Gabapentin


Other name: Neurontin

Several non branded versions are available.

What is gabapentin used for in MS?

Gabapentin is a drug used in the treatment of nerve pain (neuropathic pain) in multiple sclerosis. It's often used to treat altered sensations (dysaesthesia) like numbness, burning or pins and needles.

The NICE MS Guideline also recommends gabapentin as one of the first drugs to try in the treatment of spasms and spasticity

Gabapentin is also sometimes used to treat visual problems, like nystagmus where your eyes rapidly flick up and down or from side to side involuntarily.

How do I take gabapentin?

Gabapentin is taken orally as tablets, capsules or a liquid that you drink. It's usually taken three times a day – morning, afternoon and evening. Gabapentin can be taken with or without food.

Your doctor will usually start you on a low dose and build up gradually to find a level that's effective with little or no side effects.

When stopping treatment, the dosage should be gradually reduced over a minimum of a week.

What side effects could I get with gabapentin?

Side effects can include sedation, dizziness, fatigue and weakness. They usually wear off as your body gets used to gabapentin.

Talk to your GP if you're experiencing side effects as they may be able to suggest ways to manage them or they may suggest reducing the dose.

Contraindications

Gabapentin should not be taken during pregnancy or when breastfeeding, unless you are told otherwise by your doctor.

Antacids (used to treat indigestion and heartburn) can reduce the amount of gabapentin that your body absorbs so it doesn’t work as well. It’s therefore recommended that you wait at least two hours after taking an antacid before you take your dose of gabapentin.

If you have a condition that affects your breathing, such as chronic obstructive pulmonary disease (COPD), or you are taking a medicine that affects your breathing, such as an opioid painkiller, then taking gabapentin may cause serious breathing difficulties. If you have concerns about this, discuss them with your doctor.

How does gabapentin work?

Gabapentin is an anticonvulsant and anti-epileptic drug. How it works is not fully understood.

From April 2019, the government has announced that gabapentin will be reclassified as a Class C controlled drug under the Misuse of Drugs Act 1971 and be placed in Schedule 3 to the Misuse of Drug Regulations 2001. This follows concerns over the drug being misused. These law changes mean that it will be illegal to possess gabapentin without a prescription and to supply or sell it to others.

What does this mean for me?

Doctors will still be allowed to prescribe gabapentin, however there are a number of rules that you, your doctor and your pharmacist will need to follow from April 2019. NHS England has published a patient leaflet to explain these changes – we also cover some of them below.

  • Doctors will only be able to provide 30 days’ supply of gabapentin on one prescription.
  • You will need to request a repeat prescription each month from your GP practice.
  • Your GP practice may no longer be able to send your prescription electronically to the pharmacy. This means that you or your representative will need to visit the GP practice each month to collect your prescription and take it to the pharmacy.
  • If your GP practice uses the electronic prescription service for controlled drugs, your prescription will be sent to the pharmacy electronically. This system has not yet been rolled out in all GP practices.
  • You must collect your medicine from the pharmacy within 28 days of the date on the prescription.
  • You’ll need to sign and show proof of your identity when you collect your medicine from the pharmacy.

Do speak to your GP practice if you’re unsure about how to get your next prescription.

Research

Various clinical trials have looked at the effectiveness of gabapentin in treating neuropathic pain. A systematic review – which collates and analyses data from a range of studies – found that in people experiencing neuropathic pain after shingles, gabapentin reduced pain by half or more for 3 in 10 people and by a third or more for 5 in 10 people. In people with neuropathic pain caused by diabetes, gabapentin reduced the pain by half or more for 4 in 10 people and by a third or more for 5 in 10 people.

The systematic review concluded that gabapentin is helpful for some people with chronic neuropathic pain. Unfortunately this review didn’t look at the effectiveness of gabapentin in people with MS, but it does give some idea of the level of pain relief that gabapentin can provide.

Find out more

References
Cutter NC, et al.
Gabapentin effect on spasticity in multiple sclerosis: a placebo-controlled, randomized trial.
Archives of Physical Medicine & Rehabilitation 2000;81(2):164-169.
Summary (link is external)
Mellegers M, et al.
Gabapentin for neuropathic pain: systematic review of controlled and uncontrolled literature.
Clinical Journal of Pain 2001;17:284-295.
Summary (link is external)
Wiffen PJ, et al.
Gabapentin for chronic neuropathic pain in adults.
Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD007938.
Full article (link is external)
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