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Gabapentinoids
Gabapentinoids are medicines often prescribed for pain relief and other conditions like epilepsy or anxiety. This page focuses on their limitations for managing pain and how to reduce them safely.
Learn more about Gabapentinoids and their effects.
What are Gabapentinoids?
Gabapentinoids, such as gabapentin and pregabalin, can help with nerve (neuropathic) pain. This includes pain after shingles (post-herpetic neuralgia) or nerve pain caused by diabetes.
Nerve pain happens when nerves become overly sensitive and send too many pain signals. It can cause tingling, burning, shooting pain, or make normal touch feel painful. These sensations can be constant or come and go.
Gabapentinoids don’t work for all types of pain. They are usually prescribed for persistent pain (lasting more than three months), especially when caused by nerve problems. However, they generally don’t help with other types of pain, like joint pain, lower back pain, or fibromyalgia.
Understanding Risks and Limits of Gabapentinoids
Painkillers are often not as effective as we would like. Research shows that, for many, these medicines don’t relieve their pain much at all. Only about 1 in 4 to 1 in 3 people taking gabapentinoids find they help with nerve pain.
Our bodies also become used to these medicines which can make them even less effective. At the same time these medicines often cause side effects that are not wanted.
Unwanted Side Effects
6 in every 10 people taking gabapentin or pregabalin experience side effects. For 1 in 3 people, these side effects are so unpleasant that they stop taking them. As the dose goes up, side effects appear more and more. This can make daily life harder when taking these medications.
The most common side effect include:
- Difficulty thinking clearly
- Dizziness, problems walking
- Tiredness
- Tremors (shaking)
- Weight gain, water retention or bloating
- Changes in mood and emotions, includes depression
- Headache or vision changes
Tolerance, Dependence, and Withdrawal
Taking painkillers like gabapentinoids over time can lead to needing higher amounts to feel the same relief. This is known as developing a tolerance. However, taking large doses for a long time usually doesn't improve pain relief and can cause unwanted side effects.
Gabapentin and Pregabalin can lead to dependence, this means when you have been taking the medicine for some time, your body and mind can start to rely on it. You might feel like you need the medicine to feel normal.
If you miss a dose or stop taking them in one go, you might start to feel uncomfortable or unwell. We call this withdrawal. Withdrawal can temporarily make you feel more pain. This can be confusing because it might seem like the medicine was helping more than it was. Often, you can avoid withdrawal by slowly lowering the dose.
Some common signs of withdrawal include:
- Feeling restless or confused
- A rapid heartbeat or heart palpitations
- Feeling anxious
- Sweating a lot
- Difficulty sleeping
- Feeling sick or nauseous
- Increased pain
Gabapentin and pregabalin can make some people feel very happy or euphoric. Because of this, some individuals misuse these medicines by taking too much. There is also a growing underground market where these drugs are sold illegally online.
Because of concerns about people misusing and the risks of overdose and death, in April 2019, laws were made stricter. It became illegal to have these medicines without a doctor's permission or to give or sell them to others. If you are experiencing problems with misuse of gabapentin or pregabalin, you can seek free, confidential support from your doctor or an expert in drug misuse.
See local and national support services or visit the Somerset Drug and Alcohol Service (SDAS) website.
Risks When Taking Gabapentinoids with Other Medicines
Gabapentin and Pregabalin can make you feel sleepy or drowsy. If you take them together with other medicines prone to cause sleepiness it can be risky. Opioids like codeine or morphine are especially risky to take with gabapentinoids. Certain sleeping or anxiety medicines like benzodiazepines can also carry similar dangers.
Combining these medicines and gabapentinoids can:
- Make it hard to breathe
- Increase the chance of overdose
- In some cases, cause sudden death
Older people and those with breathing or kidney problems are at higher risk.
Alcohol can cause side effects that are like those of Gabapentinoids, such as making you feel sleepy and affect your thinking. When you first start taking Gabapentinoids or increase the amount you take, it's best to avoid drinking alcohol. After your body gets used to the medication, having a small amount of alcohol might be okay, but it can still make you feel sleepy or less alert.
Deciding to Reduce or Stop Your Medication
This is a general guide and doesn’t replace advice from a doctor or clinical pharmacist. They can support you based on your personal needs.
To get a personalised plan on how to reduce your gabapentin or pregabalin use, you should request an appointment with a GP or a Clinical Pharmacist.
If you're taking gabapentin or pregabalin for pain, it's important to review your medication with a GP or clinical pharmacist every 6 to 12 months. During these check-ins, you can:
- Talk about how well it’s working
- Discuss any side effects
- Decide if you still need to take it
You might think about reducing or stopping if:
- You're still in pain and the medicine doesn’t seem to help
- Your pain has gone, and you think the condition has improved or resolved
- You’re having side effects
- You’re concerned about long-term risks
Reducing your dose can lower side effects, improve quality of life, and support your physical health.
Visit the Livewell With Pain website, which can help you think about whether continuing gabapentinoids is right for you.
Support While Reducing
Never stop gabapentinoids suddenly.
Your doctor or pharmacist will help you plan a slow, safe reduction to avoid withdrawal symptoms.
If you do feel withdrawal effects, pause at your current dose until they settle. You can then reduce more gradually. If stopping completely isn’t possible, aim to stay on the lowest helpful dose.
Modern pain management focuses on self-care and building skills to live well with pain. These approaches can also help you cope with extra pain or withdrawal as you reduce your medication.
These may include:
Physical activity and movement:
Emotional support:
Pacing strategies:
Who can support me with my pain?
The Health Connections Team
Our Health Connectors help people manage chronic pain and other health issues. They run regular self-management courses called 'Live Well with Pain'. They can also provide one-to-one support.
Clinical Pharmacists
Clinical pharmacists are highly trained in starting and stopping medication. They can explain your options and support you as you reduce or stop your medicine.
GPs
Your doctor (GP) is here to help you with your health issues. They can listen to your pain story and talk about how your current treatments are working. Together, you can find ways to feel better and work towards making your life more enjoyable.