Neurontin side effects and how to avoid them

Neurontin side effects | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Neurontin is a brand-name prescription medicine for the generic drug gabapentin. It is FDA approved to prevent and control seizures in adults and children with epilepsy and to treat postherpetic neuralgia, which is nerve pain caused by shingles (herpes zoster). It is also sometimes prescribed to treat other kinds of neuropathy, fibromyalgia, and alcohol withdrawal. 

Like any other medication, it is important to be aware of side effects and other drug interactions. Let’s look at what you should know before taking Neurontin. 

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Common side effects of Neurontin

Like all medications, Neurontin may cause minor and temporary side effects. According to the manufacturer, the most common side effects include: 

• Fatigue, drowsiness, or somnolence (sleepiness)
• Dizziness 
• Fever
• Nystagmus, or involuntary eye movements 
• Lack of coordination
• Swelling in legs and feet
• Viral infection (children)
• Nausea and vomiting (children)
• Hostility (children)

Other possible side effects

Additional adverse effects may include: 

• Diarrhea
• Tremor
• Double or decreased vision
• Infection
• Dry mouth
• Asthenia, or weakness
• Headache
• Constipation
• Abnormal thinking
• Weight gain
• Impotence
• Amnesia or memory loss
• Trouble speaking
• Upset stomach
• Back pain
• Hyperactivity (children)

Serious side effects of Neurontin

Some side effects of Neurontin are more serious and may require medical attention. These include: 

• Depression, unusual moods or behaviors
• Suicidal thoughts or thoughts of hurting yourself
• Anaphylaxis, a life-threatening allergic reaction
• Angioedema, swelling beneath the skin from an allergic reaction
• Slow, shallow, or difficult breathing
• Serious or unusual skin rash
• Seizures or serious side effects when the drug is stopped quickly

How long do Neurontin side effects last?

Some side effects, such as dizziness and drowsiness, are more likely to occur when you first start taking the drug. Most side effects are temporary and will lessen over a period of days and weeks as the body adjusts to the medication. 

Neurontin contraindications and warnings

Abuse and dependence

Neurontin has a relatively low risk for physical addiction, but it may create a psychological dependence in some people. According to Pfizer, most people who misuse Neurontin have a history of drug abuse so it is important for patients to tell their healthcare provider about any past drug use. Studies show that that the incidence of misuse was only in 1% of the population taking it, and that the primary reason was for recreational purposes or intentional self-harm. 

The effects of Neurontin (gabapentin) may range from an elevated mood or euphoria to a sense of calm or relaxation. These effects are amplified when taken with other substances such as alcohol or opioids like heroin, fentanyl, and prescription painkillers, and are more lethal when taken in combination. Gabapentin and alcohol each cause central nervous system (CNS) depression and respiratory depression. Combining alcohol and gabapentin can worsen either or both effects. Patients should not drink alcohol or consume marijuana while taking Neurontin. 

Withdrawal

Patients should not stop taking Neurontin without talking with their healthcare provider, and abrupt cessation of Neurontin is not recommended. Slowly titrating the dose down can help reduce the risk of withdrawal symptoms.

Withdrawal symptoms of Neurontin include anxiety, difficulty falling asleep or staying asleep, nausea, pain, and sweating. People taking Neurontin who experience worsening of these symptoms should seek medical attention. A placebo-controlled study showed that abruptly discontinuing the use of Neurontin and other anti-epileptic drugs leads to the possibility of increasing seizure frequency, even if Neurontin is not being used to treat seizures.

The half-life of Neurontin is relatively short, generally between five and seven hours. While everyone reacts to Neurontin differently, for most people, withdrawal symptoms begin about 12 hours after the last dose is taken. Common withdrawal symptoms include anxiety, irritability, fatigue, headache, dizziness, nausea, abdominal pain, and seizures. Stopping the medication too quickly may cause seizures to worsen or cause a different kind of seizure. 

Overdose

The typical recommended adult daily dosage of Neurontin is 1,800 mg, although some patients are prescribed up to 3,600 mg per day. Since everyone responds to medication differently, it is possible for individuals to overdose on smaller amounts. Patients should not take a larger dose of Neurontin than prescribed by their doctor or pharmacist. Symptoms of overdose included double vision, tremor, slurred speech, drowsiness, altered mental status, dizziness, lethargy, and diarrhea. According to Pfizer, fatal respiratory depression has been reported in individuals who have overdosed on Neurontin. Patients should seek medical advice right away if they have pale or blue lips, fingernails, or skin, difficult or troubled breathing, or irregular, fast, slow, or shallow breathing, as these are all signs of respiratory depression. 

Restrictions

• Patients should tell their healthcare provider if they have a history of depression, suicidal thoughts, or drug abuse. Anti-epileptic drugs (AEDs), including Neurontin, may increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and any unusual changes in mood or behavior. 
• People with a history of lung problems or breathing disorders should consult their healthcare professional before taking Neurontin. Gabapentin can cause life-threatening breathing problems, especially in older adults or people with chronic obstructive pulmonary disease (COPD). Patients who experience shallow or slow breathing, vomiting, or abnormal breath sounds should seek medical attention as these are signs of respiratory depression, a potentially fatal condition.
• Seniors, children, people with certain medical conditions such as liver or kidney problems, heart disease, diabetes, and seizures are more at risk of developing a wider range of side effects. 
• In seniors, there is an increased risk of dizziness, which can lead to falls. 
• People who have had an allergic reaction to gabapentin in the past should not take it. Patients should seek medical help if they experience signs of a serious allergic reaction such as hives, swelling in the face, lips, or tongue, or sudden weakness, confusion, nausea, or vomiting. 
• People should not drive or operate heavy machinery until they know how Neurontin affects them. 
• The risks and benefits of taking Neurontin and all AEDs need to be carefully considered for pregnant and breastfeeding patients. Notify your healthcare provider if you are pregnant, breastfeeding, or think you may become pregnant before taking Neurontin.

Neurontin interactions

Neurontin is an anti-epileptic drug (AED), also called an anticonvulsant. It affects chemicals and nerves in the body and suppresses the excessive rapid firing of neurons during seizures. Neurontin can be used in combination with other commonly used antiepileptic drugs, such as Gralise. 

The risk of serious side effects, such as shallow breathing and severe drowsiness, may be increased if this medication is taken with other products that cause drowsiness or breathing problems. Do not combine Neurontin with:

• Antidepressants and anxiolytics, including bupropion
• Antiemetics, including metoclopramide  
• Antihistamines, sedatives, or anything else that will make you drowsy 
• Alcohol and marijuana, which may increase the risk of CNS and respiratory depression and psychomotor impairment 
• CNS Depressants—according to the Food and Drug Administration, people who have respiratory risk factors may have trouble breathing when taking Neurontin combined with CNS depressants
• Immunosuppressants, including muromonab-CD3
• Multiple sclerosis agents, including dalfampridine and amifampridine 
• Opioid medications, such as hydrocodone, can increase the risk of respiratory depression

Antacids containing aluminum or magnesium may interfere with the absorption of this medication. Therefore, if you are also taking an antacid, it is best to take gabapentin at least two hours after taking the antacid.

How to avoid Neurontin side effects

1. Take Neurontin as prescribed

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended. Neurontin is available as a capsule, tablet, extended-release tablet, and oral solution. It can be taken by mouth with or without food. 

For patients 12 years of age and older, the starting dosage is 300 mg three times a day, and the maintenance dose is typically 300 to 600 mg three times a day. During the first few days of treatment, your doctor may gradually increase your dose so your body can adjust to the medication. In general, dose selection for older patients should be cautious, usually starting at the low end of the dosing range. Dosage for children younger than 12 is based on weight.

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The time between doses should not exceed 12 hours. Take a missed dose as soon as possible. Do not take extra medicine to make up for a missed dose. If you have epilepsy, do not allow more than 12 hours to pass between doses. 

2. Discuss your full medical history with your healthcare provider

Tell your doctor of any medications you are taking, including prescription and over-the-counter drugs, vitamins, and herbal supplements. Let them know if you are pregnant or breastfeeding. Tell your provider if you have a history of kidney or lung disease. It’s also important to discuss a history of depression or mental health issues and if you’ve ever experienced suicidal ideation, as Neurontin may increase these thoughts. 

3. Monitor effects

Neurontin may cause dizziness and tiredness. Tell your provider if you use anything else that makes you sleepy, such as allergy medicine, narcotic pain medicine, and alcohol. Do not use more than the recommended dose of gabapentin, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Make sure to get plenty of rest and stick to a regular sleep routine.

4. Avoid alcohol

Alcohol and anticonvulsants both slow brain activity and can cause drowsiness, dizziness, and difficulty concentrating. Taking these together can worsen these effects, making you feel extra drowsy and dizzy with the potential for impaired thinking. There is also an increased risk of seizures with excess alcohol use or alcohol withdrawal. Therefore, you should not take alcohol while taking Neurontin. Talk to a healthcare professional if you have any questions or concerns.