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Using Gabapentin for Opiate Withdrawal: Will it Work?

gabapentin for withdrawal

Gabapentin, and its brand-name formulation Neurontin, are used as anticonvulsants as well as to treat certain types of neuropathic pain.1 In addition to these FDA-approved indications, gabapentin has been investigated for several off-label uses, including as an adjunct pharmacotherapeutic used during opioid detox as it can be helpful for managing some of the symptoms of opioid withdrawal.2

Though the research is quite mixed, one study in the Journal of Clinical Psychopharmacology indicates that when used as an adjunctive to methadone-assisted detoxification, gabapentin does help to relieve some of the physical side effects of opioid withdrawal. The key word here is adjunctive, which means in addition to and as a method of complementing other medications and treatments.2

 Gabapentin has shown some promise when used during medical detox to reduce some of the unpleasant effects specific to opioid withdrawal, but it is not a replacement to other primary methods of treatment.

Managing Opioid Withdrawal with Medications like Gabapentin

Long-term opioid use or misuse often results in the development of physical dependence. Opioid withdrawal can be significant once a person has developed physical dependence on an opioid drug, such as heroin or a prescription painkiller like OxyContin (oxycodone) or Vicodin (hydrocodone/acetaminophen).3 The severity of the acute opioid withdrawal syndrome is dependent on the type of opioid drug having been used, the amount and length of time that such drug was used, and how abruptly continued use of the drug is slowed or stopped.

 

 This is where gabapentin comes in. Though the mechanism of action isn’t well understood, gabapentin is thought to have a key interaction with both the inhibitory and excitatory neurotransmitter systems in the brain (GABA and glutamate) in the brain. Its effects on the balance of inhibition and excitation within the brain may help to modulate some of the autonomic nervous system functions that can be overactive during opioid withdrawal.4

Gabapentin may specifically help with the following side effects of opiate withdrawal:2,3

  • Dysphoria (a general feeling of unease and unhappiness).
  • Insomnia.
  • Irritability.
  • Agitation.
  • Tremors.
  • Muscle tension.
  • Muscle aches.

Physical flu-like symptoms and emotional lows are common during opioid withdrawal; in some instances, individuals may be urged to not attempt to suddenly stop taking these drugs. Instead, a medical detox program that uses opioid replacement medications to manage withdrawal symptoms can be helpful. Typically, opioid agonist medications such as methadone or buprenorphine are used during detox to stabilize a person in withdrawal and, later, can be given in gradually lower doses as a person is weaned off slowly to keep cravings and withdrawal symptoms to a minimum.5

Other medications may be helpful during detox as well to act on certain withdrawal symptoms. The Pakistani Journal of Pharmacology reports that when used during detox along with other medications, such as methadone, gabapentin can alleviate some of the withdrawal symptoms associated with opioid drug dependence.5

References

  1. NEURONTIN (gabapentin) | Pfizer Medical Information – Canada. https://www.pfizermedicalinformation.ca/en-ca/neurontin. Accessed June 22, 2019.
  2. Salehi M, Kheirabadi GR, Maracy MR, Ranjkesh M. Importance of Gabapentin Dose in Treatment of Opioid Withdrawal. J Clin Psychopharmacol. 2011;31(5):593-596.
  3. Canadian Centre on Substance Use. Prescription Opioids (Canadian Drug Summary).; 2017. https://www.ccsa.ca. Accessed January 17, 2019.
  4. Gabapentin | Drugbank. https://www.drugbank.ca/drugs/DB00996. Accessed June 22, 2019.
  5. Moghadam M, Alavinia M. The effects of gabapentin on methadone based addiction treatment: A randomized controlled trial. Pakistani J Pharmacol. 2013;26(5):985-989.
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About The Contributor
Shirley received her MD from the University of Western Ontario. She trained in family medicine and has experience working in laboratory medicine, medical education, medical writing, and editing. Shirley recently completed a MHSc in Translational... Read More