Gabapentin and Feeling Cold
Feeling cold is not a recognized or documented side effect of gabapentin based on current clinical evidence and guidelines. The most common side effects are dizziness, somnolence, peripheral edema, and coordination problems—not temperature-related sensations 1.
Common Side Effects of Gabapentin
The established adverse effects of gabapentin include:
- Central nervous system effects such as dizziness, somnolence, and unsteadiness/coordination problems affect up to 20-28% of patients 1
- Peripheral edema occurs in a notable proportion of patients 1
- Weight gain develops in 2-3% of patients 1
- Falls and fractures show increased risk, particularly at doses ≥600 mg/day, with a dose-response relationship peaking at ≥2,400 mg/day 2
- Altered mental status occurs more frequently at doses between 600-2,399 mg/day 2
What About Cold Sensations?
While the American Heart Association/American Stroke Association guidelines mention that central poststroke pain can include allodynia associated with cold (abnormal pain response to cold stimuli), this refers to the pain condition being treated, not a side effect of gabapentin itself 3. Gabapentin may be considered as a second-line treatment for this type of cold-induced pain 3.
The evidence shows gabapentin relieves neuropathic pain descriptors including burning, shooting pain, and hyperesthesia, but one study noted it did not relieve cold-type pain in spinal cord injury patients 4. This again refers to the pain symptom, not a medication side effect.
Clinical Implications
- Most side effects are mild to moderate and transient, improving markedly after the first week and largely resolving by week 4 1
- Slow titration minimizes adverse effects: start at 300 mg/day, increase to 600 mg on day 2, and 900 mg on day 3 1, 5
- Dose adjustment is required in renal impairment due to reduced clearance 1
- No significant drug interactions occur, and gabapentin does not cause sexual dysfunction or withdrawal syndrome 1
Bottom Line
If a patient reports feeling cold while taking gabapentin, investigate alternative explanations such as underlying medical conditions, other medications, or environmental factors rather than attributing it to gabapentin. The documented side effect profile does not include temperature dysregulation or cold sensations 1, 6, 5.