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.

Gabapentin 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.

How to take it

Swallow gabapentin capsules and tablets whole with a drink of water or juice. Do not chew them.

You can take gabapentin with or without food, but it’s best to do the same each day.

Try to space your doses evenly through the day. For example, you could take it first thing in the morning, early afternoon and at bedtime.

If you or your child are taking a liquid, it will come with a plastic syringe or spoon to measure your dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen spoon, as it will not measure the right amount.

How long to take it for

If you have epilepsy, it’s likely that once your condition is under control you’ll still need to take gabapentin for many years.

If you have nerve pain, once your pain has gone you’ll continue to take gabapentin for several months or longer to stop it coming back.

If you forget to take it

If you forget a dose, take it as soon as you remember. If it’s within 2 hours of the next dose, it’s better to leave out the missed dose and take your next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you have epilepsy, it’s important to take this medicine regularly. Missing doses may trigger a seizure.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking too much gabapentin can cause unpleasant side effects.

Abuse of Gabapentin

The stance of the DEA is that gabapentin is not a significant drug of abuse and does not have a significant capability to produce physical dependence. Similar drugs to gabapentin, such as pregabalin (brand name Lyrica), are classified as controlled substances; Lyrica is classified as Schedule V. Research evidence has indicated that there are some isolated reports of individuals abusing gabapentin; however, these appear to be rather extreme cases.

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that as an overall estimate, 80 percent of people with prescriptions for medications do not abuse them. The actual figures of misuse vary from medication to medication with prescription opiate drugs, benzodiazepines, and some sedatives having higher rates of misuse. However, it is clear from the research that the majority of people who are prescribed medications do not abuse them, even if they do develop some level of physical dependence on them as a result of using them for medicinal reasons.

The risk of a person abusing a prescription medication increases if the person’s use of the medication is not closely monitored by their physician. For instance, individuals now prescribed narcotic medications in the United States have difficulty legally obtaining more of the medication if they use their prescription up too quickly. Likewise, an individual abusing gabapentin who has a prescription for the medication would most likely use significantly more of the drug than prescribed, and physicians should recognize this and take steps to assist the person (e.g., discuss substance abuse with them, limit the amount of the drug they have access to, etc.). Thus, while any medication can be abused, gabapentin abuse is most likely not a major issue for individuals who are prescribed the drug, and individuals who have a prescription for the drug and abuse it should be relatively easy to recognize.

Unlike prescription opiate medications, gabapentin is not a drug that is in large demand by potential drug abusers. There is research evidence that use of high doses of gabapentin or very long-term use of the drug may produce a mild form of physical dependence. Withdrawal symptoms from gabapentin appear to be mild in the same way that withdrawal from antidepressant medications is relatively mild compared to withdrawal from other drugs.

How to Treat Gabapentin Abuse ?

Treating gabapentin abuse requires a comprehensive approach that addresses both the physical and psychological aspects of addiction. Here are some steps and strategies that may be involved in treating gabapentin abuse:

1. Medical Assessment: Individuals who are abusing gabapentin should undergo a thorough medical assessment to evaluate their overall health and any potential complications related to gabapentin abuse. This may include assessing for any co-occurring medical conditions or psychiatric disorders.
2. Detoxification: For individuals who have developed physical dependence on gabapentin, a medically supervised detoxification may be necessary to safely manage withdrawal symptoms. This process involves gradually tapering off the medication under the supervision of healthcare professionals to minimize discomfort and reduce the risk of complications.
3. Medication-Assisted Treatment (MAT): In some cases, medications may be used as part of the treatment for gabapentin abuse. For example, medications such as benzodiazepines or certain anticonvulsants may be used to manage withdrawal symptoms during detoxification. Additionally, medications like naltrexone or acamprosate may be used to help prevent relapse and support long-term recovery.
4. Therapy and Counseling: Behavioral therapies, such as cognitive-behavioral therapy (CBT) and motivational interviewing, are essential components of addiction treatment. These therapies help individuals identify and change unhealthy thoughts and behaviors related to substance abuse, develop coping skills to manage cravings and triggers, and build a strong support network.
5. Support Groups: Participation in support groups, such as Narcotics Anonymous (NA) or SMART Recovery, can provide individuals with additional peer support and encouragement during the recovery process. These groups offer a safe and non-judgmental environment where individuals can share their experiences, learn from others, and receive ongoing support.
6. Holistic Approaches: Holistic approaches, such as mindfulness meditation, yoga, and exercise, can complement traditional addiction treatment by promoting overall well-being and stress reduction. These practices can help individuals manage cravings, improve mood, and enhance their overall quality of life.
7. Dual Diagnosis Treatment: Many individuals who struggle with substance abuse also have co-occurring mental health disorders, such as depression, anxiety, or trauma-related disorders. Dual diagnosis treatment addresses both substance abuse and mental health issues simultaneously to improve outcomes and reduce the risk of relapse.
8. Aftercare Planning: Recovery from gabapentin abuse is a lifelong process, and aftercare planning is essential for maintaining sobriety and preventing relapse. Aftercare may include ongoing therapy, participation in support groups, regular medical monitoring, and lifestyle changes to support a healthy and drug-free lifestyle.