Can Gabapentin Cause Tongue Swelling?
Yes, gabapentin can cause tongue swelling (lingual edema) as part of angioedema or anaphylaxis, though this is a rare adverse effect. 1
FDA-Recognized Risk
The FDA drug label explicitly warns that gabapentin can cause anaphylaxis and angioedema after the first dose or at any time during treatment, with reported signs including swelling of the lips, throat, and tongue, along with difficulty breathing and hypotension requiring emergency treatment. 1 Patients experiencing these symptoms should discontinue gabapentin immediately and seek emergency medical care. 1
Clinical Evidence
A documented case report confirms gabapentin-induced angioedema of the tongue, emphasizing that this can be a true emergency requiring rapid evaluation and intervention if airway compromise occurs. 2 The mechanism appears to be related to drug-induced non-allergic angioedema, which differs from typical allergic reactions in that symptoms are resistant to antihistamine and corticosteroid treatment. 3
Distinguishing Features
This reaction is distinct from the more common peripheral edema (swelling of lower extremities) that gabapentin frequently causes through its binding to voltage-gated calcium channels. 4, 5 While peripheral edema occurs in a dose-dependent manner and affects the extremities, 5, 6 angioedema involving the tongue represents a hypersensitivity reaction that can occur at any dose and constitutes a medical emergency. 1
Critical Management Points
- Airway assessment is paramount when tongue swelling occurs, as progression can lead to respiratory compromise. 2
- Unlike peripheral edema which may resolve with dose reduction, 4 angioedema requires immediate discontinuation of gabapentin. 1
- Do not rechallenge with gabapentin at any dose, as hypersensitivity reactions can progress to severe anaphylaxis upon re-exposure. 7
- Document this as a drug allergy in the medical record to prevent future exposure. 7
Additional Hypersensitivity Manifestations
Gabapentin can also cause Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), which may present with fever, rash, lymphadenopathy, and multi-organ involvement. 1 Early manifestations of hypersensitivity may be present even without visible rash, requiring immediate evaluation and discontinuation if an alternative cause cannot be established. 1