Can Neurontin (Gabapentin) Cause Tremor?
Yes, gabapentin (Neurontin) can cause tremor as a recognized adverse effect, though paradoxically it is also used to treat certain tremor disorders. 1
Tremor as an Adverse Effect
Gabapentin-induced tremor is listed as a common side effect in the FDA drug label and clinical studies:
Tremor occurs as a dose-related central nervous system adverse effect of gabapentin, reported in more than 10% of patients during long-term treatment studies 2
The FDA label specifically lists tremor among the most common side effects, alongside dizziness, drowsiness, ataxia, and difficulty with coordination 1
In epilepsy patients receiving gabapentin as add-on therapy at doses of 600-2400 mg/day, tremor was one of the most frequently reported CNS adverse events over 225 patient-years of treatment 2
The Paradox: Gabapentin Also Treats Tremor
Despite causing tremor as a side effect, gabapentin is paradoxically effective for treating specific tremor disorders:
For essential tremor: Multiple controlled trials show gabapentin at 1800-3600 mg/day significantly improves tremor scores, with patient global assessments showing benefit (p <0.05) 3
For orthostatic tremor: Gabapentin produces dramatic responses, with 60-80% improvement reported at doses of 300-1800 mg/day 4, and controlled trials showing disappearance or consistent reduction of tremor in most patients 5
Clinical Implications
If a patient develops new or worsening tremor after starting gabapentin, consider it drug-induced rather than therapeutic failure:
The tremor is typically dose-related and may improve with dose reduction 2
This side effect is distinct from the therapeutic tremor suppression seen in essential tremor or orthostatic tremor patients 6, 3
Other concurrent CNS effects (ataxia, dizziness, nystagmus) support drug-induced etiology 1, 2
Key Caveat
Do not confuse gabapentin's ability to treat certain tremor syndromes with its potential to cause tremor as an adverse effect—these are separate phenomena occurring in different clinical contexts 1, 2, 3.