Gabapentin Overdose

Gabapentin overdose occurs when someone takes more of this prescription medication than prescribed, either accidentally or intentionally, leading to potentially dangerous symptoms and requiring immediate medical attention.

Over the years, I've seen a significant shift in the medications people struggle with. Gabapentin has emerged as a drug that many people don't realize carries serious risks, especially when combined with other substances or taken in excessive amounts.

What Is Gabapentin and How Does It Work?

Gabapentin is a prescription medication originally approved for treating seizures and nerve pain. You might know it by brand names like Neurontin, Gralise, or Horizant. The medication works by modifying electrical activity in your brain and affecting neurotransmitters that control pain signals.

Your doctor might prescribe gabapentin for conditions including:

• Seizure disorders and epilepsy

• Postherpetic neuralgia (pain after shingles)

• Restless legs syndrome

• Diabetic neuropathy

• Fibromyalgia (off-label use)

• Certain anxiety disorders (off-label use)

The medication has become increasingly popular because it was perceived as safer than opioids. However, this perception has led to widespread prescribing and, unfortunately, increased misuse.

How Common Is Gabapentin Overdose?

The numbers tell a concerning story. Gabapentin has become the seventh most dispensed medication in the United States, with over 73 million prescriptions written in recent years. Prescriptions for gabapentin tripled between 2002 and 2015, and they've continued rising since then.

With increased prescribing comes increased risk. Gabapentin exposures related to intentional abuse and misuse reported to poison centers increased by 104% between 2013 and 2017. More alarmingly, overdose deaths involving gabapentin have been rising steadily, particularly when combined with opioids.

Between 2019 and 2020, deaths with gabapentin detected increased alongside overall overdose trends during the pandemic. The percentage of these deaths that involved opioids remained consistently high at 85% to 90%.

Can You Really Overdose on Gabapentin?

Yes, absolutely. While gabapentin overdoses are less commonly fatal when the drug is taken alone compared to opioids, they can still be life-threatening, especially in certain situations.

The greatest danger arises when gabapentin is combined with other central nervous system depressants. When you mix gabapentin with opioids, benzodiazepines, or alcohol, the risks multiply dramatically.

Studies show that taking gabapentin with opioids nearly doubles the risk of opioid-related death. The combination therapy increases respiratory depression risk because both substances slow down breathing in different but complementary ways.

How Much Gabapentin Causes an Overdose?

The amount varies significantly based on individual factors. The typical maximum recommended daily dose is 3,600 mg divided into three doses. However, overdoses have been reported with amounts ranging from moderate doses to massive amounts exceeding 49 grams.

Several factors influence overdose risk:

Kidney Function: Gabapentin is eliminated exclusively through the kidneys. If you have kidney problems, the medication accumulates in your system much faster. People with kidney disease can experience toxicity even at normal therapeutic doses.

Other Medications: Taking gabapentin with opioids, benzodiazepines, alcohol, or other sedatives dramatically increases overdose risk.

Age: Children and elderly individuals are at higher risk of complications from toxic doses.

History of Substance Use: Research shows that 15% to 22% of people with opioid use disorder also misuse gabapentin, often to intensify the effects of opioids.

What Are the Symptoms of Gabapentin Overdose?

When someone overdoses on gabapentin, their body's systems slow down significantly. The symptoms arise because gabapentin depresses central nervous system activity.

Physical symptoms include:

• Severe drowsiness or lethargy

• Double vision or blurred vision

• Dizziness and loss of balance

• Drooping eyelids (ptosis)

• Slurred speech

• Muscle weakness and poor coordination (ataxia)

• Labored or shallow breathing

• Rapid or irregular heartbeat

• Low blood pressure

• Nausea, vomiting, and diarrhea

Neurological and psychological symptoms include:

• Confusion and disorientation

• Memory problems

• Altered mental status

• Depression

• Hallucinations

• Delirium or agitation

• Tremors or myoclonus (involuntary muscle jerking)

In severe cases, particularly in people with kidney failure, gabapentin overdose can lead to:

• Stupor or coma

• Severe respiratory depression

• Rhabdomyolysis (muscle breakdown)

• Acute kidney injury

• Death

Why Is Gabapentin Dangerous When Mixed With Opioids?

This combination has become particularly deadly, and understanding why helps explain the urgency I feel when discussing this topic with families.

When you take gabapentin with opioids, several dangerous interactions occur:

Increased Bioavailability: Opioids slow down intestinal movement, which allows more gabapentin to be absorbed into your bloodstream.

Compounded Respiratory Depression: Both substances suppress breathing, but they do so through different mechanisms. Gabapentin reduces the brain's responsiveness to carbon dioxide levels, while opioids directly slow breathing. Together, they create a dangerously synergistic effect.

Enhanced Sedation: Both medications cause drowsiness and mental cloudiness. When combined, these effects intensify dramatically, increasing the risk of accidents and dangerous situations.

Intentional Misuse: Many people deliberately combine these medications to intensify euphoric effects. Studies show that 38% of people in substance abuse treatment programs taking methadone also use gabapentin to potentiate methadone's effects.

Who Is Most at Risk for Gabapentin Overdose?

Through my years of practice, I've identified several groups who face elevated risks:

People Taking Opioids: If you're prescribed both medications for chronic pain, your overdose risk increases significantly. Co-prescription of opioids and gabapentin is associated with a nearly 60% increase in the risk of opioid-related death.

Individuals With Kidney Disease: Since gabapentin is cleared entirely by the kidneys, any impairment in kidney function leads to drug accumulation. The elimination half-life increases from about 6 hours in healthy individuals to over 130 hours in people without kidney function.

Those With Substance Use Disorders: If you're struggling with addiction treatment needs, you may face higher risks of gabapentin misuse. About 40% to 65% of people with gabapentin prescriptions report some level of misuse. Among those who abuse opioids, gabapentin misuse rates range from 15% to 22%.

Older Adults: Aging naturally reduces kidney function, making medication clearance slower. Elderly patients also tend to take multiple medications, increasing interaction risks.

Prison Populations: There have been reports of inmates crushing and snorting gabapentin to achieve a high, which dramatically increases overdose risk.

What Should You Do If You Suspect a Gabapentin Overdose?

Time is absolutely critical in overdose situations. If you suspect someone is experiencing a gabapentin overdose, take these steps immediately:

1. Call 911 or Poison Control: Contact emergency services right away. You can also reach Poison Control at 1-800-222-1222 for guidance.

2. Stay With the Person: Don't leave them alone. Monitor their breathing and level of consciousness.

3. Provide Information: Tell emergency responders what medications the person took, how much, and when. If you know they've combined gabapentin with other substances, share that information.

4. Administer Naloxone If Available: If opioid co-use is suspected, naloxone (Narcan) may help reverse opioid effects, though it won't reverse gabapentin toxicity itself.

5. Position Properly: If the person is unconscious but breathing, place them on their side in the recovery position to prevent choking if they vomit.

Never try to make the person vomit or give them anything to eat or drink unless directed by medical professionals.

How Is Gabapentin Overdose Treated?

When someone arrives at the emergency room with gabapentin overdose, treatment focuses on supportive care since there's no specific antidote for gabapentin toxicity.

Initial Stabilization: Medical staff will first ensure the person can breathe adequately. This might involve supplemental oxygen or, in severe cases, mechanical ventilation.

Gastric Decontamination: If the overdose occurred recently (within the first hour), activated charcoal may be administered to prevent further absorption of gabapentin from the digestive system. Gastric lavage (stomach pumping) may also be used in some cases.

Hemodialysis: For significant overdoses, especially in people with kidney problems, hemodialysis effectively removes gabapentin from the bloodstream. The medication is removed through the dialysate, with about 35% of a dose being cleared during a typical dialysis session.

Cardiovascular Support: Monitoring and supporting blood pressure and heart rhythm is essential, with intravenous fluids commonly administered.

Protection From Harm: If the person is experiencing confusion, agitation, or severe coordination problems, medical staff take precautions to prevent falls or self-injury.

Treatment of Complications: Any secondary issues like rhabdomyolysis or acute kidney injury require specific interventions.

Most gabapentin overdoses, when treated promptly, resolve without long-term complications. Symptoms typically improve within 24 to 48 hours with appropriate medical care.

Can Gabapentin Overdose Be Prevented?

Prevention starts with awareness and responsible medication management. Here are essential strategies:

Take Medications as Prescribed: Never adjust your gabapentin dose without consulting your healthcare provider. Don't take extra doses if you miss one.

Communicate With Your Doctor: If you're taking opioids or other sedating medications, make sure your doctor knows. They may need to adjust dosing or increase monitoring.

Dose Adjustments for Kidney Issues: If you have any kidney problems, your gabapentin dose should be reduced significantly. Regular kidney function monitoring is essential.

Secure Medication Storage: Keep gabapentin in a locked cabinet, especially if you have children or visitors who might access it.

Avoid Alcohol: Alcohol intensifies gabapentin's sedative effects and increases overdose risk.

Don't Share Prescriptions: Your dose is calculated for your specific situation. What's safe for you might be dangerous for someone else.

Proper Disposal: Dispose of unused gabapentin properly through medication take-back programs or pharmacy disposal services.

Special Considerations for Withdrawal

If you've been taking gabapentin regularly and want to stop, never quit abruptly. Sudden discontinuation can cause serious withdrawal symptoms, including increased seizure risk.

Withdrawal symptoms may include:

• Anxiety and agitation

• Excessive sweating

• Stomach upset and nausea

• Tremors

• Rapid heartbeat

• High blood pressure

• Insomnia

People with a history of substance use disorder who take daily doses of 3,000 mg or higher face the greatest withdrawal risks. Always work with your healthcare provider to taper off gabapentin gradually.

The Bigger Picture: Gabapentin in the Opioid Crisis

As opioid prescribing has faced restrictions, gabapentin prescriptions have increased dramatically. Many doctors viewed it as a safer alternative for pain management. However, this shift has created new challenges.

The percentage of people taking both opioids and gabapentin simultaneously increased by 344% between 2006 and 2018. This trend has been particularly pronounced among pain specialists, older adults, rural populations, and areas with high poverty rates.

As the opioid crisis has evolved to include more illicit fentanyl, gabapentin has increasingly appeared in overdose deaths involving synthetic opioids. The percentage of deaths with gabapentin detected that involved illicit opioids increased from 57% in early 2019 to 69% by late 2020.

Getting Help for Gabapentin Misuse

If you or someone you care about is misusing gabapentin, whether alone or in combination with other substances, professional help is available and effective.

Treatment typically begins with medical detoxification, where you gradually reduce gabapentin under medical supervision to avoid withdrawal complications. Understanding what rehab involves can help you feel more prepared for this important step. This process usually takes place in a supervised setting where healthcare professionals can monitor your symptoms and adjust your taper schedule as needed.

Following detox, comprehensive treatment addresses the underlying reasons for substance misuse. Evidence-based therapy approaches help you develop healthier coping strategies and build a foundation for lasting recovery.

Treatment options include:

• Residential or inpatient programs offering 24/7 medical monitoring and intensive therapy

• Outpatient programs that allow you to live at home while attending regular treatment sessions

• Individual counseling to explore personal triggers and develop coping skills

• Group therapy providing peer support and shared experiences

• Family counseling to heal relationships and build support systems

• Relapse prevention education teaching skills to maintain sobriety long-term

If you're experiencing co-occurring conditions like anxiety, depression, or trauma-related disorders alongside substance misuse, integrated treatment through mental health services can address both conditions simultaneously for better outcomes.

Moving Forward With Hope

Gabapentin overdose is a serious medical emergency that requires immediate attention. While the medication serves important purposes for seizure control and pain management, its risks are real, particularly when combined with opioids or used by people with kidney problems.

The good news is that with proper medical care, most people recover fully from gabapentin overdose. More importantly, gabapentin misuse and addiction are treatable conditions. Recovery is possible, and you don't have to face this challenge alone.

If you're struggling with gabapentin misuse or have concerns about your medication regimen, reach out for help today. Your health, your safety, and your future are worth protecting.

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