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There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

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Gabapentin is used to help in the treatment of various types of epilepsy, to help control the fits or blackouts. It is nearly always used with other antiepileptic drugs. Gabapentin is also used for neuropathic pain. It has also been used to help as a mood stabiliser in bipolar mood disorder and for anxiety (GAD or Generalised Anxiety Disorder), where other medicines have not helped, but it doesn't seem to be effective in many people for these.

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For epilepsy, the dose should be increased slowly to keep side effects to a minimum. The usual doses in adults are:

Day 1: 300 mg once a day

Day 2: 300 mg twice a day

Day 3: 300 mg 3 times a day

This can then be increased by 300mg a day every 2-3 days. The top dose is 3600mg a day. Sometimes the dose can be started at 300mg three times a day.

In children, the dose is based on age and weight.

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This will rather depend on what you are taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Anxiety - main options, main medicines and handy chart
• Bipolar mood disorder - main options, main medicines and handy chart
• Epilepsy - main options and main medicines

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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Epileptic seizures (fits or blackouts) happen when an abnormal electrical discharge, like a short circuit causing a spark, occurs in the brain. There is a chemical messenger (or "neurotransmitter") in the brain called GABA which is "inhibitory" on the brain and slows it down. In some people it is thought that there may not be enough GABA in the brain, and that this helps to "trigger" fits. Nobody is very sure how gabapentin works at the moment, but it may increase the action of GABA in the brain, which helps to reduce the chances of a fit.

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Take the gabapentin as directed on the medicine label, usually at breakfast, mid-afternoon and bedtime. It is particularly important to take the doses regularly each day as directed by your doctor to make sure that you are getting the best control of your illness from your medicine. Do not go more than 12 hours without taking a dose.

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The capsules should be swallowed with at least half a glass of water whilst you are sitting or standing, so that they reach the stomach and do not stick in your throat. They can be taken with or without food.

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This may depend on what you are taking it for. Click the link below for the answer for that condition:

• Anxiety (GAD or Generalised Anxiety Disorder)
• Bipolar mood disorder
• Epilepsy

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This will depend on what you are taking gabapentin for. It may also depend on how unwell you have been or how severe the symptoms have been, as people respond differently. Click on the link below for the answer for that condition:

• Anxiety (GAD or Generalised Anxiety Disorder)
• Bipolar mood disorder
• Epilepsy

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For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation.

Gabapentin is not usually thought to be addictive or habit forming. However, there have been reports of people abusing gabapentin (especially in prisons). There have also been reports of a few people getting a withdrawal reaction, particularly being very confused a couple of days after stopping gabapentin suddenly.

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is almost time for your next dose, then go on as before. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should tell your doctor about this next time you meet. If you are ill and vomit your tablets you should take that dose again. Missing a dose, or leaving more than 12 hours between doses, can cause your fits to return. The amount in your bloodstream may drop below the level needed to control your fits.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices that can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, by your bed etc.

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If you are taking gabapentin for epilepsy you should not stop taking it suddenly or without advice from your doctor as this might mean an increase in fits or blackouts. If you and your doctor sgree that you no longer need gabapentin it should be withdrawn slowly (like any treatment for epilepsy) to make sure that your fits do not return. This will usually be by a slight reduction in your dose every few weeks. If you do this you should not get any problems.

There have been a very few reports of people getting withdrawal symptoms when taking gabapentin for neuropathic pain (which is pain caused by nerve damage rather than physical damage). These have included restlessness, marked confusion, agitation, anxiety, cravings and being disorientated. They have usually started a couple of days after stopping gabapentin suddenly, and have been confused with alcohol withdrawal symptoms. If this happens, it is best to start the gabapentin again and then drop the dose slowly.

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The table below will show you some of the main side effects you might get from gabapentin.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses and also if you have kidney problems (when a lower dose is needed). Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

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You may feel sleepy, so take care if you are allowed to drive or when operating any type of machinery. This effect should wear off or at least reduce after you have been taking it for a while.

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About one in twenty people (5%) taking gabapentin put on some weight. If you do start to have problems with your weight, tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice.

Click here for a few tips on how to help you feel less hungry and lose weight.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Gabapentin is not thought to have an effect on any of these.

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You should have no problem with any foods or drinks, other than alcohol (see separate question).

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. epilepsy, asthma or a chest infection (as alcohol can make it harder to breathe)
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

You should avoid alcohol while taking gabapentin as it may make you feel more sleepy. if this happens, you must take extra care if you are allowed to drive or operate machinery. You must seek advice on this.  

It is not safe to drive after drinking alcohol, with or without gabapentin. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

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Gabapentin is not thought to interact significantly with any medicines and so you should have no problems, although your doses may have to be assessed carefully. There may be other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking. However, it seems that there are no extra problems if smoking with gabapentin.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, it seems that there are no extra problems if smoking cannabis with gabapentin.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, there are no reports of extra problems with gabapentin and cocaine, although this doesn't mean it's safe.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with gabapentin and ecstasy, but again this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). However, there are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with gabapentin, but again this doesn't mean it's safe.

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You should have no problems with "The Pill" and gabapentin, unlike many other antiepileptic drugs.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking gabapentin, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

Luckily gabapentin doesn't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

Gabapentin is classified as "C". A large study carried out in Denmark of 59 mothers who took gabapentin in the first trimester (months 1-3) showed that gabapentin did not increase the risk of abnormalities (Mølgaard-Nielsen and Hviid, 2011). However, you should still seek personal advice from your GP, who may then if necessary seek further specialist advice. If you are taking this medicine for epilepsy, then you will need to also consider the risk of seizures as well.

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.

• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.

• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter

• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit

• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half

• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We know that gabapentin gets into breast milk and the amount can vary from mum to mum. Overall it seems gabapentin has a low risk if you take care (see above) and are not on a very high dose. 

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People suffering from epilepsy may drive a motor vehicle in UK (but not a heavy goods vehicle) provided they have been free from fits for one year or if they have only had fits in their sleep for three years. You should consult your doctor about driving. You should consult your doctor about driving.

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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You should not need any blood tests to check on your gabapentin.

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