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Gabapentin is a generic prescription drug. It’s approved by the Food and Drug Administration (FDA) to treat the following conditions:

postherpetic neuralgia (nerve pain that occurs after shingles) in adults
partial seizures in adults and children ages 3 years and older with epilepsy, used in combination with other seizure medications

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Nerve pain is also called neuralgia or neuropathic pain. It occurs when there is damage to your nerves, due to disease or injury. Nerve pain can feel different from other kinds of pain. It can be acute (short-term) or chronic (ongoing) pain.

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.

Gabapentin is used to treat epilepsy. It’s also taken for nerve pain, which can be caused by different conditions, including diabetes and shingles. Nerve pain can also happen after an injury. In epilepsy, it’s thought that gabapentin stops seizures by reducing the abnormal electrical activity in the brain.

Drug details

Here are some details about gabapentin:

Drug class: anticonvulsant
Drug forms: oral capsules, oral liquid solution, and oral tablets
Brand-name versions: Gralise (tablets) and Neurontin (capsules, solution, and tablets)

Read on to learn about gabapentin and cost, as well as how to save money on prescriptions.

Gabapentin (Neurontin) has FDA indication to treat postherpetic neuralgia and partial onset seizures. Controlled clinical trials in diabetic neuropathy and postherpetic neuralgia show that gabapentin at 2400-3600 mg/day has a similar efficacy to tricyclic antidepressants and carbamazepine.

Consistent, though less compelling clinical evidence supports its use for neuropathic cancer pain, pain associated with HIV infection, chronic back pain and others (readers wanting more in depth research findings are urged to consult Reference 1).

Due to this emerging evidence, it is widely used for the treatment of neuropathic pain. The exact mechanism and site of action of gabapentin is unknown. Gabapentin is generally well-tolerated, easily titrated, has few drug interactions, and does not require laboratory monitoring.

However, cost may be a limiting factor for some patients. Patients suitable for gabapentin should have a clear neuropathic pain syndrome, characterized by sharp, shooting, lancinating and/or burning pain, in a nerve root (radicular) or stocking/glove distribution. See Fast Fact #289 for a comparison of gabapentin with pregabalin a similar neuropathic analgesic.

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.

Adult Dosing Gabapentin is started at low doses (100 mg to 300 mg total daily) and increased by 100 – 300 mg every 1-3 days to effect. A typical schedule might be: day 1-2: 300 mg nightly; day 3-4: 300 mg twice daily; day 5-7: 600 mg twice daily; day 8 onwards: 600 mg three times a day. The usual effective total daily dose is 900-3600 mg, administered in three divided doses per day. Titration should proceed more slowly in elderly patients. If gabapentin is discontinued, it should be done over a minimum of a week to prevent withdrawal seizures.

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 do Healthcare Providers Treat Nerve Pain?

Neuropathic pain treatment depends on the underlying cause and what works for your unique symptoms. Your provider will create a personalized plan based on those factors.

The goals of treatment are to:

Treat any underlying disease (for example, radiation therapy or surgery to shrink a tumor that’s pressing on a nerve).
Provide pain relief.
Maintain functionality.
Improve your quality of life.

In most cases, you’ll need a combination of treatments to manage neuropathic pain. These treatments might include:

Over-the-counter (OTC) pain relievers. These include medications like acetaminophen and ibuprofen.
Antiseizure medications. Experts don’t know why antiseizure medications work so well for some people with neuropathic pain. Some believe these drugs interfere with pain signals in your body.
Antidepressants. Anxiety and depression can make neuropathic pain worse. Antidepressants have proven successful in providing neuropathic pain relief. Experts believe these medications treat pain as well as anxiety and depression symptoms.
Topical treatments. Lidocaine or capsaicin may help ease neuropathic pain. You can apply these creams, ointments or patches directly to the affected areas.
Nerve blocks. These injections can provide temporary pain relief. A healthcare provider will give you the injection close to the affected nerve or group of nerves.
Physical therapy. This approach helps relieve soreness, stiffness and discomfort that results from neuropathic pain. It can also encourage your body to produce more natural pain-relieving chemicals. Physical therapy may include various types of massage and exercise.
Surgery. In some cases, surgery can help ease neuropathic pain symptoms. A surgeon may be able to release, repair or even remove certain nerves to reduce or eliminate pain.
Psychological counseling. In addition to medical treatment, you may benefit from psychological counseling. Therapy can help you cope with the emotional stress of neuropathic pain.

If these treatments don’t relieve neuropathic pain, your healthcare provider may recommend spinal cord stimulation, peripheral nerve stimulation or brain stimulation. Your healthcare provider can talk with you about the pros and cons of this type of treatment.

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

What should I know about storage and disposal of Gabapentin?

Neurontin is the brand name for the generic drug gabapentin. Gabapentin is an anticonvulsant medication that affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain.

Originally approved by the U.S. Food and Drug Administration (FDA) in 1993 for the treatment of seizures, Neurontin has also been found to be effective in treating various types of nerve pain. It is commonly prescribed for conditions such as postherpetic neuralgia (pain that occurs after shingles), diabetic neuropathy (nerve pain associated with diabetes), and trigeminal neuralgia (severe facial pain).

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

Dangers Of Gabapentin Abuse

Gabapentin may be mixed with other drugs, including central nervous system (CNS) depressants like opioids, in order to get high. Doing this, however, can be dangerous.

According to the U.S. Food and Drug Administration (FDA), mixing gabapentin with depressants can increase the risk of respiratory depression and accidental drug overdose.

Treatment Options For Gabapentin Abuse

Buying drugs like gabapentin on the street can be a sign of substance abuse, which may require professional treatment to overcome.

Treatment for gabapentin abuse may involve:

detoxification for withdrawal symptoms
behavioral therapy
addiction counseling
pain management
other treatment services, as recommended

Does the cost of gabapentin vary based on the condition the drug is used to treat?

Yes, gabapentin’s cost can vary based on the condition it’s used to treat because different amounts of the drug may be needed.

Gabapentin is approved to treat the following conditions:

postherpetic neuralgia (nerve pain that occurs after shingles) in adults
partial seizures in adults and children ages 3 years and older with epilepsy, used in combination with other seizure medications

The typical dosages of gabapentin for treating these conditions are different. And the dosage you’re prescribed can affect the number of capsules, tablets, or amount of liquid you’ll need for each prescription. All of these factors can affect the price you’ll pay for gabapentin.

If you have questions about the cost of gabapentin based on your condition or dosage, talk with your doctor or pharmacist.

Ways to reduce long-term Gabapentin costs

Below are a few ways to possibly lower the long-term costs of gabapentin.

Getting a 3-month supply

You may be able to get a 90-day supply of gabapentin. If your insurance company approves it, getting a 90-day supply of the drug could reduce your number of trips to the pharmacy and help lower the cost. If you’re interested in this option, check with your doctor or insurance provider.

Using a mail-order pharmacy

Gabapentin may be available through a mail-order pharmacy. Using this type of service may help lower the drug’s cost and allow you to receive your medication without leaving home. Some Medicare plans may help cover the cost of mail-order medications. You may also be able to get a 90-day supply of the drug via mail order.

If you don’t have health insurance, talk with your doctor or pharmacist. They may be able to suggest online pharmacy options that could work for you.

Generic vs. brand-name drugs

Gabapentin is a generic drug, which is an exact copy of the active drug in a brand-name medication. A generic is considered as safe and effective as the original drug. And generics tend to cost less than brand-name drugs.

Gabapentin is available in two brand-name forms. These are called Gralise (which comes as oral capsules) and Neurontin (which comes as oral capsules, oral liquid solution, and oral tablets). To find out how the cost of Gralise or Neurontin compares with the cost of gabapentin, talk with your doctor, pharmacist, or insurance provider.

If your doctor has prescribed gabapentin and you’re interested in using a brand-name version of the drug instead, talk with your doctor. They may have a preference for one version or the other. You’ll also need to check with your insurance provider, as it may only cover one or the other.

Stopping gabapentin

It’s important you do not suddenly stop taking gabapentin, even if you feel fine. Stopping gabapentin suddenly can cause serious problems.

If you have epilepsy, stopping gabapentin suddenly can cause seizures that will not stop.

If you’re taking it for any reason and stop suddenly, you may have a severe withdrawal syndrome. This can have unpleasant symptoms, including:

anxiety
difficulty sleeping
feeling sick
pain
sweating

It’s possible to prevent withdrawal seizures and other symptoms by gradually reducing the dose of gabapentin.

Do not stop taking gabapentin without talking to your doctor – you’ll need to reduce your dose gradually.

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