Can gabapentin (Neurontin) cause dizziness?

From the Guidelines

Gabapentin can cause dizziness as one of its common side effects, with studies suggesting that this occurs in a significant proportion of patients, particularly when first starting the medication or after increasing the dose 1, 2, 3.

Mechanism and Prevalence

This medication, which is used to treat seizures, nerve pain, and sometimes anxiety or insomnia, affects the central nervous system by modulating calcium channels and GABA neurotransmitters. Dizziness typically occurs in about 20-30% of patients taking gabapentin, especially during the initial treatment phase or after dose adjustments.

Management and Prevention

To minimize this side effect, doctors often recommend starting with a low dose (such as 100-300 mg) and gradually increasing it, taking the medication with food, and avoiding sudden position changes like standing up quickly. If you experience severe or persistent dizziness while taking gabapentin, you should contact your healthcare provider, as they may need to adjust your dosage or consider alternative treatments. Never stop taking gabapentin suddenly without medical supervision, as this can lead to withdrawal symptoms or worsening of the condition being treated.

Recent Evidence

A recent study published in 2021 found that gabapentinoids, including gabapentin, can cause dizziness, with one study reporting more dizziness with 300 mg pregabalin 3. Another study from 2016 reported adverse events, including dizziness, in 31% of the gabapentin group 2. The 2010 study also mentions that both gabapentin and pregabalin can produce dose-dependent dizziness and sedation, which can be reduced by starting with lower dosages and titrating cautiously 1.

Key Points

• Gabapentin can cause dizziness in a significant proportion of patients.
• Dizziness is more common when first starting the medication or after increasing the dose.
• Starting with a low dose and gradually increasing it can help minimize dizziness.
• If you experience severe or persistent dizziness, contact your healthcare provider for guidance.

From the FDA Drug Label

Moreover, because gabapentin causes somnolence and dizziness [see Warnings and Precautions (5.4)], patients should be advised not to operate complex machinery until they have gained sufficient experience on gabapentin to assess whether gabapentin impairs their ability to perform such tasks.

5. 4 Somnolence/Sedation and Dizziness During the controlled epilepsy trials in patients older than 12 years of age receiving doses of gabapentin up to 1800 mg daily, somnolence, dizziness, and ataxia were reported at a greater rate in patients receiving gabapentin compared to placebo: i.e., 19% in drug versus 9% in placebo for somnolence, 17% in drug versus 7% in placebo for dizziness, and 13% in drug versus 6% in placebo for ataxia. Dizziness and somnolence were among the most common adverse reactions leading to discontinuation of gabapentin sleepiness and dizziness, which could increase the occurrence of accidental injury, including falls The most common side effects of gabapentin tablets include: ... dizziness

Yes, gabapentin can cause dizziness, as evidenced by the higher incidence of dizziness in patients receiving gabapentin compared to placebo in clinical trials 4. Patients should be advised to exercise caution when operating complex machinery or performing tasks that require attention and coordination.

• Key points: + Gabapentin causes somnolence and dizziness + Dizziness is a common adverse reaction leading to discontinuation of gabapentin + Patients should be careful when operating complex machinery or performing tasks that require attention and coordination + The incidence of dizziness is higher in patients receiving gabapentin compared to placebo 4

From the Research

Gabapentin and Dizziness

• Gabapentin has been reported to cause dizziness in several studies, with varying frequencies and severities 5, 6, 7, 8.
• A study published in 1993 found that dizziness was one of the most common adverse events associated with gabapentin, occurring in about 75% of patients 5.
• Another study published in 2004 found that dizziness was one of the three most common adverse events associated with gabapentin, along with somnolence and peripheral edema 6.
• A retrospective population-based study published in 2018 found that high-dose gabapentin (>600 mg/day) was associated with a higher risk of hospitalization with altered mental status, which may include dizziness, compared to low-dose gabapentin (≤600 mg/day) 7.
• A study published in 1999 found that dizziness was one of the adverse events that occurred in a statistically significantly larger number of patients at only the low dose (< or =1,800 mg/day) than in the group reporting these same adverse events at only the high dose (>1,800 mg/day) 8.
• However, a case series published in 2021 found that low-dose gabapentin relieved vertigo in patients with periodic vestibulocerebellar ataxia, suggesting that gabapentin may have a beneficial effect on dizziness in certain conditions 9.

Factors Influencing Dizziness

• Dose: The frequency and severity of dizziness may be related to the dose of gabapentin, with higher doses potentially increasing the risk of dizziness 6, 7.
• Individual tolerance: Patients may have different tolerances to gabapentin, with some experiencing dizziness at lower doses and others at higher doses 8.
• Underlying condition: The underlying condition being treated with gabapentin may also influence the risk of dizziness, with certain conditions such as periodic vestibulocerebellar ataxia potentially responding well to gabapentin 9.