Buy Online Neurontin For Pain Relief and Migraine Prevention

Neurontin (Generic Name: Gabapentin) is approved to prevent and control partial seizures, relieve postherpetic neuralgia after shingles and moderate-to-severe restless legs syndrome. Learn what side effects to watch for, drugs to avoid while taking gabapentin, how to take gabapentin and other important questions and answers. Gabapentin is available in both branded and generic forms.

Gabapentin is frequently prescribed off-label for a variety of conditions outside its primary approvals for epilepsy and nerve pain. Gabapentin (Neurontin) is not a medication that would make the FDA proud. Less than 1% of its outpatient use is for an FDA indication, and a good portion of the off-label use takes place in psychiatry.

These trends sparked a backlash in the 2000s, when Pfizer paid a $1.3 billion fine for misleading marketing practices. Recent reports of misuse of gabapentin and its GABAergic cousin, pregabalin (Lyrica), have added to those concerns. In this article, we’ll look at where gabapentin fits in psychiatric practice.

What is gabapentin Neurontin 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.

Gabapentin capsules, tablets, and oral solution are used along with other medications to help control certain types of seizures in people who have epilepsy. Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down).

Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.

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 dispose of 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 (https://www.fda.gov/Drugs) or the manufacturer’s website to obtain the Medication Guide.

Off-Label Usages of Gabapentin

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. Long ago, there was a consensus in psychiatry that all anticonvulsants had antimanic effects. In 2000, gabapentin became the first anticonvulsant to challenge that idea, with a negative trial in bipolar mania that was followed by similar disappointments from topiramate and oxcarbazepine (Pande AC et al, Bipolar Disord 2000;2(3 Pt 2):249–255). Gabapentin is not reliable on its own in bipolar disorder, but two placebo-controlled trials suggest it may have a role as adjunctive therapy. It augmented lithium in acute mania and had mild preventive effects over a year when added to various mood stabilizers. As encouraging as these results are, both came from small trials with a total n of 85 (Astaneh AN and Rezaei O, Int J Psychiatry Med 2012;43(3):261–271; Vieta E et al, J Clin Psychiatry 2006;67(3):473–477). In practice, gabapentin is best reserved for treating bipolar disorder in patients with comorbidities like anxiety and alcohol or cannabis use disorders.
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.Gabapentin has only three FDA indications: partial seizures, post-herpetic neuralgia, and restless legs syndrome (RLS). Although used widely in pain disorders, it only has clear benefits in post-herpetic neuralgia and diabetic peripheral neuropathy, and is not considered effective for low back pain, sciatica, spinal stenosis, or migraines (Mathieson S et al, BMJ 2020;369:m1315). Gabapentin’s RLS approval is reserved for gabapentin enacarbil (Horizant), a prodrug that delays absorption by attaching the medication to an enacarbil molecule.
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.
Addiction Treatment: Despite concerns about gabapentin misuse, the medication does have a role in alcohol and cannabis use disorders. Patients who take it for alcohol use disorders report fewer days of heavy drinking, with an effect size in the medium range (0.4) from seven randomized controlled trials (Ahmed S et al, Prim Care Companion CNS Disord 2019;21(4):19r02465). Gabapentin also improves sleep quality during recovery from alcohol use. The dose range was 300–3600 mg/day, with most settling in around 900 mg/day. Gabapentin may also be useful for alcohol withdrawal, but with a caveat. Although it was generally effective in controlled trials that compared it with benzodiazepines and phenobarbital, there were a few seizures during the gabapentin taper—not enough to raise statistical alarms, but enough to give us pause. It does improve cravings, anxiety, and sleep during withdrawal, so it may still have a role as an adjunct to more established methods like a benzodiazepine taper, or its use should be confined to patients with less severe dependence. A typical schedule starts at 1200–2400 mg/day in three or four divided doses, tapers to 600 mg/day over four to seven days, then drops in increments of 300 mg or smaller every few days until reaching zero (Leung JG et al, Ann Pharmacother 2015;49(8):897–906). Alternatively, it may be continued long term to prevent relapse, a use that is endorsed by the APA guidelines on alcohol use disorders.
Akathisia, sleep, and hot flashes :Treatments for RLS often reduce akathisia, and gabapentin has promising results for this antipsychotic side effect, as evidenced in open-label trials at doses of 300–3600 mg/day. Gabapentin is often used as a hypnotic, and this is supported by small controlled and open-label trials where it improved sleep duration and quality (eg, increased slow-wave sleep) at 200–900 mg/day (Furey SA et al, J Clin Sleep Med 2014;10(10):1101–1109). In practice, this means gabapentin may not help your patients fall asleep faster, but it can deepen their sleep and reduce nocturnal awakenings. Women with post-menopausal vasomotor symptoms are good candidates for this hypnotic use, as gabapentin reduced hot flashes in several controlled trials (Saadati N et al, Glob J Health Sci 2013;5(6):126–130).

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.

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).

The Dosages of Off-Label Usages of Gabapentin

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.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. https://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of emergency/overdose

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

double vision
slurred speech
drowsiness
diarrhea

What other information should I know?

How should I take gabapentin?

Take Gralise tablets with your evening meal. Swallow tablets whole with a full glass of water. Don’t chew, break or crush.
Take Horizant tablets with food. Swallow tablets whole with a full glass of water. Don’t chew, break or crush.
Take other forms of gabapentin with or without food.
Neurontin and generic forms of Neurontin tablets may be broken into two pieces. You can take the second half for your next dose. Don’t use the half-tablet beyond 28 days after the whole tablet was cut or broken.
Carefully measure the liquid formulation of gabapentin using the measuring device that comes with the drug. If you did not receive a measuring device, please ask your pharmacist for a medication-measuring device.
If you take an aluminum or magnesium-containing antacid, such as Maalox®, Mylanta®, Gelusil®, Gaviscon®, or Di-Gel®, wait at least two hours before taking your next dose of gabapentin.
Take gabapentin exactly as prescribed by your healthcare provider.

Are there any serious interactions with gabapentin and other medications?

Serious breathing problems can happen if you take gabapentin with drugs that cause severe sleepiness or decreased awareness. Some examples include narcotic opioids, anti-anxiety medicines, antidepressants, and antihistamines. If you are 65 years of age or older and/or have a condition that affects your lungs, such as chronic obstructive pulmonary disease (COPD), there is an increased risk for breathing problems. Watch for increased sleepiness or decreased breathing when you start taking gabapentin or when the dose is increased. Get help right away if you develop breathing problems.

Seek immediate medical attention if these symptoms develop:

Confusion.
Unusual dizziness or lightheadedness.
Slowed, shallow or trouble breathing.
Unresponsiveness (can’t wake up).
Bluish-colored or tinted skin, especially on lips, fingers or toes.

What other medications and products can interact with gabapentin?

Products that interact with gabapentin include:

Alcohol.
Antihistamine-containing cold, cough and allergy products.
Certain medicines for anxiety or sleep.
Certain medicines for depression, such as amitriptyline, fluoxetine and sertraline.
Certain medicines for seizures, such as phenobarbital and primidone.
Certain medicines for stomach problems. (Wait two hours after taking aluminum and magnesium-containing antacids before taking gabapentin.)
General anesthetics, local anesthetics, or muscle relaxants given before surgery.
Narcotic pain medicines.

Can I drink alcohol while taking gabapentin?

Avoid drinking alcohol while taking gabapentin. Drinking alcohol with gabapentin could increase sleepiness or dizziness.

What else do I need to know about gabapentin?

Never stop taking gabapentin without talking to your healthcare provider first. Stopping gabapentin suddenly can cause serious problems, including increasing your risk of seizures (if you are taking gabapentin to control seizures) or not improving your symptoms (if taking gabapentin for other indications). Also, never change your dose without talking to your provider first. Always take gabapentin exactly as prescribed.

Don’t drive, operate heavy machinery or do other dangerous activities after taking gabapentin until you know how it affects you.

Read the full prescription information leaflet that comes with your medication. Never hesitate to ask your healthcare provider or pharmacist if you have any questions about gabapentin.

Can I take gabapentin if I’m pregnant or thinking of becoming pregnant?

It’s unknown if gabapentin can harm your unborn baby. For this reason, talk to your healthcare provider as soon as you know you are pregnant. You and your healthcare provider will determine if you should take gabapentin during your pregnancy or change to a different medication.

Does gabapentin pass into breast milk?

Yes, gabapentin does pass into breast milk. If you are breastfeeding or planning to breastfeed, talk with your healthcare provider about breastfeeding or medication options.

Is gabapentin a narcotic or controlled substance?

Gabapentin is not a narcotic. It’s not classified as a controlled substance in most states. (Kentucky, West Virginia, Michigan, Tennessee, and Virginia have reclassified gabapentin as a Schedule V controlled substance). Gabapentin is not an opioid.

Is gabapentin addictive?

Gabapentin is not addictive, but this doesn’t mean that gabapentin can’t be abused. A small number of studies have reported misuse and abuse of gabapentin.

Does gabapentin cause withdrawal symptoms?

Gabapentin withdrawal symptoms have been reported since the drug was approved. However, the individuals in these reports experienced symptoms after discontinuing higher-than-recommended doses of gabapentin and for uses for which the drug was not approved.

What’s known about gabapentin and overdose?

Overdoses on gabapentin have been reported. Individuals experienced double vision, slurred speech, drowsiness, diarrhea and sluggishness.