All medications
Pain & symptom relief
Gabapentin
Brand names: Neurontin, Gralise, Horizant (gabapentin enacarbil)
A nerve-calming medicine that turns down overactive pain signals. It is used for nerve pain, and sometimes for fibromyalgia and poor sleep from pain, but it does not treat inflammation or joint damage.
Video lesson
Animated explainer
What it’s used for
FDA-approved for nerve pain after shingles (postherpetic neuralgia) and, with other medicines, for certain seizures. Doctors also use it off-label for diabetic and other nerve pain, sciatica and pinched nerves, burning or tingling feet, fibromyalgia, and restless legs (Horizant is approved for restless legs).
How it works
It binds to a part of the calcium channels on overactive nerve cells (the alpha-2-delta subunit). This reduces the release of the chemical messengers that carry pain signals, so the volume on nerve pain is turned down. Its name sounds like GABA, but it does not act directly on GABA receptors.
How it’s taken
Capsules, tablets or liquid, usually taken two or three times a day, with or without food. Your doctor starts low, often 100 to 300 mg at bedtime, and raises the dose slowly over days to weeks. It can take a few weeks to feel the full benefit. Gralise and Horizant are once- or twice-daily forms that are not interchangeable with regular gabapentin. If you take antacids such as Maalox or Mylanta, take gabapentin at least 2 hours after them.
Side effects
Common: dizziness, sleepiness, unsteadiness, tiredness, swelling of the ankles or feet, weight gain, blurred vision and trouble concentrating. These often ease as your body adjusts. Rare but serious: slowed or shallow breathing (especially with opioids, sleeping pills, alcohol or lung disease), severe allergic reactions with swelling of the face or throat, a serious drug reaction with fever, rash and swollen glands (DRESS), and new or worsening depression or thoughts of self-harm.
Monitoring
Your doctor checks kidney function before and during treatment, because gabapentin leaves the body through the kidneys and lower doses are needed if they are not working well. Expect check-ins on pain relief, sleepiness, balance, swelling, mood and any other sedating medicines you take.
Good to know
Do not stop it suddenly. Your doctor will taper it over at least a week to avoid withdrawal symptoms and, in people with epilepsy, seizures. Avoid alcohol, and do not drive until you know how it affects you. Tell your doctor about opioids, sleep aids, anxiety medicines or muscle relaxants, since the combination can slow breathing. Older adults are more prone to falls. It can be misused, so keep it secure and take it only as prescribed. Talk to your doctor if you are pregnant, planning pregnancy or breastfeeding.
At a glance
Class
Pain & symptom relief
Brand names
Neurontin, Gralise, Horizant (gabapentin enacarbil)
Reviewed by Farhan Tahir, MD, FACR
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For education only. Don’t start, stop or change a medicine without talking to your care team.