Neurontin is the trade name for the generic drug gabapentin. It is useful as an anti-epileptic drug and as an analgesic, particularly for pain of the neuropathic or neurogenic type. (pain from irritation or inflammation of nerves). When used for controlling epilepsy, it is usually used in conjunction with another anti-epileptic drug. It is used much more extensively in the medical field to treat pain than it is to treat epilepsy.
NEURONTIN is a prescription medicine used to treat:
- Pain from damaged nerves (postherpetic pain) that follows healing ofshingles (a painful rash that comes after a herpes zoster infection) in adults.
- Partial seizures when taken together with other medicines in adults and children 3 years of age and older with seizures.
The chemical structure of gabapentin is related that of gamma-aminobutyric acid (GABA) which is a neurotransmitter in the brain. The exact mechanism as to how gabapentin controls epilepsy and relieves pain is unknown, but it probably acts like the neurotransmitter GABA.
Animal studies show that gabapentin prevents the development of allodynia (a normally non painful stimulus which is perceived as painful) and hyperalgesia (an exaggerated response to a painful stimulus).
Gabapentin can be very helpful in controlling the pain of trigeminal neuralgia (tic doloreaux), post herpetic neuralgia (the lingering pain after a bout of shingles), the pain of diabetic neuropathy and other neuritic pains such as pain from nerve irritation due spinal arthritis or disc disease and occipital neuralgia. Occasionally it seems to be helpful in controlling migraine and other headaches. It has also been reported to be helpful in controlling the pain of fibromyalgia.
Gabapentin is generally well tolerated. The main side effects are dizziness and drowsiness. Occasionally there maybe some fluid retention, unsteadiness or G.I upset, mainly diarrhea.
Gabapentin is also sometimes used to relieve the pain of diabetic neuropathy (numbness or tingling due to nerve damage in people who have diabetes), and to treat and prevent hot flashes (sudden strong feelings of heat and sweating) in women who are being treated for breast cancer or who have experienced menopause (”change of life”, the end of monthly menstrual periods).
The effective dose of gabapentin varies greatly. Some persons need only 200-300 mg a day whereas others may need 3000 mg or more a day. It may take several weeks to become effective, so it is important to stay on it for an adequate length of time.
Neurontin is Used Much More Extensively to Treat Pain Than it is used to Treat Epilepsy
While Neurontin (generic name: gabapentin) was initially developed as an antiepileptic medication, it is now widely used in the medical field to treat various types of pain, particularly neuropathic pain.
Neuropathic pain is caused by damage or dysfunction of the nervous system and can manifest as shooting or burning sensations, tingling, or numbness. Conditions such as diabetic neuropathy, postherpetic neuralgia (shingles pain), and peripheral neuropathy are examples of conditions where gabapentin is frequently prescribed to alleviate pain.
The mechanism of action of gabapentin in pain management is not fully understood, but it is believed to modulate the activity of certain neurotransmitters involved in pain signaling in the brain and nervous system.
Due to its effectiveness in treating neuropathic pain and its relatively low risk of addiction compared to opioids, gabapentin has become a popular choice for healthcare providers in managing chronic pain conditions. It is often considered a first-line treatment option for neuropathic pain and is prescribed off-label for various other types of chronic pain.
However, it’s worth noting that while gabapentin can be effective for many people, it may not work for everyone, and like any medication, it can have side effects. It’s essential for individuals to work closely with their healthcare providers to determine the most appropriate treatment plan for their specific pain condition.
The Off-Label Usages of Gabapentin
Gabapentin, originally developed as an anticonvulsant for epilepsy and FDA-approved to treat postherpetic neuralgia (nerve pain following shingles), is widely used off-label for a variety of conditions. Here are some off-label uses in detail:
1. Chronic Pain Management
- Neuropathic Pain: Gabapentin is commonly prescribed for nerve pain related to conditions other than shingles, including diabetic neuropathy, trigeminal neuralgia, and nerve injuries. It’s thought to work by stabilizing nerve cell activity, reducing the overactive firing in damaged or misfiring nerves that leads to pain.
- Fibromyalgia: Although gabapentin is not approved specifically for fibromyalgia (unlike its analog pregabalin), it is commonly used to relieve chronic pain and improve sleep in fibromyalgia patients. It appears to decrease sensitivity in overactive pain pathways in the central nervous system.
- Back Pain and Sciatica: For chronic back pain, especially with radicular symptoms like sciatica, gabapentin is prescribed to help relieve nerve-related symptoms, including tingling, numbness, and shooting pain down the leg.
2. Anxiety Disorders
- Generalized Anxiety Disorder (GAD): Gabapentin can be used as an alternative treatment for GAD, particularly in patients who cannot tolerate traditional anxiolytic medications like benzodiazepines or SSRIs. Gabapentin’s effect on GABA neurotransmission may help reduce overall anxiety.
- Social Anxiety Disorder: Off-label gabapentin may be used to help manage social anxiety symptoms. It has shown modest efficacy in reducing social anxiety symptoms by calming overactive neural circuits related to fear and anxiety.
- Panic Disorder and PTSD: Gabapentin may also be used to help reduce anxiety and panic symptoms, though this is less common and not considered a first-line treatment.
3. Bipolar Disorder and Mood Stabilization
- Gabapentin has been prescribed off-label for mood stabilization, particularly in patients with bipolar disorder who do not tolerate or respond well to other mood stabilizers (e.g., lithium, valproate). Its effects on GABA and calcium channels in the brain may help stabilize mood swings, though its efficacy for bipolar disorder remains controversial, and it is not recommended as a primary treatment.
4. Sleep Disorders
- Insomnia: Gabapentin may be prescribed to help with insomnia, especially when related to chronic pain or anxiety. It appears to increase slow-wave (deep) sleep and decrease the time it takes to fall asleep, likely due to its sedative effects on the central nervous system.
- Restless Legs Syndrome (RLS): Though gabapentin enacarbil, an extended-release form, is FDA-approved for RLS, regular gabapentin is often used off-label for RLS to reduce uncomfortable sensations in the legs and improve sleep quality.
- Periodic Limb Movement Disorder (PLMD): Similar to RLS, gabapentin may help control leg movements in PLMD, improving sleep quality.
5. Migraines and Headaches
- Gabapentin is sometimes used as a preventative treatment for migraines. While it’s not a first-line treatment, it can help reduce the frequency of migraines in some patients who are resistant to other therapies.
- Cluster Headaches: There is some limited off-label use for cluster headaches, though gabapentin is not highly effective compared to other treatments and is generally used if standard treatments are not suitable or effective.
6. Alcohol and Substance Use Disorders
- Alcohol Dependence: Gabapentin is sometimes used to help with alcohol dependence. It may reduce cravings, anxiety, and insomnia associated with alcohol withdrawal. It can also help prevent relapse by stabilizing mood and reducing stress.
- Benzodiazepine Withdrawal: For patients undergoing benzodiazepine tapering, gabapentin may help ease withdrawal symptoms, particularly anxiety, muscle tension, and restlessness.
- Opioid Withdrawal: Gabapentin is sometimes used to help alleviate symptoms of opioid withdrawal, including anxiety, muscle aches, and restlessness. It is often used alongside other medications in opioid tapering or detox programs.
7. Hot Flashes and Menopausal Symptoms
- Gabapentin has been used to help manage hot flashes in menopausal women, especially for those who cannot take hormone replacement therapy (HRT). It is thought to affect temperature regulation pathways in the brain, though the exact mechanism is not fully understood.
8. Peripheral Neuropathies
- Gabapentin is used for various types of peripheral neuropathy, including idiopathic neuropathy (neuropathy of unknown cause), chemotherapy-induced peripheral neuropathy (CIPN), and HIV-related neuropathy. It may help alleviate pain and numbness related to nerve damage in these conditions.
9. Pruritus (Itching)
- Chronic Itching: Gabapentin is sometimes used off-label to treat chronic itching associated with kidney disease, liver disease, or post-burn injury. It may reduce itching by calming overactive nerve responses associated with pruritus.
10. Tremors and Movement Disorders
- Gabapentin has shown some benefit for essential tremor (a common movement disorder causing tremors in the hands) as well as other less common tremors. It can reduce tremor severity, possibly due to its effects on nervous system signaling.
- Parkinson’s Disease Symptoms: Although it’s not a standard treatment for Parkinson’s disease, gabapentin may help manage certain symptoms, like pain or tremors, in some patients.
11. Vulvodynia and Pelvic Pain
- Gabapentin may be used to treat chronic pain conditions affecting the pelvic region, such as vulvodynia (chronic pain or discomfort around the opening of the vagina). It’s believed to help reduce nerve hypersensitivity in this area.
12. Intermittent Explosive Disorder (IED)
- Gabapentin has shown some promise in treating IED, a behavioral disorder characterized by sudden episodes of intense aggression or rage. It may help reduce the frequency and intensity of these outbursts by calming neural circuits involved in emotional regulation.
13. Diabetic Neuropathy Pain
- Often used off-label for neuropathic pain, gabapentin may help alleviate pain from diabetic neuropathy by modulating nerve signaling. Although other medications, like duloxetine, are preferred first, gabapentin is a widely used alternative when others are ineffective or not tolerated.
Considerations and Risks
Gabapentin is generally well-tolerated but can cause side effects, including dizziness, sedation, weight gain, and cognitive impairment, especially at higher doses. It can also lead to dependence in some patients, particularly those with a history of substance use disorders, and should be used cautiously in these populations.