Mixing Gabapentin and Alcohol

Gabapentin (brand name Neurontin) is a prescription medication used in the treatment of certain types of seizure disorders as well as neuropathic pain disorders including post-herpetic neuralgia (lingering pain after shingles). It may also be prescribed off-label in the U.S. to treat anxiety disorders, insomnia, other types of neuropathic pain and migraine headaches.

Consuming alcohol while taking gabapentin may heighten the side effects of gabapentin such as drowsiness, headache, nausea, and lack of coordination. That said, when done in moderation, it is not necessarily harmful. While taken in prescription-appropriate dosages, gabapentin is well tolerated in combination with responsible alcohol intake.

How Gabapentin and Alcohol Interact

In order to understand how gabapentin and alcohol interact when taken together, we must first briefly understand how they affect the brain individually.

Simply put, our brain contains two opposing pathways:

• An excitatory pathway, driven by the neurotransmitter glutamate
• An inhibitory pathway, controlled by the neurotransmitter GABA (gamma-aminobutyric acid)

Glutamate works to excite, or activate, cells in our brain whereas GABA inhibits them, preventing them from causing activation.

Gabapentin is structurally similar to our GABA neurotransmitter (hence the name gabapentin), and works to prevent our brain cells from firing (inhibition). This inhibitory effect is called central nervous system (CNS) depression, thus gabapentin is classified as a CNS depressant. It is through this inhibitory action that gabapentin works as a seizure medicine: By depressing brain excitability, gabapentin is able to calm down the pain associated with neuropathic disorders.

Alcohol is also a CNS depressant that works on those very same GABA receptors. This similar mechanism of action highlights the potential danger of taking alcohol and gabapentin simultaneously. In acting on the same receptor system, consuming alcohol while taking gabapentin may exacerbate the side effects of gabapentin.

Side Effects of Mixing Gabapentin and Alcohol

Alcohol and gabapentin both act as CNS depressants via GABA and GABA receptors.  Because they act on the same brain pathways, mixing gabapentin and alcohol can cause heightened side effects. However, in contrast to alcohol that is used with many other CNS depressants (notably the opioid family), gabapentin in conjunction with alcohol does not seem to produce respiratory depression, which is normally one of the most dangerous consequences of combining CNS depressants.

Side effects of gabapentin and alcohol interaction include:

• Dizziness
• Headaches
• Drowsiness/somnolence (caution when driving and/or operating heavy machinery)
• Nausea or vomiting
• Ataxia (difficulty with coordination)
• Viral infection
• Double vision
• Peripheral edema

Risks of Mixing Gabapentin and Alcohol

The risks of mixing gabapentin and alcohol include potential worsening of alcohol-associated side effects including dizziness, headache, drowsiness, and difficulties with coordination. Extreme caution should be maintained while operating heavy machinery or driving. It is recommended that individuals prescribed gabapentin refrain from driving during the initial treatment phase to allow for some of the initial side effects such as drowsiness to dissipate. All individuals should refrain from driving while under the influence of alcohol.

Can You Overdose on Gabapentin and Alcohol?

While taking unsafe amounts of gabapentin and/or alcohol may cause acute toxicity resulting in unpleasant side effects including drowsiness, nausea, vomiting, double vision, slurred speech, and/or difficulty with coordination, there are no life-threatening risks associated with overdose. Numerous examples of people taking unbelievable large amounts of gabapentin exist (in one case, 91 grams of gabapentin were consumed in combination with alcohol and valproic acid), none of which have been associated with side effects beyond temporary alcohol-like intoxication.

That being said, there is some evidence that gabapentin overdose can cause abnormal, even dangerous behaviors, particularly when it is taken with alcohol. Several reports have been published that detail rare cases of aggressive, violent behavior that occurs as a consequence of gabapentin overdose in the presence of alcohol, and others indicate that users may exhibit suicidal ideation or even attempts.

However, these effects are very uncommon and data outlying the situational context is often unclear; for example, many cases vaguely suggest that the person behaving erratically had prior mental health concerns including bipolar disorder. Consequently, whether there is a definitive link between gabapentin, alcohol and violent behavior remains unclear.

Gabapentin and Alcohol Withdrawal

Although not currently approved by the FDA for the treatment of alcohol withdrawal, gabapentin has shown promising therapeutic value in this area. A 2018 study showed that gabapentin was able to augment the effect of low doses of the benzodiazepine lorazepam among veterans who were admitted to the Veterans Affairs Portland Health Care System for alcohol withdrawal syndrome. Benzodiazepines are a first-line treatment in moderate to severe alcohol withdrawal syndrome but they are associated with potentially fatal adverse effects; if these preliminary findings hold in future studies, gabapentin could be a valuable pharmacotherapy in treating alcohol withdrawal. However, more research is required before gabapentin becomes an official FDA-approved medication for the treatment of alcohol use disorder.

Getting Help for Gabapentin and Alcohol Addiction

If you struggle with gabapentin and/or alcohol use disorder, The Recovery Village Ridgefield is here to help. Reach out to us for information on how to take the next step. You can get your life back.