Gabapentin, a prescription medication known under brand names such as Neurontin®, Gralise®, and Horizant®, has been widely prescribed since the early 1990s. While primarily approved by the FDA for treating partial seizures, nerve pain following a herpes infection (postherpetic neuralgia), and restless legs syndrome, it's also frequently used off-label for conditions like chronic pain, fibromyalgia, anxiety, irritable bowel syndrome, migraines, and alcohol withdrawal. Although generally considered safe, gabapentin's side effects and potential for weight changes warrant a closer examination, particularly when discontinuing the drug.
Understanding Gabapentin
Gabapentin is an anti-seizure medication that has been prescribed in the US since the early 1990’s. It 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. Prescribing medications off-label (using an FDA-approved drug for an unapproved use) is a fairly common practice, accounting for 10-20% of prescriptions, and is legal for prescribers to do.
Common Side Effects of Gabapentin
While gabapentin offers therapeutic benefits, it's associated with several common side effects, including:
- Fatigue
- Dizziness
- Swelling
- Headache
- Nausea and vomiting
- Fever
- Recurring infections
- Difficulty speaking
- Movement and coordination problems
- Weight gain
Not everyone experiences these side effects, and more serious side effects can occur. It's essential to consult a healthcare provider if new symptoms arise after starting gabapentin to determine if they could be medication-related.
Gabapentin and Weight Gain: What the Research Says
Weight gain is a potential side effect of gabapentin. One review article found an average weight gain of almost 5 pounds after just 1.5 months on gabapentin. Another study 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. While weight gain isn’t guaranteed, studies suggest significant weight gain is certainly possible.
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In people with epilepsy, weight gain occurred in 3% of people older than 12 years of age who were taking gabapentin (compared to 2% of people taking the placebo). In people with postherpetic neuralgia, 2% of patients taking gabapentin experienced weight gain.
One study reviewed changes in body weight in 44 patients treated with Gabapentin (GPN) for a period of 12 or more months. All patients had a seizure disorder and the dose of GPN was increased aiming at complete seizure control or until side effects limited further increase. Twenty-eight patients were receiving GPN dosages of > 3000 mg/day. 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.
Possible Mechanisms Behind Gabapentin-Related Weight Gain
The exact reasons for gabapentin-induced weight gain aren't fully understood. However, several factors may contribute:
- Fatigue: A common side effect, fatigue, can lead to reduced physical activity and subsequent weight gain.
- Swelling: Occurring in about 8% of patients, swelling (peripheral edema) can increase body weight.
- Increased appetite: There are reports that gabapentin causes an increase in appetite, but more research is needed.
- Decreased activity or lack of exercise: Gabapentin can cause fatigue, making you less likely to engage in exercise or movement.
- Increased appetite: By lowering blood sugar levels, gabapentin may increase appetite and make you feel hungry more often than usual.
Managing Weight Gain While on Gabapentin
Medication-related weight gain is common, but there are strategies to manage it:
- Consult Your Healthcare Provider: Discuss whether gabapentin is the likely cause and explore alternative medications less likely to cause weight gain. Never stop taking medication without professional guidance.
- Adopt a Healthy, Reduced-Calorie Diet: Focus on fruits, vegetables, lean protein, whole grains, and healthy fats. Consulting a Registered Dietitian can be beneficial.
- Engage in Regular Physical Activity: Incorporate physical activity into your routine. Even low-intensity activities like walking can positively impact weight and energy levels.
- Self-Monitoring: Track your food intake, activity levels, and weight using a journal or mobile app.
- Prioritize Adequate Sleep: Aim for at least 7 hours of uninterrupted sleep per night. Address any sleep disturbances with your healthcare provider.
Gabapentin Withdrawal and Its Implications
Gabapentin was once considered a very safe, non-addictive drug, which has led to it being one of the top 10 prescribed drugs in the United States; however, it may not be as safe as once thought. Gabapentin should not be stopped suddenly without talking to a healthcare provider. Stopping it suddenly can increase your risk of having withdrawal symptoms, including withdrawal seizures. Your brain cells (neurons) become dependent on a high dose of the drug for normal functioning. When the drug is stopped, your brain becomes temporarily disorganized. If you are starting to feel that you need a higher dosage of gabapentin to function, then you are most likely physically dependent on it and stopping suddenly will likely lead to withdrawal symptoms.
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Gabapentin Withdrawal Symptoms
Gabapentin withdrawal syndrome has similarities with symptoms of alcohol and benzodiazepine withdrawal. This may be because all three substances have some effect on GABA. Gabapentin withdrawal symptoms may start within 12 hours or take up to 7 days to begin after stopping suddenly.
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. Symptoms may start within 12 hours to 7 days after stopping gabapentin and may be severe.
Factors Influencing Withdrawal
If you have only used gabapentin for a short time at a low dose, withdrawing from gabapentin is not typically a problem. Most people who experience withdrawal symptoms from gabapentin have developed a physical dependence to it or have been misusing the drug. Physical dependence is when you start to build up a tolerance to the drug, and you may need to take even more of it to get the desired effect. This can develop after taking it for a few weeks or longer, especially if taking high dosages. Misusing gabapentin means taking gabapentin in higher dosages than your doctor has prescribed or taking it for reasons not intended by your doctor.
Management of Gabapentin Withdrawal
There are no approved medications to treat gabapentin withdrawal. The only reliable treatment is to slowly taper the drug under the supervision of your doctor, usually a substance abuse specialist. This may be done over a period of 3 weeks of longer. If withdrawal symptoms become too severe, the dose of gabapentin is increased again to ease these symptoms, before resuming a slower tapering schedule. Restarting gabapentin typically stops withdrawal symptoms within 3 days. Some addiction centers have used magnesium or lorazepam during gabapentin withdrawal, although there is no evidence to suggest that they work for everyone. Tapering protocols vary and they should be individualized to meet the needs of the person stopping gabapentin. The best way to avoid gabapentin withdrawal is to only take the dose prescribed by your doctor, for the shortest time possible.
Could Withdrawal Cause Weight Changes?
The impact of gabapentin withdrawal on weight is less clear. It's conceivable that withdrawal symptoms, such as nausea, appetite changes, and general malaise, could indirectly affect eating habits and activity levels, potentially leading to weight fluctuations. However, there is not enough direct research to support this idea. Any weight changes during withdrawal are likely secondary to the other effects of withdrawal.
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Other Considerations
Some drugs may cause weight gain more commonly than others. There are various reasons why medications cause weight gain. Talk to your healthcare provider if the risk of weight gain is a concern for you. It is difficult to avoid weight gain from certain medications as a side effect. However, you can try controlling weight by adopting a few lifestyle changes. Sometimes, dietary methods and lifestyle changes are not enough to achieve the desired effects. The Food and Drug Administration (FDA) has approved medications like Wegovy (semaglutide), Adipex-P (phentermine) and Xenical (orlistat) to treat obesity.
Gabapentin can cause a few side effects, including weight gain. If you’re taking gabapentin and you think you may have been gaining weight, talk to your healthcare provider. Lifestyle changes and medications may help with weight management. However, it's important to never stop taking gabapentin on your own due to additional weight gain.