Gabapentin Tolerance: Signs & Symptoms

white gabapentin capsules on blue background

Gabapentin Tolerance: Signs and Symptoms 

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 conditions. These include 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.

Can You Build a Tolerance to Gabapentin (Neurontin)? 

It is possible to build a tolerance to gabapentin. Tolerance occurs when you take a drug on a regular basis and your body adapts to its presence; as a result, lower doses do not give you the same effect as before. When you become tolerant to a substance like gabapentin, higher doses are needed. 

Generally, tolerance occurs because of changes in the receptors that a drug targets. Little is known about gabapentin tolerance because experts are not sure exactly how the drug works.

How Long Does It Take to Experience a Gabapentin Tolerance Reset?

Experts do not know how long it takes to reset gabapentin tolerance. Studies have not been specifically conducted on how long it takes to lose your tolerance to gabapentin once you stop taking it. Further, experts do not know exactly how gabapentin works in the body, so it is difficult to estimate how long it would take to no longer be tolerant to gabapentin.

If you stop taking gabapentin on a regular basis and then want to restart, doctors may differ in terms of the instructions they give you. Some doctors may tell you to start with a low dose of gabapentin after a week of being off the drug, while others may instruct you to do so after only a few days. Because of the limited research available, doctors can only go with their best guess.

Gabapentin Tolerance Symptoms

The hallmark symptom of tolerance is a reduced response to the same dose. Someone who takes gabapentin daily to manage chronic pain may find that they eventually need to increase the dosage in order to continue managing 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. 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 a drug and reacting less strongly. Like many other drugs, gabapentin 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 typically do so to increase the high they experience from other drugs of abuse, such as opioids or benzodiazepines. They may also misuse gabapentin in an 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. It can also interact with some antacids (including cimetidine), the NSAID naproxen (Aleve) and the opioid morphine. In addition, gabapentin can increase the effects of the pain relievers tramadol and metamizole. 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 advice on how to avoid 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. Your prescriber may offer you a break from gabapentin to avoid developing tolerance.

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 it 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. 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 with a gabapentin use disorder, help is available at The Recovery Village Ridgefield. Contact us to learn how professional rehab can maximize your success in short- and long-term recovery.

Bonnet, Udo; et al. “On the Addictive Power of Gabapentinoids: A Mini-Review.” Psychiatria Danubina, May 2018. Accessed August 28, 2022. Peckham, Alyssa M.; et al. “Gabapentin for Off-Label Use: Evidence-Based or Cause for Concern?” Substance Abuse: Research and Treatment, September 2018. Accessed August 28, 2022. Quintero, Gabriel C. “Review about gabapentin misuse, interactions, contraindications and side effects.” Journal of Experimental Pharmacology, February 2017. Accessed August 28, 2022. Drugs.com. “Gabapentin.” December 3, 2020. Accessed August 28, 2022.

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.