Editing Gabapentin (section)

==Side effects==
[[File:Gabapentin Orion bottle.jpg|thumb|upright|Gabapentin Orion 100 mg, bottle and pills in Sweden]]
[[Dizziness]] and [[somnolence]] are the most frequent [[side effect]]s.<ref name="Neurontin label" /> [[Fatigue (medical)|Fatigue]], [[ataxia]], [[peripheral edema]] (swelling of extremities), and [[nystagmus]] are also common.<ref name="Neurontin label" /> A 2017 meta-analysis found that gabapentin also increased the risk of difficulties in [[mentation]] and visual disturbances as compared to a placebo.<ref>{{cite journal | vauthors = Shanthanna H, Gilron I, Rajarathinam M, AlAmri R, Kamath S, Thabane L, Devereaux PJ, Bhandari M | title = Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials | journal = PLOS Medicine | volume = 14 | issue = 8 | pages = e1002369 | date = August 2017 | pmid = 28809936 | pmc = 5557428 | doi = 10.1371/journal.pmed.1002369 | doi-access = free }}</ref> Gabapentin is associated with a weight gain of {{convert|2.2|kg|lb|abbr=on}} after 1.5 months of use.<ref name="pmid25590213">{{cite journal | vauthors = Domecq JP, Prutsky G, Leppin A, Sonbol MB, Altayar O, Undavalli C, Wang Z, Elraiyah T, Brito JP, Mauck KF, Lababidi MH, Prokop LJ, Asi N, Wei J, Fidahussein S, Montori VM, Murad MH | title = Clinical review: Drugs commonly associated with weight change: a systematic review and meta-analysis | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 100 | issue = 2 | pages = 363–370 | date = February 2015 | pmid = 25590213 | pmc = 5393509 | doi = 10.1210/jc.2014-3421 }}</ref> Case studies indicate that it may cause [[anorgasmia]] and [[erectile dysfunction]],<ref name="pmid26559937">{{cite journal | vauthors = Yang Y, Wang X | title = Sexual dysfunction related to antiepileptic drugs in patients with epilepsy | journal = Expert Opinion on Drug Safety | volume = 15 | issue = 1 | pages = 31–42 | date = January 2016 | pmid = 26559937 | doi = 10.1517/14740338.2016.1112376 | s2cid = 39571068 }}</ref> as well as [[myoclonus]]<ref name="pmid29111014">{{cite journal | vauthors = Kim JB, Jung JM, Park MH, Lee EJ, Kwon DY | title = Negative myoclonus induced by gabapentin and pregabalin: A case series and systematic literature review | journal = Journal of the Neurological Sciences | volume = 382 | pages = 36–39 | date = November 2017 | pmid = 29111014 | doi = 10.1016/j.jns.2017.09.019 | s2cid = 32010921 }}</ref><ref name="pmid30381161">{{cite journal | vauthors = Desai A, Kherallah Y, Szabo C, Marawar R | title = Gabapentin or pregabalin induced myoclonus: A case series and literature review | journal = Journal of Clinical Neuroscience | volume = 61 | pages = 225–234 | date = March 2019 | pmid = 30381161 | doi = 10.1016/j.jocn.2018.09.019 | s2cid = 53165515 }}</ref> that disappear after discontinuing gabapentin or replacing it with other medication. Fever, swollen glands that do not go away, eyes or skin turning yellow, unusual bruises or bleeding, unexpected muscle pain or weakness, rash, long-lasting stomach pain which may indicate an [[pancreatitis|inflamed pancreas]], [[hallucination]]s, [[anaphylaxis]], [[respiratory depression]], and increased [[suicidal ideation]] are rare but serious side effects.<ref>{{cite web |title=Side effects of gabapentin|date=16 September 2021 |url=https://www.nhs.uk/medicines/gabapentin/side-effects-of-gabapentin/ |publisher=National Health Service |access-date=20 January 2024}}</ref>

===Suicide===
As with all antiepileptic drugs approved in the US, gabapentin label contains a warning of an increased risk of suicidal thoughts and behaviors.<ref name="Neurontin label">{{cite web | title=Neurontin- gabapentin capsule Neurontin- gabapentin tablet, film coated Neurontin- gabapentin solution | website=[[DailyMed]] | date=11 April 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee9ad9ed-6d9f-4ee1-9d7f-cfad438df388 | access-date=21 December 2019}}</ref> This warning is based on a meta-analysis of all approved antiepileptic drugs in 2008, and not with gabapentin alone.<ref name="Patorno_2010" /> According to an experimental meta-analysis of insurance claims database, gabapentin use is associated with about 40% increased risk of [[suicide]], [[suicide attempt]] and violent death as compared with a reference [[anticonvulsant]] drug [[topiramate]]. The risk is increased for people with [[bipolar disorder]] or [[epilepsy]].<ref name="Patorno_2010">{{cite journal | vauthors = Patorno E, Bohn RL, Wahl PM, Avorn J, Patrick AR, Liu J, Schneeweiss S | title = Anticonvulsant medications and the risk of suicide, attempted suicide, or violent death | journal = JAMA | volume = 303 | issue = 14 | pages = 1401–1409 | date = April 2010 | pmid = 20388896 | doi = 10.1001/jama.2010.410 | title-link = doi | doi-access =  }}</ref> Another study has shown an approximately doubled rate of suicide attempts and [[self-harm]] in people with bipolar disorder who are taking gabapentin versus those taking [[Lithium (medication)|lithium]].<ref>{{cite journal | vauthors = Leith WM, Lambert WE, Boehnlein JK, Freeman MD | title = The association between gabapentin and suicidality in bipolar patients | journal = International Clinical Psychopharmacology | volume = 34 | issue = 1 | pages = 27–32 | date = January 2019 | pmid = 30383553 | doi = 10.1097/YIC.0000000000000242 | s2cid = 54130760 }}</ref> A large Swedish study suggests that gabapentinoids are associated with an increased risk of suicidal behaviour, unintentional overdoses, head/body injuries, and road traffic incidents and offences.<ref>{{cite journal | vauthors = Molero Y, Larsson H, D'Onofrio BM, Sharp DJ, Fazel S | title = Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden | journal = BMJ | volume = 365 | pages = l2147 | date = June 2019 | pmid = 31189556 | pmc = 6559335 | doi = 10.1136/bmj.l2147 }}</ref> On the other hand, a study published by the Harvard Data Science Review found that gabapentin was associated with a significantly reduced rate of suicide.<ref>Gibbons, R., Hur, K., Lavigne, J., Wang, J., & Mann, J. J. (2019). Medications and Suicide: High Dimensional Empirical Bayes Screening (iDEAS). Harvard Data Science Review, 1(2). https://doi.org/10.1162/99608f92.6fdaa9de</ref>

===Respiratory depression===
Serious breathing suppression, potentially fatal, may occur when gabapentin is taken together with [[opioid]]s, [[benzodiazepine]]s, or other [[depressant]]s, or by people with underlying lung problems such as [[COPD]].<ref name="FDA breathing">{{cite web | title=FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR) | website=U.S. [[Food and Drug Administration]] (FDA) | date=19 December 2019 | url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin | archive-url=https://web.archive.org/web/20191222091828/https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin | archive-date=22 December 2019 | url-status=dead | access-date=21 December 2019 }} {{PD-notice}}</ref> Gabapentin and opioids are commonly prescribed or abused together, and research indicates that the breathing suppression they cause is additive. For example, gabapentin use before [[joint replacement]] or [[laparoscopic]] surgery increased the risk of [[respiratory depression]] by 30–60%.<ref name="FDA breathing" /> A Canadian study showed that use of gabapentin and other gabapentinoids, whether for [[epilepsy]], [[neuropathic pain]] or other chronic pain was associated with a 35–58% increased risk for severe exacerbation of pre-existing [[chronic obstructive pulmonary disease]].<ref>{{cite journal | vauthors = Rahman AA, Dell'Aniello S, Moodie EE, Durand M, Coulombe J, Boivin JF, Suissa S, Ernst P, Renoux C | title = Gabapentinoids and Risk for Severe Exacerbation in Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study | journal = Annals of Internal Medicine | issue = Online ahead of print | date = January 2024 | volume = 177 | pages = 144–154 | pmid = 38224592 | doi = 10.7326/M23-0849 | s2cid = 266985259 }}</ref>

===Withdrawal and dependence===
Withdrawal symptoms typically occur 1–2 days after abruptly stopping gabapentin (almost unambiguously due to extended use and during a very short-term [[Rebound effect|rebound]] phenomenon) {{emdash}} similar to, albeit less intense than most benzodiazepines.<ref name="pmid26721643">{{cite journal | vauthors = Mersfelder TL, Nichols WH | title = Gabapentin: Abuse, Dependence, and Withdrawal | journal = The Annals of Pharmacotherapy | volume = 50 | issue = 3 | pages = 229–233 | date = March 2016 | pmid = 26721643 | doi = 10.1177/1060028015620800 | s2cid = 21108959 }}</ref> Agitation, confusion and disorientation are the most frequently reported, followed by gastrointestinal complaints and sweating, and more rare [[tremor]], [[tachycardia]], [[hypertension]] and [[insomnia]].<ref name="pmid26721643" /> In some cases, users experience withdrawal seizures after chronic or semi-chronic use in the absence of periodic cycles or breaks during repeating and consecutive use.<ref name="Bonnet_2017">{{cite journal | vauthors = Bonnet U, Scherbaum N | title = How addictive are gabapentin and pregabalin? A systematic review | journal = European Neuropsychopharmacology | volume = 27 | issue = 12 | pages = 1185–1215 | date = December 2017 | pmid = 28988943 | doi = 10.1016/j.euroneuro.2017.08.430 | s2cid = 10345555 }}</ref> All these symptoms subside when gabapentin is re-instated<ref name="pmid26721643" /> or [[Tapering (medicine)|tapered]] off gradually at an appropriate rate.{{Citation needed|date=May 2023}}

On its own, gabapentin appears to not have a substantial addictive power. In human and animal experiments, it shows limited to no [[rewarding]] effects. The vast majority of people abusing gabapentin are current or former abusers of opioids or sedatives.<ref name="Bonnet_2017" /> In these persons, gabapentin can boost the opioid "high" as well as decrease commonly experienced opioid-withdrawal symptoms such as anxiety.<ref>{{cite journal | vauthors = Bonnet U, Richter EL, Isbruch K, Scherbaum N | title = On the addictive power of gabapentinoids: a mini-review | journal = Psychiatria Danubina | volume = 30 | issue = 2 | pages = 142–149 | date = June 2018 | pmid = 29930223 | doi = 10.24869/psyd.2018.142 | s2cid = 49344251 | url = http://www.psychiatria-danubina.com/UserDocsImages/pdf/dnb_vol30_no2/dnb_vol30_no2_142.pdf }}</ref>

=== Psychiatric and behavioral adverse effects ===

Gabapentin is increasingly recognized to cause a range of psychiatric and behavioral adverse effects that extend beyond its more common neurological side effects. Systematic reviews have documented atypical manifestations such as [[aggression]], [[Agitation (medical)|agitation]], [[irritability]], mood instability, and [[suicidal ideation]], with some cases noting the emergence of [[mania]], [[hallucination]]s, and [[psychosis]], particularly in pediatric populations and individuals with preexisting psychiatric conditions.<ref name="Nwankwo_2024">{{cite journal | vauthors = Nwankwo A, Koyyalagunta D, Huh B, D'Souza RS, Javed S | title = A comprehensive review of the typical and atypical side effects of gabapentin | journal = Pain Practice : The Official Journal of World Institute of Pain | volume = 24 | issue = 8 | pages = 1051–1058 | date = November 2024 | pmid = 38949515 | doi = 10.1111/papr.13400 | url = }}</ref><ref name = "MC">{{cite web |title=Gabapentin (Oral Route) |url=https://www.mayoclinic.org/drugs-supplements/gabapentin-oral-route/description/drg-20064011 |work = Mayo Clinic |publisher=Mayo Foundation for Medical Education and Research |access-date=2025-06-01}}</ref><ref name = "Gál_2024">{{cite web | veditors = Patel A | vauthors = Gál K, Holland K | date = March 2024 |title=What are the side effects of gabapentin? |url=https://www.medicalnewstoday.com/articles/323753 | work = Medical News Today |publisher=Healthline Media |access-date=2025-06-01}}</ref>

Large [[cohort studies]] and post-marketing surveillance indicate that neuropsychiatric symptoms—including confusion, depression, and behavioral disturbances—can occur in up to 29% of gabapentin users, though most reactions are mild to moderate and often dose-dependent.<ref name="Huang_2023">{{cite journal | vauthors = Huang YH, Pan MH, Yang HI | title = The association between Gabapentin or Pregabalin use and the risk of dementia: an analysis of the National Health Insurance Research Database in Taiwan | journal = Frontiers in Pharmacology | volume = 14 | issue = | pages = 1128601 | date = 2023 | pmid = 37324474 | pmc = 10266423 | doi = 10.3389/fphar.2023.1128601 | doi-access = free | url = }}</ref> There is also evidence associating gabapentin with an increased risk of suicidal behavior, especially in younger patients, and rare reports of violent or aggressive behavior, though causality is difficult to establish and such events remain uncommon.<ref name="Molero_2019">{{cite journal | vauthors = Molero Y, Larsson H, D'Onofrio BM, Sharp DJ, Fazel S | title = Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden | journal = BMJ (Clinical Research Ed.) | volume = 365 | issue = | pages = l2147 | date = June 2019 | pmid = 31189556 | pmc = 6559335 | doi = 10.1136/bmj.l2147 | url = }}</ref><ref name="Athavale_2023">{{cite journal | vauthors = Athavale A, Murnion B | title = Gabapentinoids: a therapeutic review | journal = Australian Prescriber | volume = 46 | issue = 4 | pages = 80–85 | date = December 2023 | pmid = 38152314 | pmc = 10751078 | doi = 10.18773/austprescr.2023.025 | url = }}</ref>