Tag: Horizant

Gabapentin Side Effects

What is gabapentin?

Gabapentin is an anti-epileptic drug, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain.

Gabapentin is used together with other medicines to treat partial seizures in adults and children at least 3 years old.

Gabapentin is also used to treat neuropathic pain (nerve pain) caused by herpes virus or shingles (herpes zoster) in adults.

Use only the brand and form of gabapentin your doctor has prescribed. Check your medicine each time you get a refill to make sure you receive the correct form.

The Gralise brand of gabapentin is indicated for the management of neuropathic pain only. It is not used for epilepsy.

Horizant is used to treat nerve pain and restless legs syndrome (RLS).

The Neurontin brand is used to treat seizures in adults and children who are at least 3 years old, in addition to neuropathic pain.

What is Gabapentin side effects ?

Gabapentin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • drowsiness
  • tiredness or weakness
  • dizziness
  • headache
  • uncontrollable shaking of a part of your body
  • double or blurred vision
  • unsteadiness
  • anxiety
  • memory problems
  • strange or unusual thoughts
  • unwanted eye movements
  • nausea
  • vomiting
  • heartburn
  • diarrhea
  • dry mouth
  • constipation
  • increased appetite
  • weight gain
  • swelling of the hands, feet, ankles, or lower legs
  • back or joint pain
  • fever
  • runny nose, sneezing, cough, sore throat, or flu-like symptoms
  • ear pain
  • red, itchy eyes (sometimes with swelling or discharge)

Some side effects may be serious. If you experience any of the following symptoms, call your doctor immediately:

  • rash
  • itching
  • swelling of the face, throat, tongue, lips, or eyes
  • hoarseness
  • difficulty swallowing or breathing
  • seizures

Gabapentin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

Call your doctor at once if you have:

  • increased seizures;
  • fever, swollen glands, body aches, flu symptoms;
  • skin rash, easy bruising or bleeding, severe tingling, numbness, pain, muscle weakness;
  • upper stomach pain, loss of appetite, dark urine, jaundice (yellowing of the skin or eyes);
  • chest pain, irregular heart rhythm, feeling short of breath;
  • confusion, nausea and vomiting, swelling, rapid weight gain, urinating less than usual or not at all;
  • new or worsening cough, fever, trouble breathing;
  • rapid back and forth movement of your eyes; or
  • severe skin reaction — fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Some side effects are more likely in children taking gabapentin. Contact your doctor if the child taking this medication has any of the following side effects:

  • changes in behavior;
  • memory problems;
  • trouble concentrating; or
  • acting restless, hostile, or aggressive.

Common gabapentin side effects may include:

  • dizziness, drowsiness;
  • dry mouth, blurred vision;
  • headache;
  • diarrhea; or
  • swelling in your hands or feet.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Gabapentin 300mg
Gabapentin 300mg

Can You Overdose On Gabapentin?

Compared with some drugs, such as opioids, gabapentin appears to be relatively non-lethal in overdose situations, meaning the morbidity associated with a toxic dose is low.  However, the primary danger of gabapentin overdose appears when individuals use gabapentin in conjunction with other drugs, such as alcohol or opioids.

Mixing substances with central nervous system depressant effects can easily result in an amplification of certain side effects and can lead to significant issues, including overdose. For instance, individuals using gabapentin in conjunction with alcohol are subject to intensified depressant side effects such as sedation and dizziness. Alcohol itself may also cause a more rapid release of the contents of certain extended-release tablet formulations of the drug, potentially putting the user at greater risk of gabapentin overdose.

Alcohol isn’t the only danger for those using gabapentin. Among those on a prescription opioid regimen, being concurrently prescribed gabapentin is associated with a substantially increased risk of opioid-related death.

an overdose of gabapentin may result in the following symptoms:

  • Dizziness.
  • Drowsiness.
  • Double vision.
  • Slurred speech
  • Diarrhea.
  • Nausea.
  • Vomiting.
  • Loss of control of bodily movements (ataxia).
  • Low blood pressure.
  • Rapid heart rate.
  • Labored breathing.
  • Coma (in patients with kidney failure).

Gabapentin overdoses are often medically managed without significant complications. Nonetheless, any type of drug overdose can be very serious, and some individuals may experience more severe reactions in the setting of a gabapentin overdose. For instance, children, elderly individuals, and those with impaired renal function may be at a much higher risk of complications from a toxic dose of gabapentin than healthy adults.

The concurrent ingestion of other substances may also result in a more dire medical situation and, as mentioned, could increase the likelihood of overdose death. Individuals who overdose on a combination of gabapentin and another drug with depressant effects (e.g., alcohol, benzodiazepines, opioids, etc.) are at serious risk of significant adverse effects, and these individuals may require immediate medical attention.

Gabapentin may cause respiratory depression when used alone or with other substances. Combining the drug with other respiratory depressing substances may be deadly.

Unfortunately, it is all too common for gabapentin to be prescribed to individuals who also use opioids, the combination of which can result in profound respiratory depression (especially when these drugs are misused in larger-than-recommended doses).

Because of the very real risk of dangerously slowed breathing and, ultimately, respiratory arrest, those who abuse gabapentin to intensify an opioid high may risk death with each use.

Depending on the severity of any resultant oxygen deprivation and the length of time that it persists, consequences may include:

  • Seizures.
  • Permanent brain damage.
  • Coma.
  • Death.

 

What Diseases is Gabapentin Used For ? Is Gabapentin Suitable for Children under 6 Years of Age ?

Gabapentin is not suitable for children under 6 years of age but, if it has been prescribed for a child who is older than this, check the label carefully to make sure you are giving the correct dose.
Gabapentin is FDA approved as an anti-convulsant for the treatment of Epilepsy and seizures resulting from other disorders. It is used to treat neuralgia and neuropathy, both of which are syptoms of many different diseases; such as, diabetic neuropathy or Shingles related neuralgia, among other disorders like fibromyalgia, as well as, physical trauma.

Dr.s also prescribe it for general anxiety and panic disorders, instead of more addicting benzodiazepines. and very recently it has been tried as a treatment for major depression and mood disorders.
It can help potentiate the efficacy of analgesic drugs, mostly opiate/opioid medications. It also helps mitigate the unpleasant side effects of withdrawal from opiates during titration and cessation of those drugs.  It can treat Restless Leg Syndrome (RLS).
It is not a controlled substance in the United States, and has a very low abuse potential, because it’s efficacy is dose dependent, with limited bioavailability and therefore, the higher the dose the less effective it is. It’s a gabapentinoid and it’s molecular structure is similar to that of GABA , making it a GABA analog, and it works by inhibiting Voltage-dependent Calcium channels (VDCC), it often is thought of as a GABA agonist, like benzodiazepines, but that is incorrect.
Take gabapentin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
The Horizant brand of gabapentin should not be taken during the day.  For best results, take Horizant with food at about 5:00 in the evening.
Both Gralise and Horizant should be taken with food. Neurontin can be taken with or without food.
If you break a Neurontin tablet and take one half of it, take the other half at your next dose. Any tablet that has been broken should be used as soon as possible or within a few days.
Measure liquid medicine with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
If your doctor changes your brand, strength, or type of gabapentin, your dosage needs may change. Ask your pharmacist if you have any questions about the new brand you receive at the pharmacy.
Do not stop using gabapentin suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor’s instructions about tapering your dose.
Wear a medical alert tag or carry an ID card stating that you take gabapentin. Any medical care provider who treats you should know that you take seizure medication.
This medication can cause you to have a false positive urine protein screening test. If you provide a urine sample for testing, tell the laboratory staff that you are taking gabapentin.
Store at room temperature away from light and moisture.

  • Before starting this treatment, read the manufacturer’s printed information leaflet from inside the pack. The leaflet will give you more information about gabapentin and any possible side-effects from taking it.
  • Take gabapentin exactly as your doctor has told you to. You will be advised to take a small dose when you first start taking gabapentin and then to increase your doses over a few days as your body gets used to it. Your doctor or pharmacist will explain this to you and your dose will also be on the label of your pack.
  • Gabapentin is not suitable for children under 6 years of age but, if it has been prescribed for a child who is older than this, check the label carefully to make sure you are giving the correct dose.
  • You can take gabapentin before or after meals. Swallow the tablets/capsules with a drink of water.
  • Once you are taking a regular amount of gabapentin, try to take your doses at the same times each day. This will help you to avoid missing any of your doses.
  • If you do forget to take a dose, take it as soon as you remember, but do not take two doses together to make up for a forgotten dose.
  • If you need to take an antacid or indigestion remedy, do not take it during the two hours before and the two hours after you take gabapentin. This is because they interfere with the way gabapentin works.

Store the liquid medicine in the refrigerator. Do not freeze.
 

When Was Gabapentin Approved by the U.S. Food and Drug Administration (FDA) ?

About Gabapentin

There are many drugs used to treat anxiety. New studies are now showing that Gabapentin has been a successful treatment for individuals who suffer from anxiety. However, there are no randomized controlled trials on the effectiveness of this medication in generalized anxiety disorder (GAD), and there are only a few case reports.
People with GAD who take Gabapentin have shown to be less irritable, reduce the use of alcohol as self-medication, have fewer depression symptoms, feel less anxious anticipating the future, improve in phobic avoidance (going out in public more and experiencing a significant decrease in panic disorder and reduction of panic attacks).
Gabapentin is an anticonvulsant drug that is primarily used to treat seizures and the pain that follows after an episode of shingles. Gabapentin is considered an off-brand drug used to treat anxiety. Neurontin is the most common brand name for Gabapentin, as well as Horizant and Gralise. Gabapentin has shown to help people with sleeping better, as insomnia is a symptom of anxiety.

Side Effects of Gabapentin 

Like all medications, there are several side effects to taking Gabapentin. Side effects that you experience are relative to your personal reaction to the drug. Everyone is different, so you may not experience side effects that others do or don’t. Some side effects can be nausea, vomiting, tremors, dizziness, sleepiness, double vision, loss of control of bodily movements, fluid retention, difficulty speaking, jerky movements, unusual eye movements, double vision, and unsteadiness.
If you begin to experience any of these symptoms, speak with your doctor immediately. Get emergency help if you suspect you are having an allergic reaction like; swelling of your face, lips, tongue, or throat, hives, and difficulty breathing. If you notice that your symptoms are worsening, contact your doctor immediately. You may not notice symptoms until weeks after taking Gabapentin.

Is Gabapentin Approved by the U.S. Food and Drug Administration (FDA) ?

Gabapentin was originally approved by the U.S. Food and Drug Administration (FDA) in December 1993, for use as an adjuvant medication to control partial seizures (effective when added to other antiseizure drugs) in adults; that indication was extended to children in 2000. In 2004, its use for treating postherpetic neuralgia (neuropathic pain following shingles) was approved.

Gabapentin is best known under the brand name Neurontin manufactured by Pfizer subsidiary Parke-Davis. A Pfizer subsidiary named Greenstone markets generic gabapentin.
In December 2004 the FDA granted final approval to a generic equivalent to Neurontin made by the Israeli firm Teva.
Neurontin began as one of Pfizer’s best selling drugs; however, Pfizer has come under heavy criticism and serious litigation for its marketing of the drug.
They face allegations that, behind the scenes, Parke-Davis marketed the drug for at least a dozen supposed uses that the FDA had not approved.
Today it is a mainstay drug for migraines, even though it was not approved for such use in 2004.

What is Gabapentin Used for ?

Gabapentin comes as a capsule, a tablet, an extended-release (long-acting) tablet, and an oral solution (liquid) to take by mouth. Gabapentin capsules, tablets, and oral solution are usually taken with a full glass of water (8 ounces [240 milliliters]), with or without food, three times a day.
These medications should be taken at evenly spaced times throughout the day and night; no more than 12 hours should pass between doses. The extended-release tablet (Horizant) is taken with food once daily at about 5 PM. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take gabapentin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Gabapentin extended-release tablets cannot be substituted for another type of gabapentin product. Be sure that you receive only the type of gabapentin that was prescribed by your doctor. Ask your pharmacist if you have any questions about the type of gabapentin you were given.
Swallow the extended-release tablets whole; do not cut, chew, or crush them.
If your doctor tells you to take one-half of a regular tablet as part of your dose, carefully split the tablet along the score mark. Use the other half-tablet as part of your next dose. Properly dispose of any half-tablets that you have not used within several days of breaking them.
If you are taking gabapentin to control seizures or PHN, your doctor will probably start you on a low dose of gabapentin and gradually increase your dose as needed to treat your condition. If you are taking gabapentin to treat PHN, tell your doctor if your symptoms do not improve during your treatment.
Gabapentin may help to control your condition but will not cure it. Continue to take gabapentin even if you feel well. Do not stop taking gabapentin without talking to your doctor, even if you experience side effects such as unusual changes in behavior or mood. If you suddenly stop taking gabapentin tablets, capsules, or oral solution, you may experience withdrawal symptoms such as anxiety, difficulty falling asleep or staying asleep, nausea, pain, and sweating. If you are taking gabapentin to treat seizures and you suddenly stop taking the medication, you may experience seizures more often. Your doctor may decrease your dose gradually over at least a week.
Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with gabapentin and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs) or the manufacturer’s website to obtain the Medication Guide.

Off-label use exposes patients to adverse effects and generally is not supported by evidence.

The only conditions for which gabapentinoid drugs are FDA-approved to manage pain are postherpetic neuralgia (both gabapentin and pregabalin [Lyrica]) and diabetic neuropathy, spinal cord injury, and fibromyalgia (pregabalin only). Nevertheless, use of these drugs has tripled during the past 15 years. This increase likely reflects gabapentinoid use for managing non–FDA-approved pain conditions, in part to avoid opioid use. In this review, researchers identified 34 placebo-controlled randomized trials (with ≈4200 patients) of gabapentinoids for noncancer, non–FDA-approved pain conditions. Most trials’ durations were 4 to 12 weeks.
Results of the review were as follows:

  • Only weak evidence supports use of gabapentin for diabetic neuropathy (only pregabalin is approved for this indication).
  • Minimal evidence supports use of gabapentin for nondiabetic painful neuropathies.
  • Studies of gabapentinoids for managing low back pain or sciatica have been largely negative.
  • Only minimal evidence supports a clinically meaningful benefit of off-label gabapentin use for fibromyalgia (for which pregabalin is approved).
  • Both gabapentin and pregabalin are approved for managing postherpetic neuralgia, but both are used often for acute zoster pain, for which studies have shown no benefit.
  • A small number of studies of gabapentinoid use for other pain syndromes (e.g., traumatic nerve injury, complex regional pain syndrome, burn injury, sickle cell pain) showed no clinically important benefits.

COMMENT

The markedly increased off-label use of gabapentinoids to manage pain has no or limited evidence of benefit. This practice is worrisome, especially given known high rates of side effects, including dizziness, somnolence, and unsteadiness. In addition, the authors note that patients often are prescribed gabapentinoids to avoid opioid use, but such patients sometimes still use opioids, either prescribed or illicit. The combination of gabapentinoids and opioids is associated with excess risk for opioid overdose.

Dr. Brett is an author of this article and is the Editor-in-Chief of NEJM Journal Watch General Medicine; however, he had no role in selecting or summarizing this article.

 

How to use gabapentin oral ?

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking gabapentin and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth with or without food as directed by your doctor. Dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight.
If you are taking the tablets and your doctor directs you to split the tablet in half, take the other half-tablet at your next scheduled dose. Discard half tablets if not used within several days of splitting them. If you are taking the capsules, swallow them whole with plenty of water.
It is very important to follow your doctor’s dosing instructions exactly. During the first few days of treatment, your doctor may gradually increase your dose so your body can adjust to the medication. To minimize side effects, take the very first dose at bedtime.

Do not take this medication more often or increase your dose without consulting your doctor. Your condition will not improve any faster and the risk of serious side effects may increase.
Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.
Antacids containing aluminum or magnesium may interfere with the absorption of this medication. Therefore, if you are also taking an antacid, it is best to take gabapentin at least 2 hours after taking the antacid.
Different forms of gabapentin (such as immediate-release, sustained-release, enacarbil sustained-release) are absorbed in the body differently. Do not switch from one form to the other without consulting your doctor.
Tell your doctor if your condition does not improve or if it worsens.