Substance Use

Gabapentin Withdrawal

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Gabapentin Withdrawal Symptoms, Timeline & Detox Treatment Options

Gabapentin is a medication used with other medications to prevent and control seizures. However, it is also prescribed for several other off-label uses. These uses include nerve pain relief associated with shingles or diabetes, bipolar disorder, and post-traumatic stress disorder (PTSD).

First discovered in the 1970s, gabapentin became FDA-approved in 1993 and has been generically available in the U.S. since 2004. Interestingly, gabapentin is not a controlled drug. It is considered a non-addictive medication — which is why it is often prescribed as a substitute for opioids. 

However, there is growing evidence that gabapentin may have a high risk of potential misuse. Misuse of gabapentin was first described in the literature in 1997. Since then, concerns over abuse potential have significantly increased. Several states have now moved gabapentin to the Schedule V controlled substance category. Despite these concerns, this class of drugs, including Neurontin, is commonly prescribed and heavily used. The prevalence of gabapentin prescription nearly doubled from 2009 to 2016. Prescription rates increased in every state during this period, ranging from 44% to 179%.

Although gabapentin does not have a high risk of overdose, it can increase euphoria caused by opioids — which is why there is an increased prevalence of misuse within populations that abuse opioids. When you combine gabapentin with opioids, your risk of a fatal overdose increases. For example, in Kentucky, toxicology data from 2015 showed that approximately 41% of fatal multi-drug overdoses were positive for gabapentin. Another recent analysis conducted in Virginia found that in 77.6% of cases where gabapentin was the underlying cause of death, at least one opioid was also present. 

Whether you are addicted to gabapentin or not, you may have developed a physical dependence if you have been taking this medication for an extended period. If you try to stop taking this medication, your dependence will lead to gabapentin withdrawal symptoms. These symptoms can be overwhelming, especially if you live with an underlying mental health condition, such as a mood or anxiety disorder.

What Are the Symptoms of Gabapentin Withdrawal?

In many cases, gabapentin withdrawal symptoms develop among patients prescribed this medication for extended periods — even when taken as directed. However, you may also be misusing your medication with alcohol, benzodiazepines, or opioids. This polydrug use can complicate the withdrawal process. 

Once dependent, you can expect some primary gabapentin withdrawal symptoms when you attempt to stop using. Many of these symptoms mirror those experienced during alcohol withdrawal. Depending on the severity of the gabapentin withdrawal process, you can expect some or all of the following.

  • Irritability 
  • Anxiety 
  • Insomnia 
  • Headaches
  • Pain 
  • Nausea 
  • Restlessness 
  • Sensitivity to light 
  • Irregular heartbeat 

The gabapentin withdrawal process is often highly individualized. For example, this case study highlights the symptoms experienced by a 53-year-old woman. Alcohol abuse likely complicated her gabapentin withdrawal symptoms. She also took a fairly substantial list of other medications, including trazodone (an antidepressant) and nadolol for complications of cirrhosis. The woman was admitted to the intensive care unit because of severe abdominal pain and black tarry stools. She required surgery. For two days, she did not take gabapentin. On day three, she developed restlessness, disorientation, confusion, agitation, and anxiety. By days four and five, she became increasingly confused, agitated, and anxious, with complaints of headache, light sensitivity, and nervousness. Once administration of gabapentin began again, her symptoms resolved. 

Another case study observed a 76-year-old woman with type 2 diabetes who was admitted because of a change in mental status, agitation, and restless limb movements. She took gabapentin 3,600 mg daily for approximately one month for diabetic nerve pain. Four days before admission, she stopped taking her medication because she could not get her prescription filled. As a result of the gabapentin withdrawal process, she developed akathisia. This condition causes extreme restlessness, causing urges to move that are beyond your control. She was given gabapentin, and after eight hours, her symptoms resolved.

Some users experience unique ongoing gabapentin withdrawal symptoms even when patients receive a tapering plan. For example, this case report followed a geriatric patient with a five-year history of gabapentin use. She had a life-long history of bipolar and schizoaffective disorder. She tapered off gabapentin for over one week. On day one, she complained of somatic symptoms, such as chest pain and flu-like symptoms, which worsened until 10 days after the termination of gabapentin. At this time, she developed significant mental status changes. The researchers concluded that a tapering plan for gabapentin should more closely mimic a benzodiazepine taper — slowly and over weeks to months.

These three cases studies are just two examples, showcasing how the gabapentin withdrawal process varies from one user to the next. Many variables need to be considered, especially your medical history and current mental health. No two people will have an identical experience, so it’s important to seek personalized care and ongoing treatment. When working with an expert team, you will receive the tools, resources, and support you need based on your unique symptoms, health history, and ongoing goals. 

What Causes Gabapentin Withdrawal?

The cause of gabapentin withdrawal often begins with tolerance. When you develop a tolerance to this medication, you may take more to achieve the same effect — sometimes, without discussing this increased dose with your doctor. Over time, this can lead to dependence, resulting in gabapentin withdrawal symptoms following abrupt cessation. 

To better understand how dependence progresses, it’s essential to define some key terms:

  • Misuse is the use of a drug other than indicated, including taking higher doses than prescribed, taking someone else’s medication, or using a drug via a non-recommended route of administration. 
  • Abuse is the persistent use of a drug despite negative consequences.
  • Dependence is the physical and psychological elements linked to abuse, including compulsive use, withdrawal, and tolerance. 

Data shows that the motivations for misusing gabapentin are mainly classified into three categories — recreational (e.g., to get high or substitute for higher-cost drugs), self-harm, and self-medication (e.g., pain management). The bulk of cases involve individuals who have a prescription for gabapentin but take larger doses than prescribed by their doctor. Although it is challenging to pinpoint risk factors for gabapentin misuse, a history of drug abuse plays a significant role. 

While focusing on gabapentin’s mechanism of action, researchers are not exactly sure how this drug interacts with GABA receptors. However, it is known that gabapentin can freely cross the blood-brain barrier to act on neurotransmitters. Since gabapentin influences GABA, some gabapentin withdrawal symptoms resemble those associated with alcohol or benzodiazepine withdrawal. 

There is no evidence that gabapentin acts on dopamine, serotonin, histamine, or benzodiazepine receptors. However, research shows that gabapentin does increase serotonin levels in healthy controls. More research is required to understand the complexity of gabapentin withdrawal on a neurological level. 

How Long Does Gabapentin Withdrawal Take?

Gabapentin’s half-life is five to seven hours. This timeline refers to the amount of time it takes to reduce the concentration of gabapentin in your system by half. On average, it takes two days for the body to eliminate gabapentin from its system.

How quickly gabapentin withdrawal symptoms come on depends on several variables, including how long you have been using, dosage, and whether you are using gabapentin with other substances of abuse. The example case study above shows that gabapentin withdrawal can surface in 2–3 days and then intensify. However, you may experience symptoms in as little as 12 hours after your last dose, whereas another user may not experience gabapentin withdrawal symptoms until 5–7 days after quitting medication. On average, expect the initial withdrawal symptoms to last 10–14 days. 

How long gabapentin withdrawal takes is highly dependent on each individual. Although the initial acute withdrawal symptoms will not likely last more than two weeks, some users experience ongoing psychological symptoms. These symptoms last for weeks, months — even years in some cases. However, these lingering symptoms, associated with post-acute withdrawal syndrome, are most commonly seen among recovering opioid, alcohol, and benzodiazepine users. Again, you must be individually assessed, especially concerning your mental health and history of drug use, specifically any concurring drug use. 

How to Safely Manage a Gabapentin Detox

As stated by the FDA, in recent years, gabapentin has been increasingly encountered by law enforcement, reported in poison centers, and documented in crime lab reports. It has become an issue concerning illicit use. Regardless of why you started taking gabapentin, if you have tried to stop taking this drug, only to start using it again because of the symptoms you experienced, it’s vital to seek professional help. 

When withdrawing from any medication, primarily one used to treat an underlying health condition, you must complete this process in a structured, supervised environment. A clinical health team will monitor your progress and any potentially problematic symptoms. For example, if you were taking gabapentin to deal with seizures, this needs to be addressed with your care team. However, even among users without a history of seizure disorder, it is possible to experience generalized seizures because of the gabapentin withdrawal process.

This case study is a prime example of why dosing matters. A 34-year-old male had surgery for lumbar disc disease. For his chronic back pain, he was prescribed gabapentin and remained on a steady dose of 8,000 mg/day for nine months. The FDA reported that clinically therapeutic doses are between 900 and 3,600 mg/day, to put this into perspective. When he ran out of his medication and could not refill his prescription for two days, he was admitted to the emergency department for status epilepticus — having a seizure that lasted at least 30 minutes. 

This is crucial to remember before you begin the withdrawal process. There can be unexpected and severe complications when it comes to the withdrawal symptoms of any substance you’re dependent on. To avoid complications, you should seek the assistance of a professional treatment facility. Such a facility will have the tools, expertise, and resources you need to ensure a safe and comfortable gabapentin withdrawal process. Best of all, when you attend a treatment center that offers comprehensive, evidence-based treatment, you will also gain access to the next crucial step — your individualized, ongoing treatment plan.  

A professional treatment facility understands that no two people are identical, so why should their treatment plans be?

The key is to seek the support of an expert team that will implement a holistic plan. For some, that means a combination of individual and group therapies. For others, it means individual and family therapies, plus ongoing support concerning coping and life skills. From meditation-based therapy to cognitive behavioral therapy, there are many options available. 

Take the Next Step

The gabapentin withdrawal process is the first step of many. Although withdrawal symptoms can be daunting, do not allow them to get between you and your goals. If you’re ready to stop using gabapentin, you can. Seek the support you need, and you will be able to complete the process. 

However, just because you physically rid your body of gabapentin does not mean you have necessarily recovered. The recovery process looks different for everyone, and what you need depends on why you began misusing gabapentin and other substances of abuse — and what that means moving forward. Do you have a mental health condition that has never been successfully addressed? Are you worried about your triggers concerning potential relapse?

When you gain access to individualized care, you will receive a treatment plan that focuses on your needs. This plan will evolve with you throughout the recovery process. That means more than a successful withdrawal period for many — it’s an opportunity to start again. 

Contact Zinnia Healing now if you’re ready to take the next step. Starting today, you can achieve a happier, healthier, and more fulfilling future.