What Does A Gabapentin Overdose Look Like?
Key Points
- While rare when used alone, Gabapentin can result in severe physical and mental issues when not used as directed.
- A Gabapentin overdose is likely to present in a manner similar to an overdose of other drugs that affect the central nervous system, which can include extreme sleepiness or lethargy, mental confusion, problems breathing, nausea or vomiting, loss of motor control, rapid heartbeat, and low blood pressure.
- A severe overdose can result in oxygen levels dropping dramatically, observable tremors, or coma. If these occur, call for emergency medical care immediately.
Gabapentin, despite its structural similarity to GABA, does not bind to GABA receptors or directly affect GABA uptake or degradation. Its mechanism of action is not fully understood, but it is believed to work by affecting calcium channels in the nervous system. As such, an overdose can look like physical problems such as labored or slowed breathing, rapid heartbeat, low blood pressure, tremors, coma, or, in severe cases, death, especially when combined with other substances.
Overdose can also lead to psychological effects with profound mood changes, reduced cognitive, physical, and mental abilities, and unusual behaviors.
What Is Gabapentin, And What Conditions Does It Treat?
Gabapentin is a prescription anticonvulsant or antiepileptic. It’s known by brand names such as Neurontin®, Horizant®, and Gralise®. The pills are also sometimes called “Johnnys” or “Johnnies.” In some states, Gabapentin is a Schedule V controlled substance.
While it has a low probability for abuse in comparison to opioids, for example, if it is misused, Gabapentin can result in mind-altering effects or withdrawal symptoms.
Uses of Gabapentin
Gabapentin is approved by the US Food and Drug Administration (FDA) to treat seizures as well as pain from shingles. Gabapentin is used as both a primary and an add-on medication. Use of Gabapentin is currently increasing for off-label use as well as for illicit uses.[1]
Off-Label Use
Off-label use of Gabapentin has grown over the past decade to the point that it is the seventh most frequently prescribed drug in the US in 2019.[2 ]
In addition to seizures and shingles pain, off-label uses for Gabapentin include:
- Alcohol dependence
- Anxiety (specific types)
- Epilepsy
- Fibromyalgia
- Hot flashes
- Insomnia
- Nerve pain
- Post-surgery pain
- PTSD (post-traumatic stress disorder)
- Restless leg syndrome
Illicit Use / Abuse
Gabapentin can be used to intensify the effects of opioids. An opioid, most often fentanyl, was involved in 90% of deaths in which Gabapentin was also detected.[3]
This drug is meant to be taken orally. Crushing Gabapentin and snorting/inhaling it increases the probability of serious side effects and is a signal of substance abuse.
How does Gabapentin work?
Gabapentin is a compound similar to gamma-aminobutyric acid (GABA). It mirrors the effects of GABA.
GABA decreases the excitability of certain neurons or nerve cells (neurons) in your brain. Those neurons are involved in how pain signals are transmitted to your brain and the signals that produce seizures.
How does Gabapentin make you feel?
Most people feel calmer, relaxed, and blissful when they take prescription Gabapentin as directed.
Gabapentin Side Effects
If you take prescription Gabapentin as directed, you may experience these side effects [4]
- Sleepiness
- Dizziness
- Arm or leg swelling
- Nausea and/or vomiting
- Uncoordinated movements
What does a Gabapentin overdose look like?
Someone who’s overdosed on Gabapentin may exhibit any or all of these symptoms:[5]
- Drowsiness
- Dizziness
- Fast heartbeat
- Low blood pressure
- Vomiting and/or nausea
- Reduced motor control or Loss of motor control
IMPORTANT: Gabapentin overdose can be fatal. Seek medical attention immediately.
Call for Medical help immediately if you observe extreme symptoms or any of the following:
- Coma
- Profound fatigue or lethargy
- Tremors
- Low oxygen levels (hypoxia)
When can increase the risk of Gabapentin overdose?
Your risk of overdose may be higher depending on these factors:
- Your overall health
- Your age
- Any medical conditions you have
- How your body individually processes the medication (your metabolism)
- Your mental health
- Whether you use another substance at the same time, opioids or alcohol in particular
- Whether you use a higher dosage than what you are prescribed
- Whether you use Gabapentin more frequently than what you are prescribed
What should you do if you suspect a Gabapentin overdose?
Unfortunately, as of this writing, there is no known antidote or way to reverse a Gabapentin overdose. Call for emergency medical help if you suspect a Gabapentin overdose.
Substance Use Disorder Treatment
Gabapentin is extraordinarily helpful in treating certain conditions. And it has the potential for abuse that can lead to Substance Use Disorder (SUD). Recovery Unplugged stands ready to help those struggling with SUD, with our unique, music-based recovery programs.
Frequently Asked Questions About Gabapentin Overdose
If Gabapentin is mixed with other substances, does that increase the risk of overdose?
Yes. In particular, if you combine Gabapentin with other substances that depress the central nervous system, such as those listed, you not only increase the risk of overdose, but you also increase the risk of a severe or possibly fatal reaction.
These substances can amplify the effects of Gabapentin and combine to depress activities in your body that control your breathing, heart rate, motor control and coordination, thinking process and judgment, gastrointestinal functions, and level of alertness.
Rarely, gabapentin overdose can also increase seizure risks, even though Gabapentin is used to treat seizures.
What substances should be avoided when taking Gabapentin?
These substances also depress the central nervous system and should be avoided:
- alcohol
- benzodiazepines
- opioids
- sedatives
Can Gabapentin overdose be fatal?
Yes. While it is rare, fatalities from an overdose of Gabapentin have occurred. For example, a 62-year old woman who struggled with depression died from a Gabapentin overdose.[6]
More often, in deaths in which Gabapentin was present in the system, another substance, such as an opioid, was also involved.
Can I drive while taking Gabapentin?
In most states, it is illegal to drive, bike, or operate machinery when you are under the influence of a medication or alcohol. Use extreme caution when considering driving, riding a bike, or operating machinery when taking Gabapentin.
Especially when you first begin taking the medication or when your dose is increased, you are more likely to experience sleepiness, dizziness, and motor control issues. If that is the case, wait until those symptoms have passed to consider driving, biking, or operating machinery.
If you’re taking Gabapentin for epilepsy, you typically are not to drive until you have been free of seizures for a year or more or only have seizures when asleep.
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Sources
[1][3] Mattson, C; Chowdhury, F., Gilson, T. Centers for Disease Control & Prevention: Notes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths — 23 States and the District of Columbia, 2019–2020. Retrieved from https://www.cdc.gov/mmwr/volumes/71/wr/mm7119a3.htm on June 29, 2023
[2] Kuehn, B. JAMA Network: Gabapentin Increasingly Implicated in Overdose Deaths. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/2793648 on June 29, 2023
[4][5] Alvarez, D. National Capital Poison Center: Poison Control (n.d.) Retrieved from https://www.poison.org/articles/neurontin-gabapentin on June 29, 2023.[6] O. Middleton. (May 2011) [6]National Library of Medicine: Suicide by gabapentin overdose. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21554310/ June 29, 2023
