Tag: Headache

What Happens When you Suddenly Stop Taking Gabapentin?

Case reports have shown that gabapentin withdrawal can last for up to 5 days or longer, but the duration has not been well established in human studies.

Gabapentin is a prescription medicine. It’s important to take it as advised by your doctor.

Dosage and strength

Each capsule of gabapentin contains 100mg, 300mg or 400mg of gabapentin. Each tablet contains 600mg or 800mg of gabapentin.

If you’re taking gabapentin as a liquid, 2ml is usually the same as taking a 100mg tablet or capsule. Always check the label.

Dosage for epilepsy

The usual dose for:

  • adults and older children (aged 12 and over) is 900mg to 3,600mg a day, split into 3 doses
  • younger children (aged 6 to 12) – varies depending on their weight

Dosage for nerve pain

The usual dose to treat nerve pain in adults is 900mg to 3,600mg a day, split into 3 doses.

Changes to your dose

To prevent side effects, your doctor will prescribe a low dose to start with and then increase it over a few days. Once you find a dose that suits you, it will usually stay the same.

How to take it

Swallow gabapentin capsules and tablets whole with a drink of water or juice. Do not chew them.

You can take gabapentin with or without food, but it’s best to do the same each day.

Try to space your doses evenly through the day. For example, you could take it first thing in the morning, early afternoon and at bedtime.

If you or your child are taking a liquid, it will come with a plastic syringe or spoon to measure your dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen spoon, as it will not measure the right amount.

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 withdrawal is not a common problem unless you are abusing the drug.

Abuse means taking gabapentin in higher than prescribed amounts and taking it for reasons not intended by your doctor.

A study on gabapentin abuse from 1993 through 2015 showed that people who experienced withdrawal were taking an average of 3,000 mg (600 to 8,000 mg) of gabapentin per day, but some case reports mention withdrawal symptoms at 400 mg per day.

What happens when you suddenly stop taking gabapentin?

If you are taking gabapentin at a normal dose prescribed by your doctor and you don’t have a history of substance abuse, you are less likely to have withdrawal symptoms when you stop taking it.

Higher doses and a history of substance problems pose more risk for abuse. You can 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 is called physical dependence.

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 start to feel that you need more of the drug to function, stopping suddenly is more likely to lead to withdrawal symptoms.

Withdrawal symptoms may start within 12 hours or take up to 7 days to begin after stopping suddenly. Symptoms commonly include:

      • Restlessness (agitation)
      • Disorientation
      • Confusion

Various case reports describe these other symptoms of gabapentin withdrawal:

  • Headache
  • Body/stomach pain
  • Anxiety
  • Heart palpitations
  • Sweating
  • Muscle twitching
  • Light sensitivity
  • Restless limb movements
  • Nervousness

What is the treatment for 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. Sometimes gabapentin is restarted to ease withdrawal symptoms before tapering off.

There is no evidence to show that other drugs or supplements — such as magnesium or CBD oil — are helpful in treating withdrawal symptoms.

Most case reports show that withdrawal patients went back onto gabapentin to relieve their symptoms. But there may be unreported cases of gabapentin withdrawal, as not everyone seeks treatment.

How can I avoid gabapentin withdrawal?

The best way to avoid gabapentin withdrawal is to only take the drug in the dose prescribed by your doctor for its approved uses.

Gabapentin is a prescription medication approved to treat certain types of seizures and nerve pain that follows a herpes infection (postherpetic neuralgia). A long-acting form is used to treat restless legs syndrome. The most common brand name is Neurontin.

Gabapentin is also prescribed and used for unapproved reasons. These are called off-label uses. Off-label uses for gabapentin include:

  • Substance abuse treatment
  • Migraine headaches
  • Fibromyalgia
  • Mental health disorders
  • Insomnia

People with a history of drug or alcohol abuse may be at increased risk for:

  • Tolerance
  • Self-dose escalation
  • Drug-seeking behavior
  • Withdrawal symptoms

What is muscle relaxants and What is the main side effect of Muscle Relaxants ?

Muscle relaxers or muscle relaxants are medications used to treat acute muscle pain and discomfort caused by muscle spasms. Muscle spasms are involuntary contractions that cause excessive strain in muscles and are often associated with conditions such as lower back pain and neck pain.

Medications used as muscle relaxers can differ in their chemical structures and the way they work in the brain. In general, muscle relaxers act as central nervous system depressants and cause a sedative effect or prevent your nerves from sending pain signals to your brain. The onset of action is rapid and effects typically last from 4-6 hours.

Muscle Relaxants for Muscle Spasms

Muscle spasms are painful and may restrict mobility, which can limit your ability to perform even basic activities. Painful, tight muscles can also interfere with getting a good night’s sleep.

Muscle relaxants may help reduce pain, and improve movement and range of motion, but your doctor will likely recommend that you first try acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). In some cases, these over-the-counter medications will be enough to help alleviate your pain.

If your muscle pain persists, your doctor may prescribe a muscle relaxant in addition to your pain medication. Below are common muscle relaxants (the generic names are listed first, with a brand name example in parentheses):

  • Baclofen (Lioresal)
  • Carisoprodol (Soma)
  • Cyclobenzaprine (Amrix)
  • Metaxalone (Skelaxin)
  • Methocarbamol (Robaxin)

When You Might Need a Muscle Relaxer

Your doctor might first suggest you try an over-the-counter medicine like acetaminophen (Tylenol) or ibuprofen (Advil) to treat your pain. But if those don’t work, or you can’t take them because you have another issue like liver problems or ulcers, you may need to try a muscle relaxant.

Muscle relaxants are ideally prescribed for acute rather than chronic pain. They may be an option if pain is preventing you from getting enough sleep. Because muscle relaxants cause drowsiness, they can help you get rest when you take them at night.

Some of the common side effects of muscle relaxers include:

  • Drowsiness
  • Dizziness
  • Agitation
  • Irritability
  • Headache
  • Nervousness
  • Dry mouth
  • Decreased blood pressure

The most commonly prescribed muscle relaxers are carisoprodol (Soma) and cyclobenzaprine (Flexeril). According to data from IMS Health, there were 4.2 million prescriptions of Soma and 28.4 million prescriptions of Flexeril dispensed in the United States in 2017.

Muscle Relaxant List
Muscle Relaxant List

What Are Side Effects of Flexeril?

Common side effects of Flexeril include:

  • dry mouth or throat
  • headache
  • blurred vision
  • drowsiness
  • dizziness
  • fatigue
  • loss of appetite
  • stomach pain
  • nausea
  • diarrhea
  • constipation
  • gas, or
  • muscle weakness.

Dosage for Flexeril –  For most patients, the recommended dose of Flexeril is 5 mg three times a day.

You shouldn’t drink alcohol while taking muscle relaxants. These medications make it hard to think and function normally, even if you take a low dose, so combining them with alcohol can increase your risk of an accident.

You also shouldn’t drive or operate heavy machinery while taking muscle relaxants. Some muscle relaxers start working within 30 minutes of taking them, and the effects can last anywhere from 4 to 6 hours

Muscle Relaxant Abuse

Muscle relaxers have a potential for abuse and addiction. Prolonged use can lead to increased tolerance and physical dependence, especially with Soma.3 For this reason, muscle relaxers are intended as a short-term treatment not to be prescribed for more than 2-3 weeks.

Unfortunately, many individuals take muscle relaxers alone or in combination with other illicit drugs for nonmedical reasons, such as to produce or enhance feelings of euphoria and dissociation. According to the Drug Enforcement Administration, Soma is one of the most commonly diverted drugs in the United States.2 Evidence also indicates prevalent misuse of Flexeril. In 2010 there were over 12,000 emergency room visits associated with Flexeril, and in 2016 over 10,000 calls to the Poison Control Centers had involved Flexeril.1

Muscle relaxer abuse can lead to serious dangers such as an increased risk of overdose, which can result in:

  • stupor
  • hallucinations
  • seizures
  • shock
  • respiratory depression
  • cardiac arrest
  • coma
  • death

Alcohol and Muscle Relaxers

Like muscle relaxers, alcohol also depresses the central nervous system. When alcohol is consumed with muscle relaxers the side effects are exacerbated. This can be very dangerous, leading to symptoms like:

  • Blurred vision
  • Urine retention
  • Extreme dizziness
  • Extreme drowsiness
  • Low blood pressure
  • Fainting
  • Memory problems
  • Liver damage
  • Increased risk of overdose

It is recommended to not drive or operate heavy machinery when under the influence of muscle relaxers. It is especially important to avoid drinking, as combining muscle relaxers with alcohol greatly increases your risk of an accident.

Withdrawal and Treatment

Regular use of muscle relaxers causes the brain to become used to its effects. If you attempt to suddenly stop using muscle relaxers you may experience withdrawal symptoms. Depending on the specific drug and how long you have been using it, there are various treatment options available to help you overcome your addiction.

For many people, Flexeril withdrawal causes mild symptoms such as nausea, headache, drowsiness, malaise, and discomfort. Symptoms tend to peak about 2-4 days after you last took the Flexeril, although in some people withdrawal symptoms may last for up to 1-2 weeks. For many people Flexeril detox can be done at home. However, if Flexeril addiction is accompanied by alcohol or opioid abuse the withdrawal symptoms from these other substances can be severe. In these situations, it may be best to undergo professional medical detox.

Soma withdrawal is usually more severe and can include symptoms like hallucinations and seizures. For your safety and comfort, it is often best to find an inpatient treatment program that includes a detox program to manage withdrawal symptoms. After detox patients can transition into the actual treatment phase of the program. Some people may not require a supervised detox program and will be able to undergo treatment on an outpatient basis.

Most inpatient and outpatient rehab programs include cognitive behavioral therapy that will help you learn the coping skills needed for long-term recovery.

Sources

  1. Drug Enforcement Administration. (2019). Cyclobenzaprine.
  2. Drug Enforcement Administration. (2019). Carisoprodol.
  3. Gonzalez, L.A., Gatch, M.B., Forster, M.J., & Dillon, G.H. (2009). Abuse Potential of Soma: the GABA(A) Receptor as a Target. Molecular and Cellular Pharmacology, 1(4), 180-186.