Why is Gabapentin 600mg Prescribed?

Gabapentin is a prescription medication known as a gamma aminobutyric acid (GABA) analogue. GABA reduces the excitability of nerve cells (neurons) in the brain, which play a role in seizures and the transmission of pain signals. Gabapentin mirrors the effects of GABA calming excited neurons. Gabapentin, available in doses like 600 mg and 800 mg, is primarily prescribed for managing certain types of nerve pain (neuropathic pain) and as an adjunctive therapy for seizures.

How Gabapentin (Neurontin) Works ?

Gabapentin (Neurontin) is an antiepileptic that’s also used to help with nerve pain. It has a similar structure to gamma-aminobutyric acid (GABA), a chemical in the brain that calms nerves. It’s not completely known how gabapentin (Neurontin) works to treat seizures or nerve pain, but it’s thought to work by lowering the activation of nerves involved with causing nerve pain and seizures.

Here’s a closer look at how these doses work and what to keep in mind:

Uses

Nerve Pain: Often prescribed for conditions like postherpetic neuralgia (nerve pain following shingles) or diabetic neuropathy.
Seizure Control: Used as an adjunctive treatment for partial seizures in adults and children over a certain age.
Off-Label Uses: Sometimes used to manage generalized anxiety, certain types of headaches, and fibromyalgia, though this varies by individual and physician.

Differences Between 600 mg and 800 mg

Strength and Dosing: The main difference lies in the strength, with 800 mg providing a higher dose. A doctor will determine the appropriate dose based on the condition being treated, patient tolerance, and medical history.
Dosing Schedule: Gabapentin is often started at a lower dose and gradually increased. The maximum daily dose can go up to 3600 mg (split across the day), but this depends on individual tolerance and needs.

How It Works

Gabapentin affects the way nerves transmit pain and seizure signals by acting on certain neurotransmitters, though it’s not fully understood. This action helps to stabilize nerve activity, which can alleviate pain or reduce seizure frequency.

Possible Side Effects

Common Side Effects: Drowsiness, dizziness, fatigue, and sometimes swelling in the extremities.
Serious Side Effects: Some may experience mood changes, respiratory issues, or severe allergic reactions. It’s crucial to monitor for any sudden changes, especially when starting or adjusting the dose.
Addicted to gabapentin: Some people can become addicted to gabapentin. If this happens, you’ll have withdrawal symptoms after you stop taking the medicine. When you stop taking gabapentin, you’ll need to reduce your dose gradually to avoid withdrawal symptoms. Do not stop taking gabapentin without talking to your doctor. You can also talk to your doctor if you’re concerned you are becoming physically dependant on gabapentin.

Important Considerations

Gradual Tapering: Gabapentin should not be stopped abruptly. Stopping suddenly can increase the risk of withdrawal symptoms and potentially trigger seizures in susceptible individuals.
Drug Interactions: Gabapentin can interact with other medications, particularly those that depress the central nervous system, like opioids or alcohol, which can amplify side effects.

If you’re considering Gabapentin or adjusting the dose, consult your healthcare provider for a safe and effective treatment plan based on your specific needs.

What is Gabapentin Approved For?

Gabapentin is used to:

Prevent and control partial seizures. Gabapentin can be used in adults and children age 3 and older who have partial seizures.
Relieve nerve pain following shingles in adults. Shingles is a painful rash that develops many years after you’ve had chickenpox. The virus that causes chickenpox stays dormant in a portion of your spinal nerve root called the dorsal root ganglion. For whatever reason, this otherwise dormant virus gets reactivated — usually by stress — causing a shingles rash. Nerve pain following a case of shingles is called postherpetic neuralgia (PHN).
Treat moderate-too-severe primary restless legs syndrome.

The branded gabapentin products Neurontin and Gralise are approved for partial seizures and PHN. The branded gabapentin enacarbil product Horizant is approved for restless legs syndrome and PHN.

How Should Gabapentin be Used?

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 throw away 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.

What dosage strengths and forms does gabapentin come in?

Gabapentin is available as:

Gabapentin tablets. It’s available as 300- and 600-milligram tablets (Gralise) and 600- and 800-milligram tablets (Neurontin or generic gabapentin).
Gabapentin oral solution. The oral solution contains 250 millgrams of gabapentin per 5 milliliter (50 mg per mL) Neurontin or generic gabapentin.
Gabapentin capsules. It’s available as 100-, 300- or 400-milligram gelatin capsules (Neurontin or generic gabapentin).
Gabapentin enacarbil, 300- and 600-milligram extended-release tablets (Horizant).

Off-Label Usages of Gabapentin

Gabapentin is frequently prescribed off-label for a variety of conditions outside its primary approvals for epilepsy and nerve pain. Here is a list of some of the common off-label uses:

Anxiety Disorders: Gabapentin is sometimes used to manage generalized anxiety disorder (GAD) and social anxiety, especially in patients who don’t respond well to traditional anti-anxiety medications.
Bipolar Disorder: While not a first-line treatment, gabapentin may be used as an adjunct to stabilize mood in patients with bipolar disorder, particularly those who have difficulty tolerating other mood stabilizers.
Insomnia: Due to its sedative effects, gabapentin is occasionally prescribed to help with sleep disorders, especially for those who struggle with sleep due to chronic pain or anxiety.
Alcohol Dependence and Withdrawal: Gabapentin is used to help reduce cravings and manage withdrawal symptoms in patients with alcohol use disorder, as it can help alleviate anxiety, tremors, and insomnia associated with withdrawal.
Migraine Prevention: Gabapentin is sometimes used off-label to prevent migraines, especially in cases where traditional migraine medications are ineffective or not tolerated.
Hot Flashes: Particularly for postmenopausal women or breast cancer patients, gabapentin can be prescribed to help reduce the frequency and intensity of hot flashes.
Restless Legs Syndrome (RLS): Gabapentin can help alleviate symptoms of RLS, a condition that causes uncomfortable sensations and an urge to move the legs.
Pruritus (Chronic Itching): Gabapentin has shown effectiveness in managing severe itching related to conditions like kidney disease, liver disease, or certain types of neuropathy.
Chronic Cough: Some cases of refractory chronic cough, where traditional treatments are ineffective, have responded to gabapentin.
Multiple Sclerosis (MS)-Related Symptoms: Gabapentin can help alleviate nerve pain, spasticity, and certain types of tremors associated with MS.
Temporomandibular Joint (TMJ) Disorders: In cases of chronic TMJ-related pain, gabapentin may be used to reduce discomfort.
Post-Traumatic Stress Disorder (PTSD): It is sometimes prescribed to help manage PTSD symptoms, particularly anxiety, sleep disturbances, and hyperarousal.
Vulvodynia: Gabapentin can help reduce pain in patients with vulvodynia, a chronic pain condition affecting the vulvar region.
Phantom Limb Pain: After amputation, some patients experience pain in the “phantom” limb, and gabapentin may be used to help relieve these sensations.
Chronic Pelvic Pain: Gabapentin is sometimes prescribed to help manage chronic pelvic pain, especially when associated with nerve involvement.
Trigeminal Neuralgia: Although more commonly used for postherpetic neuralgia, gabapentin can also help with trigeminal neuralgia, a painful nerve condition affecting the face.

These off-label uses are based on clinical observations, smaller studies, or anecdotal evidence, so efficacy may vary. Always consult with a healthcare provider for guidance on using gabapentin for any off-label purpose.

Why is Gabapentin Prescribed Off-Label?

Versatility: Gabapentin affects the nervous system broadly by calming overactive nerves, making it useful for a wide range of conditions.
Low Abuse Potential: Unlike opioids, gabapentin has a lower potential for abuse, making it a safer alternative for chronic pain management.
Safety Profile: Generally, gabapentin is well-tolerated and considered safe when used properly, encouraging doctors to explore its benefits for other conditions.

What should I know about storage and disposal of Gabapentin?

Keep Gabapentin in the container it came in, tightly closed, and out of reach of children. Store the tablets, extended-release tablets, and capsules at room temperature, away from excess heat and moisture (not in the bathroom). Store the oral solution in the refrigerator. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include the following:

double vision
slurred speech
drowsiness
diarrhea

What other information should I know?

Keep all appointments with your doctor.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking gabapentin.

If you use a dipstick to test your urine for protein, ask your doctor which product you should use while taking this medication.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

What are the Brand Names of Gabapentin?

Gabapentin is available as both a brand name product and a generic product (chemically the same, usually lower cost than the brand name product). Brand names of gabapentin include Horizant®, Gralise® and Neurontin®.

Who can and cannot take gabapentin ?

Who can take gabapentin

Gabapentin can be taken by most adults and children aged 6 and over.

Who may not be able to take gabapentin

Gabapentin is not suitable for some people.

To make sure it’s safe for you, tell your doctor if you:

have ever had an allergic reaction to gabapentin or any other medicine
have ever misused or been addicted to a medicine
are trying to get pregnant or are already pregnant
are on a controlled sodium or potassium diet, or your kidneys do not work well (gabapentin liquid contains sodium and potassium, so speak to your doctor before taking it)

Will Recreational Drugs Affect Gabapentin?

Gabapentin can intensify the highs of recreational drugs like heroin.

So, if you use recreational drugs alongside gabapentin, there may be more chance of unpleasant side effects like panic attacks, anxiety and memory loss.

Are There Similar Medicines to Gabapentin?

Pregabalin (also called Lyrica) is a medicine that works in a similar way to gabapentin.

Like gabapentin, it’s taken for epilepsy and nerve pain. It can also be taken for anxiety. But there are differences between pregabalin and gabapentin.Pregabalin can be taken less often and in different doses to gabapentin.

If you need to change to pregabalin, your doctor will explain how to swap safely from gabapentin.

Pharmacist Tips for Gabapentin (Neurontin)

Gabapentin (Neurontin) can raise the risk of suicidal thoughts. Contact your provider right away if you or your loved ones notice any new or worsening changes in your behavior or mood while taking the medication.

Gabapentin (Neurontin) commonly causes sleepiness and dizziness. Don’t drive or do anything requiring concentration until you know how this medication affects you.

Avoid drinking alcohol while taking gabapentin (Neurontin) because it can worsen side effects (e.g., drowsiness, dizziness).

Gabapentin (Neurontin) can interact with some commonly prescribed medications. Make sure to tell your provider and pharmacist about all of the medications you’re taking before starting gabapentin (Neurontin). Some medications that interact with gabapentin (Neurontin) include benzodiazepines, anxiety medications, and opioid pain medications. These combinations with gabapentin (Neurontin) can raise your risk of side effects, such as sleepiness, dizziness, and dangerously slow breathing.

Medications containing aluminum or magnesium (e.g., multivitamins, Mylanta Maximum Strength) can lower the amount of gabapentin (Neurontin) that gets absorbed into your body, which can make the medication not work as well for you. Take gabapentin (Neurontin) at least 2 hours after taking a medication with aluminum or magnesium.

Don’t change your dose or suddenly stop taking gabapentin (Neurontin) without talking to your provider first. Doing so can cause withdrawal symptoms like seizures, anxiety, and sleeping problems. Follow your provider’s instructions to lower your dose slowly over a period of time to stop the medication completely.

You can take gabapentin (Neurontin) with or without food, but if it upsets your stomach, try taking it with food to help.

If you’re taking the gabapentin (Neurontin) capsules, swallow the capsules whole with water. Don’t crush, chew, or open the capsules.

If you’re taking the gabapentin (Neurontin) tablets, you can split the tablets where they’re scored with a line in the middle of the tablet. Half-tablets not taken within 28 days of splitting in half should be thrown away.

If you’re taking gabapentin (Neurontin) liquid, make sure to use an oral syringe or medication dosing cup to measure out your dose. Don’t use household spoons because they aren’t accurate and might cause you to take the wrong dose.

Store the liquid in the refrigerator in the original bottle it came in from the pharmacy.