Gabapentin for Anxiety
Gabapentin (brand name Neurontin) is a commonly used off-label treatment for anxiety.
What is gabapentin FDA approved for?
- Partial seizures
- Post-herpetic neuralgia
- Restless Leg Syndrome (RLS): dosed at 300 to 2400mg at bedtime.
What are the research backed but off label uses of gabapentin?
-Anxiety: Generalized anxiety, social anxiety, and panic disorder.
-Bipolar Disorder: it’s not a mood stabilizer but it can help treat anxiety and alcohol use disorder in patients with bipolar without destabilizing them. It does have some mood stabilizing properties when used along with stronger mood stabilizers like lithium or atypical antipsychotics.
-Insomnia
-Alcohol use disorder: fewer days of heavy drinking.
-Alcohol detox: not used as a stand alone treatment but can help with cravings, anxiety, and insomnia during withdrawal.
-Akathisia from atypical antipsychotics.
-Hot flashes in menopause.
How is gabapentin dosed?
If it’s being used for sleep, then it is dosed just at bedtime.
For anxiety and other disorders, it is given 2 to 3 times per day, as it lasts 6-8 hours.
It’s usually started at 100 to 300mg three times per day (every 6 to 8 hours). Goal doses vary by disorder and patient sensitivity to the medication, but tend to be 900 to 3600mg/day, divided into 3 doses.
It has a unique absorption via the GI system so as doses increase, less of the increase in dose is absorbed as transporters get saturated.
Lyrica, or pregabalin, is also very good very anxiety. Why do some prefer gabapentin over pregabalin?
Gabapentin has much lower rates of weight gain and ataxia (difficulty walking).
What substance use disorders can gabapentin potentially be helpful for?
-Alcohol: reduces the number of days of heavy drinking and improves sleep. Its effect size is 0.4.
-Marijuana: it helps with improving abstinence and cognition.
What are the most common side effects?
-Sedation
-Dizziness
-Imbalance
-Tremor
-Nystagmus
For a complete list of potential side effects, please click here.
How is gabapentin broken down?
It is excreted by the kidneys so use lower doses in the elderly and those with kidney disease.
