Gabapentin is an anticonvulsant or seizure medication that’s primarily used to treat epilepsy and nerve pain. It’s also sometimes used to treat restless leg syndrome, sleep, anxiety and bipolar disorder. Gabapentin has shown some promising results for people experiencing withdrawal, cravings, anxiety and insomnia related to alcohol use disorder (AUD). It generally helps improve mood, cravings and sleep. Medication management for AUD should always be personalized for the individual’s treatment goals, medical history and health status.

Gabapentin is safest and most effective for mild alcohol withdrawal symptoms. There are some risks for certain populations: It can cause seizures in people with severe withdrawal. It can also have mild euphoric effects at high doses. It’s sometimes misused, especially by people with opioid use disorder. However, people with AUD who don’t use opioids or other recreational drugs don’t often misuse gabapentin.

In this article, we’ll talk about how gabapentin helps people with alcohol use disorder, why it’s effective, and what you and your prescriber should keep in mind when considering this medication.

How gabapentin works for alcohol use disorder 

Gabapentin increases the level of GABA (gamma-aminobutyric acid) in the brain. GABA is a neurotransmitter that acts as the “brakes” of the nervous system to calm overactive nerve signals and reduce stimulation. In people with alcohol use disorder, this mechanism can help reduce withdrawal symptoms and cravings as well as anxiety. It can also help people relax at night to get more restful sleep. 

Clinical evidence and research

Gabapentin has shown significant benefits for treating mild withdrawal and preventing relapse in clinical studies. All forms of gabapentin have been well-tolerated by participants. Benzodiazepines and naltrexone are still the first-line treatments for these challenges, respectively. However, they come with certain risks, and they may not be effective for everyone. 

Benzodiazepines are more habit-forming than gabapentin. They can cause sedation and impairments as well as breathing problems. Naltrexone may interact with certain medications, and while serious side effects are rare, they are possible. 

People who can’t take benzodiazepines or naltrexone may benefit from taking gabapentin. It may be especially helpful for those who experience anxiety or insomnia. Gabapentin can also be combined with naltrexone for a greater effect. However, it may not be the best choice for people experiencing severe withdrawal. 

Integration with comprehensive treatment plans 

Gabapentin should be part of a comprehensive and personalized treatment plan for AUD. Your prescriber may want to provide other medications or refer you to other treatment providers for psychotherapy or support groups, and should also take any other medical conditions you have into account for a more integrated approach. Tell your prescriber about any medications and supplements you’re taking before starting a new treatment for AUD.

Gabapentin dosing, monitoring and side effects

Dosing for gabapentin ranges between 600 mg and 1,800 mg daily. Higher doses have shown advantages for cravings, insomnia, anxiety, dysphoria and relapse. Gabapentin is available in an extended-release format, but the immediate-release version seems to be more helpful for AUD. You should only take gabapentin when working closely with a prescriber. Some states have classified it as a controlled substance, so it may be subject to specific monitoring requirements.

In terms of side effects, Gabapentin can cause changes in mood or behavior, such as worsening depression, anxiety, confusion and suicidal thoughts. It can also contribute to breathing problems and low oxygen levels when taken with central nervous system depressants. Skin rashes, hives, irritation or fever may be a sign of an allergic reaction. If you notice any of these symptoms or a bluish tint to your skin, lips, fingers or toes, along with tiredness and muscle pain, seek medical help immediately.

Gabapentin may cause damage to the liver or kidneys, which might look like the following:

• Yellowing of the skin or eyes
• Vomiting
• Changes in urine color and urination
• Unusual bleeding or bruising
• Light-colored stools
• Weight gain 
• Swelling of legs and feet 

Other potential side effects of gabapentin include:

• Feeling tired
• Headache
• Dizziness
• Nausea and vomiting
• Fever
• Difficulty speaking
• Infections
• Memory loss
• Weight gain
• Tremors, jerky movements and coordination problems
• Problems with eye movement or double vision

Explore treatment options for alcohol use disorder, like gabapentin, with ReKlame Health

Your personal treatment goals and preferences are one of the most important elements for your care providers to consider when creating a treatment plan for alcohol use disorder. Gabapentin has some specific advantages, especially if you can’t take other first-line medications. Your treatment plan should include several stages to account for your changing needs as you make progress. It should also be responsive to unexpected life changes. 

A board-certified psychiatric nurse practitioner (PMHNP-BC) can be a critical member of your care team for medication management and support in navigating AUD treatment. At ReKlame Health, we match people with psychiatric nurse practitioners who can provide high-quality, culturally relevant care.

You can find relief from the most challenging symptoms of alcohol use disorder. You’ve got this, and we can help. Start by booking your first session today.