Gabapentin is federally approved to treat epilepsy and neuropathic pain, but research has discovered a surprising link between it and alcohol.
Gabapentin has become something of a wonder drug. It reduces seizures in people with epilepsy and treats nerve damage pain caused by shingles, phantom limb pain, carpal tunnel, and reflex sympathetic dystrophy. It also has a calming, relaxing effect similar to benzodiazepines.
The success of its ability to reduce convulsions and nerve-damage pain stems from its relaxing effect on the emotional part of the brain, the amygdala.
Interestingly, this relaxing effect has shown more health benefits than initially intended. Of particular note is its proven ability to treat alcohol use disorder.
The World Health Organization reports that 3 million die from alcohol-related harm each year. Although legal, alcohol is the third most significant global public health problem.
Gabapentin has the potential to reduce cravings for alcohol in heavy drinkers.
So why isn’t it being prescribed more widely?
WHAT IS GABEPENTIN?
Gabapentin is an anticonvulsant.
It was created as a treatment for seizures in people with epilepsy.
Sold under the name Neurontin, gabapentin was created by Gerhard Satzinger PhD, Johannes H. Hartenstein PhD, and James R Zeller PhD in 1974 at Park Dawes laboratory in Germany. Park Dawes is a part of Warner-Lambert, itself a subsidiary of Pfizer.
In 2003, the three Chemists were granted the Heroes of Chemistry award by the American Chemical Society for the success of Neurontin in improving the lives of children and adults who have epilepsy globally.
HOW DOES IT WORK?
The drug is similar in molecular structure to GABA receptors. These are neurotransmitters.
The drug works by raising the activity of the receptors, which subsequently calms the central nervous system.
WHAT ARE GABA RECEPTORS?
GABA receptors are neurotransmitters in the membrane of the central nervous system. They play a role in regulating fear circuits in the amygdala, the part of the brain responsible for emotions.
Gabapentin has a relaxing effect, reduces anxiety, and increases well-being.
Gabapentin was designed to be similar in structure to GABA receptors. Increased GABA receptor activity promotes calmness, relaxation, and euphoria.
Certain compounds increase GABA receptor activity. This increases relaxation and feelings of well-being. These include alcohol, benzodiazepines, barbiturates, and propofol.
Decreased levels of GABA receptor activity cause higher anxiety and fear levels. Lower levels of GABA are associated with anxiety, depression, insomnia, stress, and reduced concentration levels.
Satzinger and his researchers suspected that people living with epilepsy might have a deficiency in GABA receptors so they decided to create a medication that increased GABA activity levels.
In this way, gabapentin was synthesized and branded Neurontin.
Slight variations of Neurontin include Gralize and Horizant.
Horizant – A variant of the medication used to treat restless leg syndrome.
Gralize – Used to treat the shooting, burning, or stabbing pain sensations caused by:
- Carpal tunnel
- Nerve damage from shingles
- Phantom leg pain
- Reflex sympathetic dystrophy
Pregabalin (sold as Lyrica) is similar to gabapentin, but it acts as a more potent painkiller.
Pregabalin also works three times faster than gabapentin. It has fewer side effects and is more effective for treating neuropathic pain.
A 2016 study also recommends pregabalin as an alternative treatment for alcohol use disorder and alcohol withdrawal symptoms.
The 16-week study found pregabalin prolongs abstinence and reduces alcohol cravings.
UK clinical researchers will complete tests on Pregabalin in March 2020. The tests will determine the effectiveness of pregabalin on alcohol use and withdrawal.
Pregabalin and gabapentin work in similar ways, but they have different side effects.
If you take pregabalin, you could experience the following side effects:
- Dry mouth
- Weight gain
If you take gabapentin, you can expect to encounter the following side effects:
- Difficulty speaking
- Irregular eye movements
- Jerky movements
- Viral infection
GABAPENTIN AND ALCOHOL USE DISORDER
Due to the role that GABA receptors play in alcohol use disorder, scientists decided to test the hypothesis that gabapentin can treat alcohol use disorder.
Barbara Mason, PhD and colleagues at the Scripps Research Institute for Addiction in California conducted a 12-week study on 150 men and women with alcohol dependence.
The results of the study proved that gabapentin assists abstinence and relieves relapse-related symptoms such as insomnia and anxiety caused by alcohol use disorder.
Only 9% of patients detoxing from alcohol get prescribed the medication.
Why, then, isn’t this drug used more often to treat alcohol dependence?
Well, a 2007 double-blind study found that gabapentin had no more efficacy than the placebo. It also found that the drug did not cause any adverse effects in comparison to the placebo.
GABAPENTIN AND ALCOHOL WITHDRAWAL
Sudden discontinuation of alcohol drinking can result in withdrawal symptoms such as:
- Delirium tremens
- Hand tremors
- Seizures (which can prove potentially fatal)
Benzodiazepines are usually prescribed to treat alcohol withdrawal symptoms and reduce cravings to prevent relapse.
Hugh Myrick has studied the link between gabapentin and alcohol withdrawal. When he compared lorazepam and gabapentin, he found that they worked equally well in easing alcohol withdrawal symptoms.
In his 2003 research, J Voris also found gabapentin to work well with mild to moderate symptoms of alcohol withdrawal.
Earlier studies suggested gabapentin as an alternative treatment because of the low abuse potential in people with alcohol use disorder. Although some people do mix gabapentin and alcohol, opioid users are most likely to abuse gabapentin.
However, there are recent reports that gabapentin abuse is increasing…
ABUSE OF GABAPENTIN
Recreational abuse of gabapentin is rising according to substance misuse workers in a report by Blair Smith.
A 2012 study reported that abuse of gabapentin is on the rise. Recreational users take it for its calming, relaxing, euphoric effects and the high it produces.
A sharp increase in requests for gabapentin prescriptions suggests that gabapentin abuse has increased.
A study on gabapentin abuse in Appalachia revealed some startling statistics.
Gabapentin abuse rose 165% between 2013 and 2014, and then 2950% from 2008 to 2014.
Recreational users from the study said the drug has stimulant effects that “just keep you wanting to move.” Other users said it has a calming effect, “relaxes your body,” and “helps with rest.”
The study respondents said they were most likely to get gabapentin from family, friends, or from prescriptions from their physician.
GABAPENTIN ABUSE IN OPIOID USERS
Interestingly, the likelihood of gabapentin abuse is more likely in opioid users but not in people with alcohol use disorder.
It’s becoming increasingly apparent that people are using gabapentin for recreational purposes.
Gabapentin stolen from hospitals and pharmacies finds its way onto the black market. Some people sell their prescription drugs on the street.
On the street, gabapentin tablets are called gabbies or johnnies. Usually, people take gabapentin with benzodiazepines, opioids, and sometimes alcohol. They retail for roughly a dollar a piece on the street.
Heroin users use gabapentin with heroin as it increases the potency. Heroin is sometimes cut with gabapentin. This means the drug is diluted to increase volume and profits.
Gabapentin does not respond to overdose antidote medicine which means it is fatal in heroin overdoses.
Recreational users may also snort or smoke gabapentin.
GABEPENTIN IN PRISONS
In 2012, Marcus Bicknell recommended stopping prescription of Pregabalin in UK prisons. Gabapentin is misused and used as a bullying tool in prison culture. Heroin users are most likely to request pregabalin prescriptions.
Recreational users tend to take higher doses, increasing the chance of overdose.
Hospital emergency departments now screen for gabapentin alongside usual tests for opioids, benzodiazepines, or alcohol.
GABAPENTIN ABUSE IN PEOPLE WITH ALCOHOL USE DISORDER
Research shows that whilst some do mix gabapentin with alcohol the likelihood of alcoholics abusing gabapentin are low. People with opioid addictions are more likely to abuse gabapentin.
Gabapentin has been prescribed off-label for various other conditions such as:
- Bipolar disorder
- Drug and alcohol withdrawal
- Neuropathic pain
- Restless leg syndrome
Doctors may prescribe off-label if they know that a drug is an effective treatment for conditions other than those initially intended.
It’s perfectly legal for doctors to prescribe off-label. That said, pharmaceutical companies are not allowed to promote off-label prescriptions.
In 1996 Pfizer was found guilty of promoting off-label prescriptions of gabapentin to doctors in a 1996 lawsuit. Consequently, the company had to pay a hefty fine.
A 2012 study found that doctors tend to prescribe gabapentin off-label more than for its intended purpose.
Ten Toronto doctors interviewed in the study said they prescribed gabapentin off-label despite a lack of evidence-based research.
The doctors said they based their decision to prescribe gabapentin on what they have learned from peers and conferences.
The study concludes that the drug is effective in treating alcohol dependence. However, more scrutiny is needed to ensure patient safety.
WHAT HAPPENS WHEN YOU TAKE IT WITH ALCOHOL?
Gabapentin and alcohol increase each other’s potency when mixed.
This substance magnifies the effect of alcohol so it’s easier to get drunk. The mixture can cause euphoria, calmness, and sociability but can also cause headaches, nausea, and anxiety.
Research suggests that moderate drinking is not affected by alcohol although heavy drinkers may experience loss of coordination, nausea, vomiting, memory loss, and drowsiness.
Mixing gabapentin and alcohol can be dangerous due to the risk of injury from falls.
A study of 17 non-alcohol-dependent individuals found that when gabapentin is taken 4 hours before drinking, it affected balance but had no effect on subject or performance effects.
MEDICATIONS APPROVED FOR TREATMENT OF ALCOHOL USE DISORDER
There are three medications approved by the Food and Drug Administration for the treatment of alcohol abuse disorder:
Acamprosate is more effective in people who have already undergone medical detoxification and have stayed abstinent. It can have some side effects such as nausea, vomiting, or stomach-ache.
If taken with alcohol, disulfiram creates an adverse reaction. You can expect to experience variable heart rate, headache, nausea, and vomiting.
This medication is effective in reducing cravings and proven to reduce heavy drinking.
APPROVAL FOR ALCOHOL ABUSE TREATMENT
In her study, Barbara Mason recommends this medication as an effective treatment for alcohol use disorder treatment.
However, to get a drug approved for the treatment of alcohol dependency is a very costly and timely process.
For the US Food and Drug Administration to approve gabapentin as a treatment for alcohol dependence, they must run it through several phases of trials.
This is costly and time-consuming. Clinical trials cost $19 million to approve a drug.
Clinical trials are typically conducted in three or four phases…
The first phase tests the efficacy and side effects of the drug.
A subsequent test with a wider reach tests the drug for effectiveness, side effects, and safety.
The final phase monitors use of the drug in public.
SUMMARIZING GABAPENTIN AND ALCOHOL
Studies have proven that this medication is effective in reducing cravings for alcohol in people with alcohol abuse disorder. It improves sleep and helps with insomnia, a common symptom of alcohol withdrawal.
This drug can help to reduce drinking volumes, reduce drinking days, and helps to maintain abstinence.
Less than 10% of people withdrawing from alcohol are prescribed gabapentin despite its efficacy in reducing withdrawal symptoms.
Barbara Mason recommends scrutinizing the side effects further before approving it as a treatment for alcohol use disorder.
Due to potential drug abuse, it may not be possible to approve it for treating alcohol use disorder.
Although gabapentin and pregabalin are useful treatments for alcohol abuse, it’s open to abuse.
More people are using gabapentin as a recreational street drug, often mixing it with harder recreational substances.
However, studies have shown that gabapentin abuse is most likely in opioid users. In her research, Barbara Mason found that alcohol-dependent individuals did not expect to abuse gabapentin.
Mixing gabapentin and alcohol can have adverse effects as they can increase the potency of each other.
WHAT TO DO NEXT
Research proves that gabapentin and pregabalin are effective treatments for alcohol use disorder.
The sudden spike in gabapentin abuse amongst opioid use is a significant concern. It was initially an alternative to benzodiazepines in alcohol dependence treatment for its low abuse potential.
Its rising popularity in recreational use may prevent it from becoming a fully approved treatment for alcohol use disorder and withdrawal.
If you have any concerns about gabapentin or alcohol, get in touch with the friendly team here at Landmark Recovery. We can help you get back on track from medically-supervised detox through to whichever treatment you need for issues with gabapentin and alcohol. Call us at 888-448-0302 and we can help you with residential rehab or an intensive outpatient program.
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