Gabapentin NHS: a complete patient guide

Gabapentin is a prescription medicine available on the NHS that belongs to the group of medicines called anti-epileptics (anticonvulsants). It is used to treat two main conditions:

Licensed indications:

• Epilepsy: gabapentin is used as an add-on (adjunctive) treatment for focal seizures, with or without secondary generalisation, in adults and children aged 6 years and over
• Peripheral neuropathic pain: it is licensed for the treatment of neuropathic pain in adults, such as painful diabetic neuropathy or post-herpetic neuralgia (pain after shingles)

Common off-label uses on the NHS:

Gabapentin is frequently prescribed for conditions outside its formal licence, including:

• Generalised anxiety disorder (when first-line treatments have failed)
• Migraine prevention
• Restless legs syndrome
• Chronic pain conditions, including fibromyalgia
• Menopausal hot flushes (when HRT is not suitable)

Gabapentin is available as capsules (100 mg, 300 mg, 400 mg), tablets (600 mg, 800 mg) and an oral solution. It is prescribed generically rather than by brand name in most cases on the NHS.

Gabapentin dosing follows a gradual titration schedule to minimise side effects. The BNF provides the following guidance for adults:

For neuropathic pain:

• Day 1: 300 mg once daily
• Day 2: 300 mg twice daily
• Day 3: 300 mg three times daily
• Increase further in steps of 300 mg every 2 to 3 days as needed
• Usual maintenance dose: 900 mg to 1800 mg daily in three divided doses
• Maximum dose: 3600 mg daily (in three divided doses)

For epilepsy:

• Similar titration schedule
• Usual maintenance dose: 900 mg to 2400 mg daily in three divided doses
• Higher doses (up to 3600 mg daily) may be used under specialist supervision

Important dosing considerations:

• Doses should be spaced no more than 12 hours apart to avoid breakthrough symptoms
• Gabapentin is renally cleared, so dose reduction is necessary in patients with impaired kidney function (based on eGFR or creatinine clearance)
• The medicine can be taken with or without food
• Tablets and capsules should be swallowed whole with water

Your GP or specialist will determine the most appropriate dose for your condition.

Since 1 April 2019, gabapentin has been classified as a Class C controlled substance under the Misuse of Drugs Act 1971 and placed in Schedule 3 of the Misuse of Drugs Regulations 2001.

What this means for patients:

• Prescriptions for gabapentin are valid for 28 days from the date of issue (rather than the usual 6 months for non-controlled medicines)
• Repeat dispensing is not permitted on standard NHS repeat prescriptions; a new prescription is needed each time
• You cannot collect someone else's gabapentin from the pharmacy without proper authorisation
• If you are travelling abroad, you may need a personal licence to take gabapentin with you (more than 3 months' supply)

Why was gabapentin reclassified?

The Advisory Council on the Misuse of Drugs recommended the change after evidence showed:

• Increasing misuse of gabapentin, often alongside opioids
• A link between gabapentinoid misuse and drug-related deaths
• Gabapentin being sold illicitly and diverted from legitimate prescriptions

This reclassification does not affect your ability to receive gabapentin if you have a genuine medical need. It simply means tighter controls on prescribing and dispensing to improve safety.

The NHS lists the following common side effects of gabapentin. Most are mild and tend to improve as you get used to the medicine.

Common side effects:

• Feeling sleepy, tired or dizzy
• Headaches
• Feeling sick (nausea) and being sick (vomiting)
• Diarrhoea
• Mood changes
• Swollen arms and legs (peripheral oedema)
• Blurred vision
• Dry mouth
• Difficulties with memory or concentration
• Weight gain

Serious side effects (seek medical advice):

• Thoughts of self-harm or suicide
• Yellowing of the skin or eyes
• Unusual bruising or bleeding
• Severe tiredness or weakness
• Muscle pain or tenderness (with general illness)
• Difficulty breathing

For a detailed discussion of gabapentin side effects, including how to manage them, see our dedicated gabapentin side effects page.

You can report suspected side effects through the Yellow Card Scheme, either online at yellowcard.mhra.gov.uk or by calling the MHRA on 0800 731 6789.

One of the most important messages about gabapentin is that it must never be stopped suddenly. Abrupt discontinuation can cause serious withdrawal effects.

Withdrawal symptoms may include:

• Anxiety and agitation
• Insomnia
• Nausea and sweating
• Pain
• Seizures (even in patients who do not have epilepsy)

The BNF recommends withdrawing gabapentin gradually over at least one week. For patients who have been on higher doses or longer courses, a slower taper over several weeks may be appropriate.

Recommended approach:

• Reduce the dose by no more than 300 mg every 4 days (faster tapers should be supervised)
• If withdrawal symptoms develop, slow the taper or hold at the current dose until symptoms settle
• Keep in regular contact with your GP during the withdrawal period
• Never adjust the dose without medical advice

If you are struggling with withdrawal, your prescriber can provide a personalised tapering plan. In some cases, temporary use of other medications may be needed to manage withdrawal symptoms.

NICE recommends that the decision to stop gabapentin should be a shared one between patient and prescriber, taking into account the original indication, treatment response and any risks of discontinuation.

Gabapentin is available on NHS prescription from your GP or a hospital specialist. Here is what to expect.

The prescribing process:

• Your GP or specialist will assess whether gabapentin is appropriate for your condition
• If prescribed, you will receive instructions on how to take it and how the dose will be increased
• As a controlled substance, you will need a new prescription each time (no automatic repeats)
• You can collect it from any community pharmacy

Costs:

• If you pay for NHS prescriptions, the standard charge applies (currently per item per dispensing)
• If you are exempt from prescription charges (e.g. over 60, on certain benefits, or with a pre-payment certificate), gabapentin is free
• Gabapentin is available generically, so it is relatively inexpensive for the NHS

Monitoring and reviews:

• Your GP should review your gabapentin treatment regularly
• Blood tests may be requested if you have kidney problems or are on long-term treatment
• You should attend reviews to discuss effectiveness, side effects and whether to continue

Private prescriptions:

Gabapentin can also be prescribed privately, but the same controlled substance regulations apply. Private prescriptions for gabapentin must comply with Schedule 3 requirements.

If you have questions about your gabapentin prescription, speak to your GP or pharmacist.