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It’s likely you’ve heard of gabapentin: In 2022, the Centers for Disease Control and Prevention (CDC) reported that it was the 7th most commonly prescribed medication in the U.S. Gabapentin is approved by the U.S. Food and Drug Administration (FDA) to treat postherpetic neuralgia from shingles, partial seizures due to epilepsy, and moderate to severe restless legs syndrome (RLS).
The anticonvulsant medication was originally developed as a muscle relaxer and anti-spasmodic agent, but it has become increasingly popular as a treatment for many conditions. Healthcare providers frequently prescribe gabapentin off-label to relieve other kinds of nerve pain (including nerve pain due to diabetes), as well as to treat a wide range of other conditions, including anxiety, resistant depression and mood disorders, hot flashes, insomnia, post-operative pain relief, irritable bowel syndrome (IBS), alcohol use disorder, post-traumatic stress disorder, fibromyalgia, and migraine.
If you’re prescribed gabapentin (also known by its brand names Neurontin, Gralise, and Horizant), it’s essential that you review the drug information and know how to use it safely. Read on to learn more about potential drug interactions and what to avoid when taking gabapentin.
How gabapentin works
Gabapentin works by acting on neurotransmitters—chemicals produced by the nerve cells in your brain—and changing how those nerve cells communicate with each other. It reduces the excitability of nerve cells in the brain. Experts also believe it blocks pain signals for certain conditions in your nervous system, like nerve damage or pain caused by a shingles infection or diabetes.
Once you start taking gabapentin, research indicates that you’ll likely experience some benefits within the first week. However, it can take up to a month to experience significant improvement in your condition.
6 things to avoid while taking gabapentin
Gabapentin can be helpful for so many conditions. Still, like every medicine, it can also cause some common side effects, most commonly dizziness and sleepiness, but also tremors, drowsiness, weakness, dehydration, trouble with movements, and weight gain, among others. However, it is also possible to experience some gastrointestinal side effects, like nausea, vomiting, constipation, or diarrhea.
Although not all of these side effects of gabapentin can be mitigated, it’s important to know about interactions with the medication to avoid any adverse reactions. Here are six things that should be avoided while taking gabapentin.
1. Alcohol
It’s a good idea to opt for mocktails instead of cocktails when taking this medication as alcohol does not mix well with gabapentin. The combination will increase dizziness and sleepiness.
“Alcohol is a central nervous system depressant and impairs a person’s cognitive function, processing speed, mobility, and gait,” says Kobi Nathan, Pharm.D., founder of Geriatric Academy in Rochester, New York. “Gabapentin does most of these things as well. So drinking alcohol while taking gabapentin will result in additive or synergistic impairment.”
2. Central nervous system depressants
Gapabentin is a central nervous system (CNS) depressant, so it can be a dangerous combination to take it with another CNS depressant, such as oxycodone, Valium (diazepam), Xanax (alprazolam), or Ambien (zolpidem).
In 2019, the FDA announced it was requiring new warnings on gabapentanoids (which includes gabapentin) about the risk of severe respiratory distress, which could lead to death, when combining the medication with opioid drugs or other CNS depressants. Older people and those with existing respiratory issues (such as asthma or COPD) have a higher risk of respiratory complications.
Other medications have potential interactions with gabapentin as well. For your safety, it’s important to let your healthcare provider know every medicine you’re taking, including any recreational drug use.
3. Some vitamins and supplements
When you tell your provider about medications you take, don’t leave out vitamins and supplements. While gabapentin doesn’t have any known vitamin interactions, being deficient in—or having too much—of a particular vitamin sometimes resembles a condition that might warrant using gabapentin. For example, B6 and B12 deficiencies can cause nerve damage and neuropathy. Knowing what you are taking will help your provider diagnose and prescribe you properly.
If you are taking gabapentin for epilepsy, you should avoid ginkgo biloba. Large amounts of ginkgotoxin, which is found in ginkgo biloba, can cause seizures. Thus, it’s possible that taking ginkgo could reduce the anticonvulsive effects of gabapentin.
4. Antacids
It may be tempting to pop an antacid to counteract heartburn or an upset stomach when it arises. However, antacids can reduce the effectiveness of your gabapentin by not allowing the body to absorb as much.
If you need to take an aluminum- or magnesium-containing antacids like Maalox or Mylanta, wait at least two hours before you take your next dose of gabapentin. “This way, the mineral has been absorbed before the gabapentin hits the circulation,” Dr. Nathan says. Or, ask your healthcare provider if you should try another type of medication for heartburn, such as Nexium (esomeprazole).
5. Dehydration
You should be purposeful about drinking plenty of water, as gabapentin can sometimes cause mild dehydration or dry mouth as possible side effects, according to Josh Lichtman, DO, a psychiatrist and medical director at Neuro Wellness Spa in Los Angeles. It’s important to note this possibility and try to drink throughout the day. Peeing less often and dark pee that smells strong are signs of dehydration to look out for. Becoming dehydrated can cause its own set of problems while on gabapentin.
RELATED: 7 health benefits of drinking water
6. Caffeine
While some animal studies have indicated that excessive caffeine intake could lower gabapentin’s ability to prevent seizures, caffeine and gabapentin are not contraindicated with normal use. Just be sure let your healthcare provider know if you drink excessive amounts of coffee, tea, or energy drinks or are sensitive to caffeine.
It’s also important to be mindful that excessive caffeine consumption may make you feel anxious or make it harder to sleep, which is particularly relevant if you’re taking gabapentin for anxiety or sleep-related conditions, cautions Dr. Lichtman.
How to take gabapentin effectively
Because gabapentin treats many conditions, it comes in different formulations, and the treatment protocol is not the same for everyone. It’s essential to read the label before you pop that pill (or oral solution) and take it as advised. When in doubt, ask your pharmacist.
“For the most part, gabapentin can be taken with or without food, depending on the specific formulation,” Dr. Lichtman says. Some formulations are designed to be taken at night, and some with a full meal. It may depend, in part, on whether you’re taking an immediate-release or extended-release form of the medication.
However you take it, gabapentin works best when it’s at a steady level in your system, so it’s important to stick to the same time to avoid having your levels drop too low—and the medicine not working.
If you experience any serious side effects, be sure to contact your healthcare provider.
“Your healthcare provider can assess your situation and determine if your symptoms are related to gabapentin and provide appropriate guidance,” Dr. Lichtman says. “They may adjust the dose, change the timing of the dose, consider alternative treatment options, or just wait it out, as it is most likely a temporary side effect.”
Takeaway
If you start experiencing side effects while taking gabapentin, don’t stop taking the drug without talking to your healthcare provider. You should notify your healthcare provider about your symptoms or seek immediate medical attention for any severe side effects like suicidal thoughts, signs of an allergic reaction, or trouble breathing.
As with all medications, discuss your medical history with your healthcare provider so they can prescribe the appropriate regimen for your symptoms. Let them know if you’re taking any prescription or over-the-counter meds that could be causing an interaction. But also be honest about your pre-existing medical conditions, diet, your alcohol consumption, and any vitamins or supplements you take.
