Gabapentin NHS: a complete patient guide

Gabapentin is a prescription medicine. The NHS provides it. It is an anti-epileptic, also called an anticonvulsant. It treats two main conditions.

Licensed indications:

• Epilepsy: Gabapentin helps treat focal seizures. This includes seizures with or without secondary generalisation. It is an add-on treatment for adults and children aged 6 and over.
• Peripheral neuropathic pain: It treats nerve pain in adults. Examples include painful diabetic neuropathy or post-herpetic neuralgia. This is pain after shingles.

Common off-label uses on the NHS:

Doctors often prescribe gabapentin for other conditions. These are outside its formal licence. They include:

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

Gabapentin comes as capsules (100 mg, 300 mg, 400 mg). It also comes as tablets (600 mg, 800 mg) and an oral solution. The NHS usually prescribes it generically, not by brand name.

Gabapentin doses increase slowly. This helps to reduce side effects. The BNF gives the following advice for adults:

For neuropathic pain:

• Day 1: Take 300 mg once daily.
• Day 2: Take 300 mg twice daily.
• Day 3: Take 300 mg three times daily.
• Increase the dose by 300 mg every 2 to 3 days if needed.
• Usual maintenance dose: 900 mg to 1800 mg daily. Take this in three divided doses.
• Maximum dose: 3600 mg daily. Take this in three divided doses.

For epilepsy:

• The dose increase schedule is similar.
• Usual maintenance dose: 900 mg to 2400 mg daily. Take this in three divided doses.
• Higher doses, up to 3600 mg daily, may be used. A specialist must supervise this.

Important dosing considerations:

• Doses should be no more than 12 hours apart. This prevents symptoms from returning.
• Your kidneys remove gabapentin. If you have poor kidney function, your dose must be lower. This is based on your eGFR or creatinine clearance.
• You can take the medicine with or without food.
• Swallow tablets and capsules whole with water.

Your GP or specialist will decide your correct dose.

Gabapentin became a Class C controlled substance on 1 April 2019. This is under the Misuse of Drugs Act 1971. It is in Schedule 3 of the Misuse of Drugs Regulations 2001.

What this means for patients:

• Gabapentin prescriptions are valid for 28 days. Other medicines are usually valid for 6 months.
• Repeat dispensing is not allowed for standard NHS repeat prescriptions. You need a new prescription each time.
• You cannot collect gabapentin for someone else. You need proper authorisation.
• You may need a personal licence to take gabapentin abroad. This applies if you have more than 3 months' supply.

Why was gabapentin reclassified?

The Advisory Council on the Misuse of Drugs recommended this change. Evidence showed:

• More people were misusing gabapentin, often with opioids.
• Misuse of gabapentinoids was linked to drug-related deaths.
• Gabapentin was being sold illegally. It was also diverted from legal prescriptions.

This reclassification does not stop you from getting gabapentin. It applies if you have a real medical need. It just means stricter rules for prescribing and dispensing. This improves safety.

The NHS lists common side effects of gabapentin. Most are mild. They usually improve as your body gets 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
• Problems with memory or concentration
• Weight gain

Serious side effects (seek medical advice):

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

For more details on side effects, see our gabapentin side effects page. This includes how to manage them.

You can report suspected side effects. Use the Yellow Card Scheme. Do this online at yellowcard.mhra.gov.uk. Or call the MHRA on 0800 731 6789.

It is very important never to stop gabapentin suddenly. Stopping it abruptly can cause serious withdrawal effects.

Withdrawal symptoms may include:

• Anxiety and agitation
• Insomnia
• Nausea and sweating
• Pain
• Seizures (even if you do not have epilepsy)

The BNF advises stopping gabapentin gradually over at least one week. If you have taken higher doses or for longer, a slower taper may be better. This could take several weeks.

Recommended approach:

• Reduce the dose by no more than 300 mg every 4 days. A faster taper needs supervision.
• If you get withdrawal symptoms, slow the taper. Or stay at the current dose until symptoms improve.
• Keep in regular contact with your GP during withdrawal.
• Never change your dose without medical advice.

If you struggle with withdrawal, your prescriber can give you a personal plan. Sometimes, other medicines may be needed temporarily. These help manage withdrawal symptoms.

NICE suggests that stopping gabapentin should be a joint decision. You and your prescriber should discuss it. Consider the original reason for taking it, how well it worked, and any risks of stopping.

You can get gabapentin on an NHS prescription. Your GP or a hospital specialist can prescribe it. Here is what to expect.

The prescribing process:

• Your GP or specialist will check if gabapentin is right for you.
• If prescribed, you will get instructions on how to take it. You will also learn how the dose will increase.
• It is a controlled substance. You will need a new prescription each time. No automatic repeats are allowed.
• You can collect it from any community pharmacy.

Costs:

• If you pay for NHS prescriptions, the standard charge applies. This is per item per dispensing.
• Gabapentin is free if you are exempt from prescription charges. For example, if you are over 60, on certain benefits, or have a pre-payment certificate.
• Gabapentin is available generically. This makes it relatively cheap for the NHS.

Monitoring and reviews:

• Your GP should review your gabapentin treatment regularly.
• You may need blood tests if you have kidney problems. This also applies if you are on long-term treatment.
• Attend reviews to discuss how well it works. Talk about side effects and whether to continue.

Private prescriptions:

You can also get gabapentin privately. But the same controlled substance rules apply. Private gabapentin prescriptions must follow Schedule 3 requirements.

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