Gabapentin Tolerance

white gabapentin capsules on blue background

Gabapentin is a prescription medication that is sold under the brand name Neurontin. Gabapentin is FDA-approved to manage epileptic seizures and treat pain associated with nerve damage; however, it is frequently prescribed “off-label” to treat other disorders like restless leg syndrome, drug and alcohol use disorders and uncomfortable symptoms associated with menopause, among others.

Regular use of gabapentin is unlikely to lead to increased tolerance to the drug. However, there is a risk of increased tolerance for people who misuse the drug. If someone is dependent on the drug, they will experience physical and psychological withdrawal symptoms when they reduce the dose or stop taking gabapentin altogether.

Gabapentin Tolerance Symptoms

The hallmark symptom of tolerance is a reduced response to the same dose. It’s possible that someone who takes gabapentin daily to manage chronic pain finds that they eventually need to increase the dosage in order to continue to manage their pain.

Another sign of tolerance development is the presence of physical and/or psychological withdrawal symptoms that surface when someone reduces or stops taking gabapentin. Withdrawal symptoms could include:

  • Anxiety
  • Agitation
  • Insomnia
  • Fatigue
  • Restlessness
  • Headache
  • Dizziness
  • Pain
  • Sweating
  • Nausea
  • Irregular heartbeat

Causes Of Gabapentin Tolerance

Drug tolerance is a consequence of the brain adapting to the consistent presence of the drug and reacting less strongly. Gabapentin, like many other drugs, could lead to tolerance if it is taken regularly for several weeks or months at a time. However, the people who are at the highest risk for tolerance and dependence are those who misuse gabapentin. People who misuse the drug often do so to increase the high they experience from other drugs of abuse (often opioids or benzodiazepines) and when they attempt to treat opioid withdrawal symptoms.

The most significant factors that influence tolerance development include:

  • Gabapentin dose: Increased dosage is associated with more rapid tolerance development
  • Frequency of use: Increased frequency is associated with a more rapid onset of tolerance, even when doses are relatively low
  • Duration of use: People who have misused gabapentin regularly are at higher risk for developing tolerance and dependence
  • Other factors: Genetics, age, gender, metabolic state and mental/physical health can all contribute to tolerance development

While there is not a lot of data on gabapentin drug interactions, gabapentin can interact with other antiepileptic drugs ⁠— some antacids (including cimetidine), nonsteroidal anti-inflammatory drug naproxen (Aleve) and the opioid morphine. In addition, gabapentin can increase the effects of the pain relievers tramadol and metamizol. Caffeine may reduce the efficacy of gabapentin. It’s never a good idea to mix prescription drugs with non-approved drugs or substances.

How To Prevent Gabapentin Tolerance

Gabapentin has a lower risk of developing serious tolerance and forming a dependence compared to pregabalin ⁠— a similar drug in the “gabapentinoid” family of drugs. Nevertheless, regular gabapentin use is not risk-free.

Currently, the only reliable way to prevent gabapentin tolerance is to take it as infrequently as possible and at the lowest effective dose. If you are concerned that you are developing a tolerance to gabapentin, make an appointment with your prescriber to discuss your options.

It is important that people never increase their gabapentin dose or administration frequency without getting an updated prescription from their doctor. Any use of gabapentin in a way other than prescribed constitutes misuse or abuse and can increase the risk of developing physical dependence and even addiction.

Getting Help With Gabapentin Addiction

Gabapentin has a low risk of abuse and addiction, but dependence and addiction can occur ⁠— especially among people who use gabapentin recreationally to enhance the effects of opioids or other drugs that are being abused. If you are faced with a gabapentin use disorder, the best way to start your path to recovery is to seek an evaluation with an addiction specialist who can make recommendations and referrals. Gabapentin addiction treatment may include a period of medically-supervised detox, followed by a period of residential or outpatient rehab.

If you or someone you know is struggling to overcome a gabapentin use disorder, help is available. Call The Recovery Village Ridgefield to learn how professional rehab can maximize success in short and long term recovery.

Peckham, Alyssa M et al. “Gabapentin for Off-Label Use: Evidence-Based or Cause for Concern?” Substance Abuse: Research and Treatment, September 2018. Accessed September 28, 2019.

National Institute on Drug Abuse. “The Neurobiology of Drug Addiction.” Updated January 2007. Accessed September 27, 2019.

Bonnet, Udo et al. “On the Addictive Power of Gabapentinoids: A Mini-Review.” Psychiatria Danubina, May 2018. Accessed September 28, 2019.

Salehi, Mehrdad et al. “Importance of Gabapentin Dose in Treatment of Opioid Withdrawal.” Journal of Clinical Psychopharmacology, October 2011. Accessed September 28, 2019.

Quintero, Gabriel C. “Review about gabapentin misuse, interactions, contraindications and side effects.” Journal of Experimental Pharmacology, February 2017. Accessed September 28, 2019.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.