Gabapentin Is an Effective Treatment for Alcohol Withdrawal Symptoms?

  • A new study reports the nerve pain reliever gabapentin may be helpful in treating people with serious alcohol withdrawal symptoms.
  • Some experts say gabapentin is most effective if used in combination with a benzodiazepine medication.
  • Gabapentin can have serious side effects, including drowsiness and abnormal eye movements.

Can a drug used primarily to treat nerve pain and partial seizures be effective in helping ease alcohol withdrawal symptoms?

The anticonvulsant drug gabapentin is used off-label to treat alcohol-related withdrawal, cravings, anxiety, and insomnia. Although it is well tolerated and has demonstrated efficacy for mild alcohol withdrawal and early abstinence, there is concern about its potential for abuse. Gabapentin should be prescribed only as a second-line alternative to standard therapies, and only after screening for opioid or other prescription drug abuse to determine if heightened monitoring is warranted. Clinicians should be aware of gabapentin’s limitations for treating alcohol use disorder and be attentive to emerging data on risks and benefits.

A Trusted Source published this week concluded that gabapentin can relieve alcohol withdrawal symptoms but is most effective for people with a history of more severe symptoms after a few days of abstinence.

Gabapentin is known under brand names such as Neurontin, Gralise, and Horizant.

It was first developed Trusted Source in Japan during the 1970s and approved for use in the United States in 1993.

The drug was originally used as a muscle relaxer and antispasmodic medication. It’s been used off-label for other conditions.

“It has been used for detoxification — alcohol withdrawal — for many years,” said Dr. Raymond F. Anton, the study’s main author and a professor of medicine at the Medical University of South Carolina in Charleston.

“For relapse prevention, other clinical trials have had mixed results. We had published several studies suggesting it would be added to other medications with some success, but it looked like only in those with alcohol withdrawal symptoms prior to treatment,” he said.

“This study proved that gabapentin could work by itself as a relapse prevention medication, but only in this with the higher alcohol withdrawal symptoms, as predicted,” Anton told Healthline.

What the study revealed

Anton’s team looked at 90 people meeting the criteria of serious alcohol use.

Over 16 weeks, 12 of the 44 participants given gabapentin had no heavy drinking days (27 percent) compared with four (9 percent) of those participants given a placebo.

The study found mild to moderate side effects, including dizziness and some fatigue.

“Very few people had significant enough side effects to stop treatment,” Anton said. “It also improved sleep.”

Dr. Meredith Sagan, an addiction psychiatrist at Alo House Recovery Centers in Southern California, says gabapentin is most effective with benzodiazepine medications commonly used for withdrawal.

“Gabapentin cannot necessarily be used safely on its own to support such a detox,” Sagan told Healthline. “It’s always important to consult a medical professional when considering detoxifying from alcohol, as it can be very dangerous due to possible seizure and others risks.”

Individualized treatments

Sagan says the combination of medications and the timeline to take them is specific to each individual.

“Some people may need more or less medication, as well as different types and combinations, depending on their degree of alcohol consumption, in addition to other factors,” she said.

“So, although gabapentin can be a useful adjunct to the benzodiazepine category of medication for alcohol detox, it is not time to say goodbye to ‘benzos’ just yet,” Sagan said.

Benzodiazepines are also used to treat anxiety and seizures as well as to relax muscles. These medications come in many manufactured forms, including Xanax, Klonopin, Librium, Valium, and Ativan.

Participants in the South Carolina study weren’t allowed to take benzodiazepines or opioids.

“For people using gabapentin just for anxiety and not for alcohol withdrawal, gabapentin can be a good non-benzodiazepine alternative,” Sagan said.

“Gabapentin at higher doses can cause an uncomfortable withdrawal when one quits taking it. However, for some people with an addiction history, gabapentin is a safe alternative to benzodiazepines, which over the long term can be physically and psychologically addictive,” she said.

Gabapentin side effects

Common side effects of gabapentin include abnormal eye movements, clumsiness or unsteadiness, constipation, diarrhea, difficulty speaking, drowsiness, dry mouth, nausea, and vomiting.

More serious side effects — which may be more common in people with psychiatric disorders — include anger and violent behavior, increased anxiousness, depression, anxiety or irritability, mania, panic attacks, suicidal thoughts or behavior, and insomnia.

“I was prescribed gabapentin when I was struggling with my severely herniated disc,” Janine McKavish Thalblum, a resident of Dublin, California, told Healthline.

“The side effects were longer than an encyclopedia. With all the pain I was in I was borderline suicidal, so I opted not to take them, as that was one of the side effects. When the pharmacist was reading (them) before handing it over, I literally started to cry,” she explained.

Thalblum did take gabapentin for 2 days before opting out. She says she couldn’t tell if the medication contributed to her “overwhelming sense of wanting to give up.”

Andrea Johnson, a resident of Oakland, California, and her late wife, Julie, both took gabapentin for pain. They had vastly different experiences.

“She had chronic pain from her legs having been shattered in a car crash. Her doctors prescribed gabapentin about 10 years ago under its brand name of Neurontin,” Johnson told Healthline.

“She stopped it after a week because it put her into a constant dream state. She was sort of awake and could do things but without being conscious of what she was doing. When I caught her rolling a cigarette without realizing that she was doing it, I put a stop to the gabapentin and told her doctor why,” Johnson said.

Johnson’s doctor prescribed her gabapentin last year for arthritis in her hips.

“I was concerned about it because of Julie’s experience, but I didn’t get the psych effects that she did,” Johnson said. “By the end of a month, it still wasn’t having an effect on my pain either, so I stopped it.”

Gabapentin and opioids

In recent years, gabapentin has been involved in opioid overdose deaths and been dubbed “an emerging threat” in a national bulletin to law enforcement.

It’s listed as a controlled substance in some states, although officials say it’s usually not the main cause of death and not as dangerous as opioids.

Pfizer, which developed gabapentin, paid $430 million in 2004 under an agreement with government prosecutors over fraudulent claims the company was accused of making about the drug’s uses.

Anton says researchers are still looking at whether gabapentin can be used as an anti-craving drug like naltrexone.

“Right now, it is estimated that only 20 percent of individuals who might benefit from reducing or stopping drinking actually receive treatment,” Anton said.

“And, of those 20 percent, only 20 percent receive any medication-assisted treatment. The standard of care in the U.S. has historically been an AA (Alcohol Anonymous) or 12-step counseling model. While that model has helped many people, many others do not want to partake in it, or haven’t found it useful.

“Medications that can be prescribed by specialized and/or primary care providers can encourage many more people to consider treatment for their alcohol use disorder,” he added.

Gabapentin is a prescription anticonvulsant used to treat epileptic seizures, postherpetic neuralgia, and restless legs syndrome. Postherpetic neuralgia is pain caused by shingles, which can last many months after having the illness.

While the exact mechanism of action of gabapentin is not fully understood, it may work by decreasing excitatory brain signaling. This can prevent seizures and change the way the brain responds to pain signals. This medication can be found as a capsule, tablet, or oral solution.

Alcohol Addiction
Alcohol Addiction

The following 11 questions are designed to help you better understand your relationship to alcohol. They will help you to tell if it resembles abuse or addiction, or is if it closer to average.

1. Do you tend to drink more than you expected to? And for longer periods of time?

2. Do you wish you could drink less, and struggle to cut down your alcohol intake?

3. Does drinking consume much of your time? In other words, do you spend a lot of your time trying to obtain, use, or recover from alcohol hangovers?

4. Do you have very strong cravings or urges to drink? Does it feel like you “need” it to get by?

5. Does drinking cause problems for you at work, in school, or in your family obligations? Does this happen frequently?

6. If drinking does cause these social and interpersonal problems for you, do you continue to drink anyway?

7. Have you given up activities that used to be meaningful for you? For example, have you quit a sport or left friendships because you don’t seem to have the time or energy anymore?

8. Do you use alcohol even when it makes your activity physically dangerous? This could be drinking while driving, using certain prescription drugs, or working with heavy machinery.

9. Do you continue to drink even after discovering that it exacerbates, worsens, or even causes other physical or mental illnesses?

10. Are you developing a tolerance for alcohol? This could show up as a decreased effect after drinking the same quantity of alcohol that you used to use, or having to drink more and more alcohol to achieve the desired level of intoxication.

11. Have you experienced withdrawal symptoms after not drinking any alcohol for a while? These include a racing heart, trouble sleeping, shakiness, sweating, fever, restlessness, nausea, or even auditory or visual hallucinations? Does more alcohol relieve these feelings?

As an Addiction Treatment Medication

The medical research community has made great strides in synthesizing thousands of drugs over the years to treat physical ailments, mental illness, and other health conditions.

Addiction is just one of the many conditions that can be treated with specific medications. And while there are presently only a handful of FDA-approved medications used to manage substance dependence, gabapentin has been considered for off-label use for as an addiction treatment drug.

Different companies, including Parke-Davis, Greenstone, and Teva, manufacture several varieties of the generic drug. Other drugs that have been used to treat the symptoms of addiction withdrawal, for specific substances, include:

    • Clondine
    • Other anticonvulsants, such as Tegretol and Depakote
    • Methadone and buprenorphine
    • Naltrexone

Typical Application

Doses range from 100 mg to 800 mg. The frequency of administration may be based on various factors such as withdrawal symptom severity and withdrawal progress. The drug’s half-life is around 5-7 hours.

Gabapentin has been evaluated for use during medical detox and throughout subsequent treatment modalities to support relapse prevention while clients adjust to their new sober lifestyles.

Treating Substance Abuse

According to Medscape, gabapentin can inflict users with suicidal thoughts and abrupt changes in behavior. For this reason, it should only be used under medical supervision. It can also cause elevated blood pressure, fever, sleep problems, appetite changes, and chest pain.

While it has been used to treat addictions to other substances, gabapentin is most often used to treat alcoholism — an addiction some 16.6 million adults suffered from in 2013, per the National Institute on Alcohol Abuse and Alcoholism.

During withdrawal from alcohol abuse or dependency, clients may experience anxiety, tremors, agitation, and irritability. In order to understand how gabapentin works, there must be a basic understanding of how the brain works first. A balance of excitatory and inhibitory nervous system activity is, in part, mediated by neurotransmitters known as GABA and glutamate. Gabapentin may work by potentiating the inhibitory signaling of GABA and reducing the neural excitation associated with glutamate activity. As a result, signals for pain, agitation, and anxiety are reduced, too.

An American Journal of Psychiatry study showed impressive results during the 16-week treatment of 150 people who were dependent on alcohol, noting better results among those who were treated with both gabapentin and naltrexone than the latter alone. The Journal of Clinical Psychiatry reported on another study in which individuals treated for alcoholism with gabapentin showed a significant reduction in how much they drank and a greater rate of abstinence than those in the placebo group.

Gabapentin may have a similar calming effect on individuals who are detoxing from marijuana and benzodiazepines. Despite claims from fans of the plant-based drug, marijuana is indeed addictive. In 2012, 305,560 people checked into rehab citing cannabis as their primary drug of abuse, per the Substance Abuse and Mental Health Services Administration. One Neuropsychopharmacology study that analyzed the use of gabapentin in the treatment of marijuana addiction and withdrawal noted individuals in the gabapentin treatment group used less marijuana, had fewer withdrawal symptoms, and experienced improvements in cognitive functioning, compared to the placebo group.

While not quite as prevalent as a substance of abuse, benzodiazepines still accounted for 17,019 admissions to treatment in 2012, per SAMHSA. Individuals who have been abusing marijuana or benzodiazepines for a long period of time may have difficulty achieving a state of relaxation without those drugs, and gabapentin can help individuals remain calm while they’re recovering from addiction.

Can you legally buy gabapentin online

Neurontin (gabapentin) prescription is not a controlled substance and you can legally buy Gabapentin online with a US licensed doctor prescription.

Our doctors are all US licensed doctors and it will be printed in the label of your prescription bottle.

What you need to do is to answer the questions very carefully and honestly and our USA licensed doctors will decide whether to send you Gabapentin prescription or not.

Yes, you can get a Neurontin (gabapentin) prescription online, in most states, following a virtual consultation with a doctor.

But our website require that you should have already taken Gabapentin before. If it is your first time to take Gabapentin, we will not send you Gabapentin prescription.

You must have your local doctor prescribed a Gabapentin prescription and you think Gabapentin is good for your disease and you can refill your Gabapentin here in our website.

 

If you have shingles pain or seizures, Neurontin may be able to help you and thanks to modern technology you can get a Neurontin prescription online.

Let’s talk about how you can get a Neurontin prescription online as well as what it is, what it does, what side effects or complications you could experience, and our Neurontin prescription policy.

Where Can I Not Get Neurontin Prescribed Online?

It’s important to note that Neurontin (gabapentin) has been classified as a controlled substance in 5 states and therefore cannot be prescribed online in these locations.

These states are:

      • Kentucky
      • West Virginia
      • Virginia
      • Tennessee
      • Michigan

 

The Role of Gabapentin in Pain Management

Opioids, non‐steroidal anti‐inflammatory drugs (NSAIDs), antidepressants, and anticonvulsants are used as pharmacological agents to treat pain. However, no single class of drugs has been found to be effective in all types of pain, presumably because pain syndromes involve different mechanisms.

In addition, each of the currently available drugs is associated with adverse effects, some of which are potentially serious or life‐threatening such as idiosyncratic or toxic reactions.

Traditionally, the treatment of neuropathic pain has involved anticonvulsants, such as carbemazepine, valproic acid and phenytoin, and tricyclic antidepressants, such as amitriptyline and nortriptyline and doxepin. The main disadvantages of the anticonvulsants are their potential for drug interactions via the induction of hepatic enzymes, or resulting from inhibition of hepatic enzymes by other drugs. Minor side‐effects such as sedation, ataxia, vertigo and diplopia are associated with carbemazepine and phenytoin, whereas, anorexia, nausea, vomiting and tremor are associated with valproic acid. Chronic phenytoin use may cause peripheral neuropathy (30%) and gingival hyperplasia (20%), and fetal hydantoin syndrome if administered during pregnancy. Carbemazepine can cause chronic diarrhoea or the syndrome of inappropriate ADH secretion, and rarely aplastic anaemia, thrombocytopaenia, hepatocellular jaundice and cardiac arrhythmias.

Tricyclic antidepressants also cause side‐effects that can be troublesome or potentially dangerous, such as anticholinergic effects (dry mouth, blurred vision, urinary retention, ileus), sedation, orthostatic hypotension, tachycardia and atrio‐ventricular conduction disturbances. Such adverse effects are likely to reduce the tolerance of this group of drugs in elderly or unwell patients. Some subgroups of patients with painful neuropathy such as diabetes may also have autonomic neuropathy and may not tolerate the orthostatic hypotension associated with tricyclic antidepressants.

With increasing evidence of the efficacy of gabapentin in a wide variety of pain syndromes, especially neuropathic pain, gabapentin may be potentially useful because of its relative freedom from serious adverse effects, its lack of interactions with other drugs and its lack of potential for causing drug dependence.

A comparison of the evidence available of efficacy and toxicity for anticonvulsants (gabapentin, phenytoin and carbemazepine) and antidepressants (tricyclic antidepressants and SSRIs) in patients with diabetic neuropathy and postherpetic neuralgia has recently been made by Collins et al. [129] These two neuropathic pain conditions were chosen according to strict diagnostic criteria. Although two previous systematic reviews of anticonvulsants and antidepressants in diabetic neuropathy showed no significant difference in efficacy or adverse effects between the two drug classes [130, 131], Collins et al. found that when data from randomised controlled trials for both diabetic neuropathy and postherpetic neuralgia were pooled, the NNT for at least 50% pain relief was identical for both classes of drugs. When gabapentin was compared with other anticonvulsants, there was no significant difference in efficacy.

The NNT for gabapentin was 3.4 compared with 2.2 for phenytoin/carbemazepine. The number needed to harm (NNH, defined as the number needed to harm one patient from the therapy) for minor adverse effects was 2.7 for both antidepressants and anticonvulsants. Collins et al. used two trials to provide data on minor adverse effects for gabapentin and two trials for phenytoin. The NNH (minor adverse effects) was 2.6 similar to that of gabapentin and 3.2 for phenytoin. The NNH (major adverse effects) for the tricyclic antidepressants was 17, and no significant difference in the incidence of major adverse effects was found between anticonvulsants and placebo.

Collins et al. suggested that the difference in the incidence of major adverse effects can be compared by using the ratio between treatment specific benefit and treatment specific harm (defined as the number of patients needed to experience at least 50% benefit for one to experience a major adverse effect that warranted discontinuation of treatment). The ratio for gabapentin was 6 compared with an average of 8 for all anticonvulsants, and 6 for all antidepressants. As adverse data were pooled from both diabetic and postherpetic neuralgia studies, methodological factors and heterogenicity in these data may limit the validity and robustness of these ratios. The spectrum of the pain and short study duration tend to underestimate the treatment effect, whereas the small sample size of the studies overestimate the treatment effect.

The above evidence suggests that gabapentin is as efficacious at treating neuropathic pain with no significant difference in minor adverse effects and a low propensity for serious adverse effects compared with other anticonvulsants and antidepressants. Therefore, gabapentin is a useful agent in the multimodal approach in the management of neuropathic pain.

Adverse Reactions in Pooled Placebo-Controlled Trials in Postherpetic Neuralgia

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Postherpetic Neuralgia

The most common adverse reactions associated with the use of NEURONTIN in adults, not seen at an equivalent frequency among placebo-treated patients, were dizziness, somnolence, and peripheral edema.

In the 2 controlled trials in postherpetic neuralgia, 16% of the 336 patients who received NEURONTIN and 9% of the 227 patients who received placebo discontinued treatment because of an adverse reaction. The adverse reactions that most frequently led to withdrawal in NEURONTIN-treated patients were dizziness, somnolence, and nausea.

Following table lists adverse reactions that occurred in at least 1% of NEURONTIN-treated patients with postherpetic neuralgia participating in placebo-controlled trials and that were numerically more frequent in the NEURONTIN group than in the placebo group.

TABLE 3. Adverse Reactions in Pooled Placebo-Controlled Trials in Postherpetic Neuralgia
NEURONTIN
N=336
%
Placebo
N=227
%
Reported as blurred vision
Body as a Whole
  Asthenia 6 5
  Infection 5 4
  Accidental injury 3 1
Digestive System
  Diarrhea 6 3
  Dry mouth 5 1
  Constipation 4 2
  Nausea 4 3
  Vomiting 3 2
Metabolic and Nutritional Disorders
  Peripheral edema 8 2
  Weight gain 2 0
  Hyperglycemia 1 0
Nervous System
  Dizziness 28 8
  Somnolence 21 5
  Ataxia 3 0
  Abnormal thinking 3 0
  Abnormal gait 2 0
  Incoordination 2 0
Respiratory System
  Pharyngitis 1 0
Special Senses
  Amblyopia 3 1
  Conjunctivitis 1 0
  Diplopia 1 0
  Otitis media 1 0

Other reactions in more than 1% of patients but equally or more frequent in the placebo group included pain, tremor, neuralgia, back pain, dyspepsia, dyspnea, and flu syndrome.

There were no clinically important differences between men and women in the types and incidence of adverse reactions. Because there were few patients whose race was reported as other than white, there are insufficient data to support a statement regarding the distribution of adverse reactions by race.

 

How is Gabapentin Supplied and Stored ?

NEURONTIN (gabapentin) capsules, tablets, and oral solution are supplied as follows:

100 mg capsules:

White hard gelatin capsules printed with “PD” on the body and “Neurontin/100 mg” on the cap; available in:
Bottles of 100: NDC 0071-0803-24

300 mg capsules:

Yellow hard gelatin capsules printed with “PD” on the body and “Neurontin/300 mg” on the cap; available in:
Bottles of 100: NDC 0071-0805-24
Unit dose 50’s: NDC 0071-0805-40

400 mg capsules:

Orange hard gelatin capsules printed with “PD” on the body and “Neurontin/400 mg” on the cap; available in:
Bottles of 100: NDC 0071-0806-24
Unit dose 50’s: NDC 0071-0806-40

600 mg tablets:

White elliptical film-coated scored tablets debossed with “NT” and “16” on one side; available in:
Bottles of 100: NDC 0071-0513-24

800 mg tablets:

White elliptical film-coated scored tablets debossed with “NT” and “26” on one side; available in:
Bottles of 100: NDC 0071-0401-24

250 mg per 5 mL oral solution:

Clear colorless to slightly yellow solution; each 5 mL of oral solution contains 250 mg of gabapentin; available in:
Glass bottles containing 470 mL: NDC 0071-2012-23
Bottles containing 470 mL: NDC 0071-2012-44

Store NEURONTIN Tablets and Capsules at 25°C (77°F); excursions permitted between 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature].

Store NEURONTIN Oral Solution refrigerated, 2°C to 8°C (36°F to 46°F).