Gabapentin for Anxiety (A brief guide)

In this blog, we will discuss what Gabapentin for Anxiety is, what it does, how it is usually prescribed, how it works, side effects and interaction with other drugs.

Is Gabapentin prescribed for anxiety?

Gabapentin or Neurontin, how it is commercially known, is used off-label to treat anxiety.

It is primarily prescribed for preventing seizures (an anticonvulsant drug) and for post-herpetic neuralgia. 

Some studies in patients with social anxiety have found that using Gabapentin for anxiety actually reduced the symptoms the same way anti-anxiety drugs like Serotonin reuptake inhibitors and benzodiazepines would. 

How it works

This drug belongs to the anticonvulsant class of drugs and it is not entirely understood how gabapentin works.

However, for postherpetic neuralgia, seems to prevent the increased sensitivity to pain characteristic to this condition.

Additionally, for seizures, it seems to alter the effect of calcium which prevents seizures from happening. 

Dosage of Gabapentin

Dosage for Postherpetic Neuralgia

In adults it may initiate with 300 mg a day one single dose on Day 1, then it will increase to 600 mg a day on Day 2, twice a day and on Day 3 as 900 mg a day, three times a day.

This dose can eventually change to 1800 mg a day (3 times a day) depending on the pain. 

Dosage for Epilepsy with partial-onset seizures

For patients, 12 years of age and above the starting dose is usually 300 mg three times a day.

The recommended dose is 300 mg to 600 mg three times a day. Dosages up to 2400 mg a day have been proven to be well-tolerated in clinical studies 

(long-term). Doses of 3600 mg a day have also been proven to be well-tolerated in clinical studies for short periods of time. 

For children 3 years to 11 years, the starting dose ranges between 10 mg/kg a day to 15 mg/kg a day given in three divided doses.

For Children 3 to 4 years of age, the starting dose is 40 mg/kg a day, in three divided doses and for children 5 to 11 years of age is 25 mg/kg a day to 35 mg/kg a day divided into three doses. 

Dosage in elderly

Since they are more likely to have decreased renal function, then it is recommended to be careful with dose selection and it should be adjusted depending on creatinine testing.

Administration of Gabapentin

Gabapentin can be ingested orally with or without food and it should be swallowed whole with water.

Dosage forms and strengths

Capsules: 100 mg (white gelatin capsule), 300 mg (yellow gelatin capsule) and 400 mg (orange gelatin capsule) 

Tablets: 600 mg (white elliptical film-coated tablets with the number 16 on it) and 800 mg (white elliptical film-coated tablets with the number 26 on it). 

Oral solution: 250 mg per 5 mL (50 mg per mL), clear colorless to slightly yellow solution.

Side effects of Gabapentin 

Some people that take anticonvulsants for conditions such as seizures, bipolar disorder, and pain may experience depression or suicidal thoughts or behavior.

It is important to tell your doctor if you start to notice any unusual change in your mood, thoughts or behavior. 

Contact emergency services is you start having slow or shallow breathing. 

An allergic reaction to Gabapentin is rare but when it happens you can have the following symptoms according to WebMD and Drugs.com:

• Fever 
• Swollen lymph nodes
• Rash
• Itching or swelling on your face, tongue or throat
• Severe dizziness
• Trouble breathing 
• Yellow skin or in the white of your eyes
• Unusual bruising or breathing
• Severe fatigue or weakness
• Muscle pain with no apparent reason
• Frequent infections 

The National Institute for Health and Care Excellence mentions some of the following side effects to be common or very common:

• Anxiety
• Changes in your appetite
• Abnormal behavior
• Arthralgia (joint pain)
• Asthenia (abnormal physical weakness)
• Confusion
• Constipation
• Cough
• Depression
• Diarrhea
• Dizziness
• Drowsiness
• Dry mouth
• Dysarthria (problems with speech)
• Dyspnoea (difficulty breathing)
• Emotional lability (rapid and exaggerated changes in your mood)
• Flatulence 
• Abnormal gait
• Gastrointestinal discomfort
• Headaches
• Hypertension 
• Increased risk of infection
• Insomnia
• Leucopenia (decreased number of white blood cell)
• Movement disorders
• Muscle complaints
• Nausea

Uncommon side effects include cognitive impairment and palpitations. 

Gabapentin interaction with other drugs

Gabapentin may interact with other drugs so it is extremely important to be aware of some of them.

For more information ask your doctor or pharmacist. 

Pain drugs

Certain drugs used for the treatment of pain mixed with Gabapentin can increase some of the side effects such as fatigue.

An example of this type of drug is morphine

Stomach acid drugs

When combined with Gabapentin, certain drugs that help relieve stomach acid problems can reduce the amount of Gabapentin in your body making it less effective.

Examples of these drugs are aluminum hydroxide and magnesium hydroxide. 

Gabapentin warnings

The oral capsule for Gabapentin actually comes with several warnings, including calling your doctor if you start having more seizures or a different type of seizer than before taking the drug.

Can cause Drowsiness…

Gabapentin may slow down your thinking and motor skills, causing drowsiness and dizziness and the time these effects last is not known.

This is why it is recommended not to engage in activities such as driving or manipulating heavy machinery because it can be dangerous.

Can cause Depression…

As we mentioned, this drug can increase the risk of suicidal behavior or suicidal thoughts.

Contact your doctor if you are feeling depressed or if you feel you have had significant mood or behavioral changes.

Seek immediate help if you have thoughts of harming your self or committing suicide. 

Multiorgan sensitivity

This is known as a drug reaction with eosinophilia and systemic symptoms (DRESS) and can become life-threatening.

You should contact your doctor if you have symptoms like rash, fever or swollen lymph nodes. 

Can interact with alcohol…

Avoid consuming alcohol while using gabapentin. Since Gabapentin can cause sleepiness, alcohol intake can make you feel even more sleepy. 

Certain medical conditions

People with epilepsy shouldn’t stop taking gabapentin suddenly.

Doing this can cause a condition called epilepticus (short or long seizures can occur for 30 mins or more). 

People with kidney problems tend to process this medicine slower than normal so it is important to talk to your doctor to find out if it is safe for you.

During pregnancy

If you trying to become, suspect or are already pregnant, consult it with your doctor. This drug can affect the fetus. 

Other alternatives: Anti-Anxiety medication

Gabapentin is prescribed off label to treat anxiety so you might consider talking with your doctor about what other options you have available to treat your condition.

Some other options he/she could recommend are anti-anxiety drugs such as benzodiazepines. 

There are four major categories of drugs (bight colored) to treat anxiety disorders, but the truth is they are not an actual cure for anxiety. 

Benzodiazepines

This type of medication is recommended only for short periods of time.

It starts acting within minutes and it is well known for its sedative effect, helping to relax muscles and reduce tension.

Some of the known chemical components and their commercial names are listed as follows:

• Alprazolam (Xanax)
• Chlordiazepoxide (Librium)
• Diazepam
• Lorazepam (Ativan)

Selective serotonin reuptake inhibitors (SSRIs)

Even though they are usually prescribed by physicians to treat clinical depression, they are also recommended for the treatment of anxiety and obsessive-compulsive disorder (OCD).

Their main goal consists of stopping neurons from reabsorbing serotonin, which is the chemical that helps regulate mood, social behavior, memory, among important activities.

Some of the known chemical components and their commercial names are listed as follows:

• Paroxetine (Paxil, Pexeva)
• Sertraline (Zoloft)
• Citalopram (Celexa)
• Fluvoxamine (Luvox)

It is of importance to know that this specific type of medication won’t work on everyone and can actually begin to take effect within 6 to 12 weeks.

Also, it should be noted that they are not usually addictive and don’t tend to create dependency.

What happens if I miss a dose?

If you forget to take your dose, don’t panic. Just simply take it as soon as you remember.

If it is close to the time for your next dose, just discard the one you haven’t taken and continued the intake as you normally do (Do not take 2 capsules at once).

What happens if I overdose?

This medicine is not considered life-threatening when overdose goes up to 49 g. Symptoms of overdose can include dizziness, double vision, difficulties speaking, drowsiness, loss of consciousness, lethargy and mild diarrhea. 

Overdose of gabapentin in combination with other central nervous system depressant medications can result in a coma. 

Disclaimer

We have gathered the most important aspects and information about Gabapentin, however, this is not intended to be a substitute for the knowledge and experienced and licensed healthcare professional can provide.

Always consult with your doctor any questions or concerns you might have. 

Travel

When traveling with your medication take the following precautions:

• Try carrying your medication in your carry-on bag so you won’t forget taking it with you.
• X-Ray machines at the airport won’t damage your medication or the effect of it.
• If needed, ask a staff member at the airport for a label for your medication. Make sure you carry your prescription box where the medication came in. This way, you will avoid having problems. 
• Make sure you avoid exposing the medicine to very hot or very cold weather. 

Why is this blog about Gabapentin for Anxiety important?

As we discussed, Gabapentin is primarily prescribed for preventing seizures (an anticonvulsant drug) and for post-herpetic neuralgia.

On some occasions, it is prescribed off-label for anxiety, but it is not meant for it. 

If you are planning on taking Gabapentin for anxiety treatment it should be prescribed by your doctor (if he or she considers it is the best option for you). 

Feel free to leave your comments in the comment section below. 

Frequently Asked Questions (FAQ’s) about Gabapentin for Anxiety

Recommended Books

1. GABAPENTIN.: Effective and long-lasting treatment of nonmalignant neuropathic pain, seizures, epilepsy and convulsion, etc.
2. Focus On: 100 Most Popular Analgesics: Tramadol, Paracetamol, Gabapentin, Fentanyl, Naproxen, Lachryma papaveris, Desomorphine, Mitragyna Speciosa, Pregabalin, Endorphins, etc.
3. Gabapentin taste-masking using β-cyclodextrin: An in vitro evaluation: Gabapentin: Not bitter now
4. Gabapentin Enacarbil; Second Edition
5. Gabapentin 523 Questions to Ask that Matter to You 

References

Pfizer medical information

Rxlist

WebMD

NICE

Healthline