Can gabapentin (Neurontin) contribute to head congestion in a patient with a history of Generalized Anxiety Disorder (GAD) who is currently taking prednisone?

Gabapentin and Head Congestion

Gabapentin is not associated with head congestion or nasal symptoms as a recognized adverse effect, and this symptom is far more likely attributable to prednisone use, which commonly causes fluid retention, facial swelling, and sinus congestion.

Primary Culprit: Prednisone

• Prednisone frequently causes fluid retention, facial puffiness, and congestion as part of its well-documented adverse effect profile 1
• Corticosteroids like prednisone can cause vasodilation and increased vascular permeability leading to nasal congestion and sinus pressure 1
• The temporal relationship between prednisone use and head congestion symptoms should be carefully evaluated

Gabapentin's Adverse Effect Profile

• The most commonly reported adverse effects of gabapentin are dizziness, somnolence, fatigue, and peripheral edema—not head congestion 1
• In migraine prevention trials where gabapentin was studied, no head congestion or nasal symptoms were reported as significant adverse events 1
• Gabapentin's side effects are primarily neurological (sedation, dizziness, visual disturbances) rather than upper respiratory 1

Gabapentin in GAD Context

• While gabapentin has been used off-label for generalized anxiety disorder, case reports and small studies show its adverse effects remain consistent with the known profile: sedation and dizziness, not congestion 2
• Pregabalin (a related gabapentinoid) studies in GAD patients report somnolence, dizziness, headache, and dry mouth as the most common adverse events—again, no head congestion 3, 4, 5

Clinical Recommendation

• Attribute the head congestion to prednisone use rather than gabapentin 1
• Consider the duration and dose of prednisone therapy, as these symptoms typically worsen with higher doses and longer duration 1
• If prednisone is being used for a condition that permits tapering, discuss with the prescribing physician whether dose reduction is feasible 1
• Symptomatic management with saline nasal irrigation or decongestants may provide relief while prednisone therapy continues 1

Important Caveat About Gabapentin Use

• The 2024 VA/DoD guidelines now recommend against gabapentin for migraine prevention due to lack of efficacy and concerns about misuse, dependence, and withdrawal 1
• If gabapentin is being used for GAD in this patient, note that it is not a first-line agent and has limited evidence for this indication 6, 2
• Gabapentin should be used at the lowest effective dose and limited duration to minimize sedative side effects, particularly when combined with other medications 1