Gabapentin is an off-label medication for alcohol use disorder, originally developed to treat epilepsy. If you struggle with anxiety or insomnia, this medication may help you quit alcohol more easily.
Gabapentin is best for:
- Easing withdrawal symptoms
- Relieving anxiety and insomnia
- Reducing alcohol consumption
- Transitioning to other medications
Is it right for you? Skip to pros and cons
How Does Gabapentin Work?
Gabapentin reduces anxiety in many people who take it, and also controls the worst side effects of alcohol detox. It is especially useful for people for whom anxiety is a drinking trigger, or who are likely to experience acute withdrawal symptoms. It can make it easier to get started on other medications by smoothing out the transition period, and can be a good substitute for people who don’t react well to naltrexone.
The exact way gabapentin works remains unclear, but it seems to help in part by “remodeling” your synapses, or nerve-to-nerve connections. This explains its use in treating nerve-related pain such as shingles, as well as epileptic seizures. In fact, seizures are among the more extreme reactions people can have to alcohol withdrawal, and can be prevented by taking gabapentin.
For alcohol use disorder, gabapentin is considered “off-label.” An off-label medication is a drug approved for one purpose, but prescribed for another because a doctor deems it safe and useful. In this case, gabapentin is FDA approved to treat epilepsy and shingles-related nerve pain, but has found many other applications. And not without some scandal, as it turns out…
Controversy, and Scientific Evidence
Gabapentin has drawn criticism for its high number of off-label uses, and has even been the subject of a major lawsuit. After its initial approval, gabapentin’s manufacturer got in trouble for marketing it for a range of off-label purposes without enough supporting evidence. More recently, the opioid epidemic has motivated many doctors to prescribe gabapentin instead of opiates as a substitute painkiller, which has also been met with some criticism. There are reasons, therefore, to be skeptical of non-approved uses of gabapentin.
However, there are some off-label uses of this drug which have turned out to be well founded. FDA approvals of gabapentin for both shingles treatment and restless leg syndrome have happened more recently. And in the case of alcohol addiction, there is increasing evidence to support gabapentin’s effectiveness:
- One study in 2007 demonstrated that people who took gabapentin had more days of abstinence—and drank less alcohol on days when they did drink—than those who took a placebo.
- A 2011 study showed that gabapentin and naltrexone in combination had a bigger impact for people in the first 6 weeks of treatment than naltrexone alone.
- Finally, a study in 2014 showed that 900-1800mg of gabapentin per day was two to four times as effective for maintaining abstinence compared to placebo, and nearly twice as effective for reducing heavy drinking.
Although gabapentin has yet to be approved by the FDA to treat alcohol use disorder, it does seem to be both effective and safe for this purpose. Already, it has appeared on the American Psychiatric Association‘s list of suggested medications for alcoholism.
Upsides to Gabapentin for Alcohol Use Disorder
Overall, gabapentin is safe for most people to take. Side effects are uncommon, and it doesn’t seem to have negative interactions with other drugs. In fact, one of the reasons gabapentin can be a good alternative to naltrexone is that it doesn’t interfere with opioid pain medication, as naltrexone does. And on the subject of naltrexone, there are a number of ways in which these medicines seem to compliment each other:
- Gabapentin can ease withdrawal symptoms and make it easier for people to transition to naltrexone or the Sinclair method.
- The combination of the two has been shown to improve results overall.
- Gabapentin may counteract common side effects of drinking on naltrexone, including insomnia.
Finally, as a generic medication, gabapentin is relatively cheap. It comes in a wide range of dose sizes, making treatment easy to customize.
Downsides to Gabapentin
Gabapentin is slow to show results, and it can take one to two months before you know if it’s helping. In the meantime, this medication can make some people feel very sluggish or “out-of-it,” especially in the morning. While this may be a result of the neural readjustment mentioned earlier, and generally goes away after a short period, it can be irritating.
There are also questions about whether gabapentin can produce dependence. Some people report abusing the medication, while others have reported some withdrawal symptoms. While this doesn’t seem common enough to be a major concern, you may want to taper off the medication when you stop.
There are reports that, like acamprosate, gabapentin can produce suicidal thoughts in some people. There have been other studies showing no increase in suicidal behavior, and even improvement in some patients. Regardless, if a person has a history of suicidal feelings they should be monitored closely when on this medication.
Finally, because gabapentin is processed renally, it may cause problems if you have kidney disease. Talk to your doctor before taking this medication.
Other Side Effects of Gabapentin
Dizziness is the most commonly reported side effect of gabapentin. If you experience unusual clumsiness, or rapid, uncontrollable eye movements you should consult a doctor immediately. Less serious side effects include:
- Blurry vision
- Cold or flu-like symptoms
- Lower back pain
Is Gabapentin For You?
Gabapentin May Help If:
- Chronic anxiety motivates your drinking
- You expect severe withdrawal symptoms
- You are on opioid pain medications and cannot take naltrexone
- You experience insomnia
Gabapentin May Not Be the Best Choice If:
- You tend to abuse prescription medication
- You have kidney disease
- You have a history of depression or suicidal thoughts
People who struggle with alcohol addiction are twice as likely to suffer from an anxiety disorder, and withdrawal symptoms from alcohol can be severe. If either or both of these are a major concern for you, gabapentin may be the right medication to help you reduce or stop drinking. It can even serve as a bridge to another medication by helping you through detox more easily.
Gabapentin has few negative interactions with other drugs, and fewer overall side effects than some other alcoholism medications. It does, however, have a somewhat sedative effect, and doesn’t do as much to retrain brain chemistry or behavior as naltrexone. It is also “off-label,” meaning it has yet to be specifically approved for alcohol addiction treatment by the FDA.
In summary, gabapentin is a good first-line medication for people with anxiety or low tolerance for naltrexone, and a good second-line medication in many other cases. Despite its off-label status, it is a solid and effective option to have available for alcohol treatment.
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