm as a symptom can be severe.
  • Stomach pain - is one of the most common withdrawal symptoms.
  • Sweating - people quitting this drug may experience sweating, especially while asleep.
  • Being suicidal - due to the feeling of depression during withdrawal, the person might have suicidal thoughts.

Moreover, this drug is mainly used to treat epilepsy. If the patient has a history of fits, then within 12 hours of stopping this drug, he or she can experience a sudden onset of severe withdrawal symptoms with severe seizures. This is why the patient must be admitted to a rehab center to appropriately go through the withdrawal process under controlled situations rather than at home, where immediate medical attention may not be available.

This drug changes the chemical makeup of the brain that can cause sudden mood changes, which can even lead to depressive behavior with suicidal thoughts. On stopping gabapentin, the patient must be provided with all the assistance possible and given all the love, support, and care he needs to overcome the withdrawal symptoms. At the moment, there are no specific medications to help treat the withdrawal symptoms of gabapentin. For this reason, it is important for the patient to be under a controlled situation to help him make a quicker recovery.

Medications can be used to treat specific symptoms such as nausea and pain. However, the most important treatment is supportive care and behavioral interventions. In cases of addiction, withdrawal may be the first step.

Factors that Can Affect Gabapentin Withdrawal 

Several factors can affect an individual such as intake timeline, patient physiology, dosage, and withdrawal method.

  • Timeline - it is the length of time the person has been taking this drug. It can range from weeks to years. It is easier to quit the drug if the user has been using it for a shorter period. If the person has been taking it for longer periods, then the withdrawal process becomes more challenging.
  • Dosage - some doctors determine the appropriate dosage by using the body weight of the person. Usually, for younger individuals, 900 mg per day is prescribed, wherein 300 mg per dose is taken three times a day.
  • Physiology - some people may be too sensitive to medications and the process for them to discontinue gabapentin would be more difficult.

These factors are very important in determining the recovery period as well the various methods that will help in quitting this drug.

Drug Interactions

The concentration of gabapentin is reduced by antacid in the blood. Hence, this drug should be taken after two hours of taking an antacid. The blood concentration of gabapentin is also increased significantly by morphine, which may cause an increase in adverse events related to the central nervous system.

Support

While it is hard for any family member to see what is happening to their son, daughter, brother, sister, or cousin, the fact remains that patients would definitely need all the love, support, and care to help them take the next step in the treatment process. It goes without saying that most patients would not be able to successfully repeat the treatment process on their own, which is why most rehab centers highly encourage family members to actively participate in the detox and rehab process.

Socialization

It is important for all patients to realize that they have a life waiting for them outside the gates of their treatment center and it is up to them to take that first step toward a complete recovery. 

Once this first step is taken, the patient is often provided with help and support from others in the center and is often encouraged to socialize with them, so that the patient has a support group in the center. It is never easy for patients to admit that they are an addict, and yet, when they make that declaration in front of complete strangers, they know that they are indeed making good progress.

It is important for the patients to realize that the first step is just one of many, which can lead them back to their normal life.

Conclusion

There are a lot of reported cases of gabapentin abuse and withdrawal, especially in patients with a history of alcohol or drug abuse. Although gabapentin is used for the treatment of alcohol and substance abuse, it is necessary to identify addictive behaviors early in the treatment process.

Doctors and healthcare professionals must be sensitive and fully aware of the patients’ risk and should strictly monitor any signs of drug abuse or dependence as well as withdrawal symptoms.