Gabapentin

ATC code

N03AX12

Therapeutic class

Antiepileptic / Neuropathic analgesic · Alpha-2-delta (α2δ) ligand

Forms

oral capsule, oral tablet, oral solution

Brand names

Neurontin (US) · Gralise (US) · Horizant (US)

Overall confidence

medium

Regulatory sources consulted

Approved indications

Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization, in adults and pediatric patients 6 years and older.
Management of postherpetic neuralgia (PHN) in adults.
Treatment of moderate-to-severe primary Restless Legs Syndrome (RLS) in adults.
Use for sciatica pain. A systematic review and meta-analysis found a lack of evidence to support its routine use for this indication. · off-label
Perioperative multimodal analgesia to reduce postoperative opioid consumption and succinylcholine-induced myalgia. · off-label

Contraindications

Absolute

Hypersensitivity to the active substance or to any of the excipients.

Clinical warnings

Major warning · Respiratory Depression: There have been reports of severe respiratory depression in relation to gabapentin use, especially when co-administered with CNS depressants such as opioids. — Clinical Knowledge
Major warning · Somnolence/Sedation and Dizziness: Gabapentin may cause somnolence, dizziness, and other signs of CNS depression. Patients should be advised not to drive or operate complex machinery until they have sufficient experience. — Clinical Knowledge
Suicidal Behavior and Ideation: An increased risk of suicidal thoughts or behavior has been reported in patients taking antiepileptic drugs for any indication. — Clinical Knowledge
Abrupt Withdrawal: Abrupt discontinuation may precipitate status epilepticus. The dose should be tapered gradually over a minimum of one week. — Clinical Knowledge

Drug interactions

HighOpioids (e.g., Morphine)N02AA01
Mechanism: Pharmacodynamic synergy potentiating central nervous system (CNS) depression.
Recommendation: Closely monitor patients for signs of CNS depression, such as somnolence and respiratory depression. Consider a dose reduction of either gabapentin or the opioid.
Clinical Knowledge
ModerateAntacids (with Aluminum/Magnesium)A02AD
Mechanism: Co-administration reduces gabapentin bioavailability by approximately 20% by decreasing its absorption.
Recommendation: Administer gabapentin at least 2 hours after administration of aluminum and magnesium-containing antacids.
Clinical Knowledge

Adverse events

Common (≥1%)

somnolence · dizziness · ataxia · fatigue · peripheral edema · nystagmus · headache

Rare but serious

respiratory depression · anaphylaxis · angioedema · rhabdomyolysis · DRESS syndrome

Pregnancy and lactation

Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Gabapentin is excreted in human milk; a decision should be made whether to discontinue nursing or to discontinue the drug.

Recent literature (PubMed)

A systematic review and meta-analysis of the effectiveness and adverse events of gabapentin and pregabalin for sciatica pain.
Giménez-Campos MS, et al. · Aten Primaria · 2022 · Relevance 5/5
Revisión sistemática y metaanálisis que evaluó la eficacia de gabapentina y pregabalina para el dolor ciático. Concluye que hay una clara falta de evidencia sobre su efectividad, por lo que no se puede respaldar su uso clínico rutinario para esta indicación, a pesar de encontrar una mejora estadísticamente significativa en el dolor de pierna en un ECA a las 2 semanas.
Restless legs syndrome. Pathophysiology, diagnosis and treatment.
Castillo-Álvarez F, et al. · Med Clin (Barc) · 2025 · Relevance 4/5
Revisión sobre el síndrome de piernas inquietas que destaca la disfunción de vías dopaminérgicas, de adenosina y glutamatérgicas. Sitúa a los ligandos α2δ de los canales de calcio, como la gabapentina, como tratamiento de primera línea por encima de los agonistas dopaminérgicos debido a los problemas de aumento de síntomas a largo plazo con estos últimos.
Preoperative pregabalin prevents succinylcholine-induced fasciculation and myalgia: A meta-analysis of randomized trials.
Vélez PA, et al. · Rev Esp Anestesiol Reanim (Engl Ed) · 2024 · Relevance 4/5
Metaanálisis que demuestra que el uso preoperatorio de gabapentinoides (incluyendo gabapentina) reduce significativamente la incidencia de mialgias inducidas por succinilcolina en las primeras 24 horas postoperatorias, aunque no afecta a las fasciculaciones.
Implementation of a Multimodal Enhanced Recovery Protocol in Ambulatory Anorectal Surgery: A Randomized Trial.
Yao LY, et al. · Dis Colon Rectum · 2024 · Relevance 4/5
Ensayo clínico aleatorizado que muestra que un protocolo de recuperación mejorada multimodal, que incluye gabapentina pre y postoperatoria, reduce significativamente el uso de opioides en la primera semana después de la cirugía anorrectal ambulatoria.