Gabapentin, introduced in the 1990s as an anticonvulsant and anti-epileptic drug, has become a cornerstone treatment for various neurological and pain-related conditions. While primarily known for its efficacy in treating seizures and nerve pain, gabapentin's impact on body weight has garnered attention. This article explores the relationship between gabapentin and weight changes, examining the potential causes, associated risks, and management strategies.
What is Gabapentin?
Gabapentin, also known by brand names such as Neurontin, Gralise, and Horizant, is an anti-seizure medication that has been prescribed in the US since the early 1990s. The prescription drug is FDA approved to control seizures in adults and children with epilepsy and treat a type of nerve pain called postherpetic neuralgia (PHN) that can occur after a shingles infection. Another extended-release form of gabapentin is FDA-approved to treat restless legs syndrome.
Gabapentin is FDA-approved to treat moderate-to-severe restless leg syndrome, partial seizures, and nerve pain after shingles. In addition to these indications, gabapentin is frequently used off-label for a number of conditions. Symptoms may include chronic pain, fibromyalgia, anxiety, irritable bowel syndrome, migraines, and alcohol withdrawal, just to name a few. Note that prescribing medications off-label (using an FDA-approved drug for an unapproved use) is a fairly common practice, accounting for 10-20% of prescriptions. It is also legal for prescribers to do.
The efficacy of gabapentin stems from its ability to modulate voltage-gated calcium channels, reducing excitatory neurotransmitter release in the central nervous system. In people with partial seizures, gabapentin works by decreasing abnormal activity in the brain.
Common Side Effects of Gabapentin
While gabapentin can be helpful to treat the conditions described above, there are some common side effects. As with all medications, not every person taking gabapentin will experience side effects. It’s also important to note that more serious side effects can occur. If you experience new symptoms after starting gabapentin, ask your doctor if they could be a medication side effect.
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Common side effects of gabapentin include:
- Fatigue
- Dizziness
- Swelling
- Headache
- Nausea and vomiting
- Fever
- Recurring infections
- Difficulty speaking
- Movement and coordination problems
- Weight gain
Dizziness and drowsiness are common side effects of gabapentin. Some gabapentin side effects, such as feeling drowsy, are more likely to occur when you start taking the medicine. These side effects may go away as your body adjusts. Side effects sometimes occur because of a combination of medicines you're taking. Gabapentin doesn't generally interact with other medicines. But antacids that contain aluminum or magnesium can affect the way your body absorbs gabapentin.
Gabapentin and Weight Gain: What the Research Says
Yes, gabapentin can cause weight gain. While it’s not a common side effect, about 2% of patients taking gabapentin experienced weight gain, and 8% experienced fluid retention.
One review article looking at weight gain from medications found an average weight gain of almost 5 pounds after just 1.5 months on gabapentin. Another study looking at weight changes after a longer course of the medication found that over half of participants gained more than 5% of their baseline body weight, with 23% of participants gaining more than 10% of their baseline weight.
Observed changes in body weight were as follows 10 patients gained more than 10% of their baseline weight, 15 patients gained 5% to 10% of baseline, 16 patients had no change, and 3 patients lost 5% to 10% of their initial weight. Weight increase started between the second and the third months of GPN treatment in most patients and tended to stabilize after 6 to 9 months of treatment, although the doses of GPN remained unchanged.
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While weight gain after starting gabapentin isn’t guaranteed, studies suggest significant weight gain is certainly possible.
Potential Causes of Weight Gain
The reason why gabapentin causes weight gain isn’t entirely clear, but other side effects of the medication may be part of the problem. Several factors may contribute to weight gain associated with gabapentin:
- Appetite: One of the most significant ways gabapentin can cause weight gain is by stimulating appetite. There are some reports that gabapentin causes an increase in appetite, but more research is needed.
- Fluid retention: Another factor to consider is that gabapentin may lead to fluid retention within the body. Edema (fluid retention) in the legs, feet, arms, and hands. Swelling, which occurs in about 8% of patients, would also make the scale go up.
- Fat storage: The medication can alter the body’s metabolic processes, leading to a greater propensity for fat storage rather than fat burning.
- Metabolism: Gabapentin may affect how efficiently the body metabolizes food.
- Energy levels: Side effects such as dizziness or fatigue, which some individuals experience while taking gabapentin, can make regular physical activity more difficult. Fatigue, which is the most common side effect of gabapentin, could lead to limited physical activity and subsequent weight gain.
Risks Associated with Weight Gain
Weight gain, affecting up to 25% of patients, is primarily attributed to secondary effects such as altered gastrointestinal function and peripheral edema. This adverse effect can negatively impact treatment adherence, especially in patients with chronic conditions requiring long-term therapy. Patients with preexisting metabolic disorders face heightened risks, necessitating strategies like dietary counseling and tailored treatment adjustments to mitigate weight gain.
Managing Weight Gain While Taking Gabapentin
Medication-related weight gain is common, but there are things you can do to stop or reverse weight gain from gabapentin and other weight-promoting medications. If gabapentin is causing weight gain, it is crucial to have a thorough discussion with a healthcare professional, such as a neurologist, to identify the most suitable and tolerated medication for your specific needs.
Here are several strategies to manage weight gain while taking gabapentin:
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Talk to your healthcare provider about other options: If you gain weight after starting gabapentin, talk to your doctor to determine if the medication could be the cause. You can also discuss other options that are less likely to cause weight gain. For example, medications such as lamotrigine, levetiracetam, and topiramate are known to have a lesser association with weight gain (and potentially fewer side effects). However, it’s important that you don’t just stop taking your medication without first talking to your healthcare provider.
Eat a healthy, reduced-calorie diet: Consuming a reduced-calorie diet that consists of fruits and vegetables, lean protein, whole grains, and healthy fats is essential for weight loss. If you need assistance with doing this, a Registered Dietitian is a great resource to help you get started.
Participate in regular physical activity: Incorporating regular physical activity into your day is an important part of weight management. Get regular exercise: Consistent physical activity can counterbalance the potential for weight gain and improve overall health and well-being. If you’re feeling fatigued as a result of your medication, talk to your doctor about what time of day you should take the medication. Also keep in mind that you don’t have to participate in high intensity activity to lose weight. Incorporating more steps into your day can have a beneficial effect on your weight and your energy level.
Self-monitoring: Tracking what you eat, your activity level, and your weight have all been proven to help you lose weight and keep it off. Whether you use a basic journal or something more tech-savvy like an app, all can be beneficial in managing your weight.
Get adequate sleep: An often overlooked but important factor in weight management is sleep. Aim to get at least 7 hours of uninterrupted sleep per night. If you’re having trouble sleeping or you wake up feeling unrefreshed, talk to your healthcare provider about potential causes and treatments.
Gabapentin Withdrawal
Stopping gabapentin suddenly may increase your risk of seizures. Instead, you may need to gradually reduce how much gabapentin you take until you stop it completely. Case reports have shown that gabapentin withdrawal often lasts for 5 to 10 days, but some people have taken as long as 18 weeks to completely taper off gabapentin while managing withdrawal symptoms. The symptoms and how long they last depend on how much of the drug you are taking and for how long you’ve been taking it.
Gabapentin Use in Animals
Yes, Gabapentin is safe for cats when prescribed by a veterinarian. This medication is commonly used to treat cat pain, anxiety, and feline hyperesthesia syndrome with minimal side effects.
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