Does gabapentin (Neurontin) cause addiction?

Gabapentin's Addiction Potential

Yes, gabapentin can cause dependence and has potential for abuse and addiction, though its addiction risk is lower than traditional substances of abuse. 1

Physical Dependence vs. Addiction

• Gabapentin can cause physical dependence, characterized by withdrawal symptoms upon abrupt discontinuation, which is different from addiction 2
• Physical dependence is an expected response with extended gabapentin use, with withdrawal symptoms typically resolving within 3-7 days if tapered properly 1
• Withdrawal symptoms can include agitation, disorientation, and confusion, which may resolve after restarting gabapentin 1

Risk of Misuse and Abuse

• The FDA label notes that gabapentin does not exhibit affinity for benzodiazepine, opiate, or cannabinoid receptor sites 1
• There are "rare postmarketing reports" of individuals experiencing withdrawal symptoms after discontinuing higher than recommended doses of gabapentin 1
• Most individuals who misuse gabapentin have a history of polysubstance abuse or use it to relieve withdrawal symptoms from other substances 1, 3
• Pregabalin appears to have somewhat higher addiction potential than gabapentin 4, 5

Prevalence and Context of Misuse

• In England, around half of patients who were dispensed gabapentinoids had been treated continuously for at least 12 months, which may increase risk of dependence 2
• Early on, gabapentinoids were known to cause euphoria, sedation, and dissociation, but were initially believed to carry relatively low risk of dependence 2
• Gabapentin misuse is more common in patients with current or previous substance use disorders, particularly opioid users 3, 5
• A systematic review found only 4 reported cases of behavioral dependence on pregabalin (and none for gabapentin) in patients without a history of other substance use disorders 3

Clinical Considerations and Risks

• When prescribing gabapentin, carefully evaluate patients for history of drug abuse and observe for signs of misuse or abuse (development of tolerance, self-dose escalation, drug-seeking behavior) 1
• Gabapentin taken with opioids can cause dangerous respiratory depression 2
• Severe gabapentin dependence may require extremely slow tapering - one case report described an 18-month taper process for a patient with alcohol use disorder 6
• Pure overdoses of gabapentinoids appear to be relatively safe but can become lethal when mixed with other psychoactive drugs, especially opioids and sedatives 5

Recommendations for Prescribers

• Use caution when prescribing gabapentin to patients with a history of substance use disorders 3, 5
• If gabapentin must be discontinued after long-term use, offer careful tapering and support to minimize withdrawal symptoms 2
• Monitor for signs of misuse such as requests for early refills, claims of lost prescriptions, or dose escalation 1
• Be aware that withdrawal symptoms can occur even with therapeutic doses and may require gradual tapering 7

Regulatory Status

• Gabapentin is not a scheduled drug under controlled substance regulations 1
• However, due to increasing recognition of its misuse potential, some regions have implemented stricter monitoring of gabapentin prescriptions 5