The majority of people who stop using gabapentin do not experience withdrawal symptoms or report only mild symptoms. However, there seems to be a subset of people who experience very uncomfortable side effects that make discontinuation of gabapentin difficult. There are few published case studies or verified reports of gabapentin withdrawal. However, anecdotal evidence on drug forums suggests that gabapentin withdrawal occurs at a higher rate than is recognized by the medical community.
It is worth noting that there are approximately 64 million prescriptions written annually for gabapentin, and it is the 10th most commonly prescribed drug in the US. The fact that there are only a few dozen or so verifiable cases of gabapentin withdrawal dating back over a decade supports the idea that gabapentin withdrawal is relatively uncommon. However, the fact that withdrawal does occur on occasion means that people reporting withdrawal symptoms should be taken seriously.
When used in conjunction with other drugs (particularly opioids), gabapentin may contribute to the overall addiction profile and affect withdrawal timelines. It remains unclear whether regular gabapentin misuse in conjunction with chronic opioid abuse can make opioid withdrawal worse. In fact, a number of studies report that gabapentin administration can substantially improve symptoms of withdrawal associated with opioids, benzodiazepines, and alcohol. Conversely, in cases of opioid overdose, the presence of gabapentin is significantly associated with higher mortality rates.
Very little is known about gabapentin withdrawal, and only a few dozen published case studies exist that provide real insight. With few exceptions, each case describes a patient who was taking at least 3,600 mg of gabapentin per day, with the maximum dose reported to be 12,000 mg per day. In cases where people took less than 3,600 mg/day, very serious health issues were present (for example, one patient taking 900 mg/day had a history of severe alcohol use disorder, current liver cirrhosis (indicating liver failure) and continued chronic heavy alcohol consumption).
With one notable exception, all cases were associated with current or past drug or alcohol use disorders. The notable exception described a 34-year-old man with no known history of drug or alcohol abuse, no history of seizure disorders, and a history of chronic back pain and surgery. He had been taking 8,000 mg/day gabapentin to control pain for over nine months. Several days after running out of his prescription, he was brought to the emergency department while having a generalized tonic-clonic (“grand mal”) seizure.
Administration of two different benzodiazepines failed to stop his seizure, and he required intubation and artificial respiration. An anticonvulsant drug called phenytoin with a vastly different mechanism from gabapentin and benzodiazepines eventually stopped his seizures. The patient was restarted on gabapentin and made a complete recovery.
Among the published literature, the most common withdrawal symptom is agitation (>50%), followed by confusion (45%), diaphoresis (excessive sweating) (36%), gastrointestinal symptoms (23%), and a few reports of tremors, insomnia, increased heart rate, and elevated blood pressure. One case of each involved akathisia (an inability to sit still), catatonia (repetitive motions or muscle rigidity and a state of mental stupor), and seizures.
Some researchers have proposed that gabapentin withdrawal symptoms are similar to those of delirium tremens, which are associated with severe alcohol withdrawal. Hallmark symptoms of delirium tremens include confusion, agitation, dissociation, and hallucinations. However, a great deal more research is required in order to determine whether delirium tremens and gabapentin withdrawal are mechanistically similar. Further, not all published reports of gabapentin withdrawal symptoms parallel those of delirium tremens.
Anecdotal reports on popular drug forums identify symptoms of gabapentin withdrawal including agitation, confusion, sweating, vomiting/diarrhea, and insomnia, but also include occasional reports of far more diverse symptoms. Rare symptoms include widespread soft tissue pain, stuttering, phobias, and ringing/buzzing in the ears. People report symptoms lasting for anywhere from a couple of days to a couple of months. However, there are also frequent interjections from people who quit cold turkey and experienced no withdrawal symptoms.
At this time, predicting who will experience withdrawal symptoms when quitting gabapentin is difficult, if not impossible. Furthermore, the subjective experience of withdrawal may be quite different between individuals.
Both published and anecdotal reports indicate that withdrawal symptoms set in within two to four days of gabapentin cessation.
The majority of people who have been described in case studies were maintained long-term on low doses of gabapentin after their withdrawal experiences. The minority reported that their symptoms abated “over time”. Based on published literature, a reliable gabapentin withdrawal timeline is impossible to determine.
Anecdotal reports suggest that withdrawal symptoms may persist anywhere from 72 hours to one to two months, with symptom severity progressively abating over time. There does not seem to be a reliable dose-response relationship, meaning that even very large doses of gabapentin may not cause any withdrawal symptoms, while a lower dose may be associated with symptoms. Unfortunately, very little is known about the mechanism of gabapentin withdrawal and why it affects some people and not others.
There is essentially nothing known about what may help ease symptoms of gabapentin withdrawal, other than gabapentin itself. Even administering drugs such as opioids or benzodiazepines that affect similar pathways in the brain does not mitigate gabapentin withdrawal symptoms. Interestingly, gabapentin does mitigate symptoms of opioid or benzodiazepine withdrawal. The reason for this difference is unknown.
The gabapentin detox period refers to the amount of time it takes for gabapentin to be completely eliminated. Gabapentin has a half-life of approximately five to seven hours, meaning that it will be cleared within 35 hours. An unusual feature of gabapentin is that it is eliminated from the system without being appreciably metabolized, unlike opioids and benzodiazepines, both of which undergo significant metabolic processing and are eliminated largely as inert byproducts.
For those who are concerned about gabapentin detox and withdrawal symptoms, undergoing medically supervised detox can provide physical and psychological support. However, be cautious of any rehab facility that guarantees that they can prevent or treat gabapentin withdrawal. At this point, very little is understood about how gabapentin works and the mechanisms associated with gabapentin withdrawal.
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