Can gabapentin (Neurontin) cause dyspnea (shortness of breath) or peripheral edema?

From the Guidelines

Gabapentin can cause edema, particularly in the legs, feet, and hands, as a recognized adverse effect, but the evidence for shortness of breath as a direct side effect is less clear. According to the most recent and highest quality study available 1, edema of the lower extremities is frequently reported and may counteract the benefits afforded by topical medications. While shortness of breath is not explicitly mentioned as a common side effect in this study, it can occur as part of a serious allergic reaction to the medication or may be related to fluid retention in the lungs (pulmonary edema) based on general medical knowledge.

Key Points to Consider

• Edema is a known side effect of gabapentin, occurring in approximately 1-2% of patients, although the exact frequency is not specified in the provided studies.
• The mechanism behind gabapentin-induced edema is not fully understood but may involve changes in vascular permeability or alterations in fluid balance regulation.
• Patients with pre-existing heart, kidney, or liver conditions may be at higher risk for developing complications, including edema.
• If symptoms of edema or shortness of breath occur, patients should contact their healthcare provider immediately rather than stopping the medication abruptly, as sudden discontinuation can lead to withdrawal symptoms.
• The healthcare provider may need to adjust the dosage or switch to an alternative medication based on the patient's response and medical history.

Management and Monitoring

• Careful monitoring of patients on gabapentin, especially those with pre-existing conditions, is crucial to manage potential side effects effectively.
• Dosage adjustments may be necessary, particularly in patients with renal insufficiency, as both gabapentin and pregabalin require dosage reduction in such cases 1.
• Alternative medications or adjustments in treatment plans should be considered if gabapentin-induced edema or other severe side effects occur.

From the FDA Drug Label

The most common adverse reactions associated with the use of gabapentin in adults, not seen at an equivalent frequency among placebo-treated patients, were dizziness, somnolence, and peripheral edema Table 3 lists adverse reactions that occurred in at least 1% of gabapentin-treated patients with postherpetic neuralgia participating in placebo-controlled trials and that were numerically more frequent in the gabapentin group than in the placebo group. Other reactions in more than 1% of patients but equally or more frequent in the placebo group included pain, tremor, neuralgia, back pain, dyspepsia, dyspnea, and flu syndrome TABLE 4 Adverse Reactions in Pooled Placebo-Controlled Add-On Trials In Epilepsy Patients >12 years of age Body System/ Adverse Event GabapentinaN=543 % Placeboa N=378 % Respiratory System Pharyngitis 3 2 Coughing 2 1 TABLE 5 Adverse Reactions in a Placebo-Controlled Add-On Trial in Pediatric Epilepsy Patients Age 3 to 12 Years Body System/ Adverse Reaction Gabapentina N=119% Placeboa N=128% Respiratory System Bronchitis 3 1 Respiratory Infection 3 1

Gabapentin can cause peripheral edema and dyspnea 2.

• Peripheral edema is reported in 8% of patients with postherpetic neuralgia and 2% of patients with epilepsy.
• Dyspnea is reported in more than 1% of patients but equally or more frequent in the placebo group.
• Other respiratory system adverse reactions include pharyngitis, coughing, bronchitis, and respiratory infection.

From the Research

Gabapentin Side Effects

• Gabapentin has been associated with several side effects, including:
  • Dizziness 3, 4
  • Somnolence 3, 4
  • Peripheral oedema (edema) 3
  • Gait disturbance 3
  • Hypoventilation 5
  • Respiratory failure 5
  • Myopathy 5
• Regarding shortness of breath, there is evidence that gabapentin can cause respiratory problems, including hypoventilation and respiratory failure 5.
• Edema is also a reported side effect of gabapentin, with 7% of participants experiencing peripheral oedema in one study 3.

Gabapentin Efficacy

• Gabapentin has been shown to be effective in reducing pain in patients with neuropathic pain syndromes, including postherpetic neuralgia and diabetic peripheral neuropathy 3, 6, 4.
• The efficacy of gabapentin in reducing pain has been demonstrated in several studies, with significant differences in pain scores compared to placebo 3, 6, 4.

Gabapentin Safety

• Gabapentin has been associated with a range of adverse events, including nervous system and psychiatric disorders 7.
• However, there is no evidence to suggest that gabapentin use leads to addiction 7.
• The safety and efficacy of gabapentinoids, including gabapentin, have been evaluated in several studies, with the majority of adverse events being mild to moderate in severity 7.