Gabapentin is generally safe when taken as prescribed, but an overdose is possible and can be life-threatening. The risk significantly increases when gabapentin is combined with other substances or in certain individual circumstances.
What is Gabapentin?
Gabapentin is a prescription anticonvulsant. It is primarily used to manage neuropathic pain, such as postherpetic neuralgia, and restless legs syndrome. It also serves as an add-on therapy for partial seizures in epilepsy.
This medication influences nerve activity and neurotransmitter function in the brain, helping to calm overactive nerve cells. While not a controlled substance like opioids or benzodiazepines, its potential for misuse and harm, particularly when combined with other drugs, remains a concern.
How Gabapentin Overdose Occurs
A gabapentin overdose primarily impacts the central nervous system (CNS), leading to depression. This can manifest as profound sedation, confusion, and a reduced level of consciousness.
While gabapentin alone is often associated with less severe outcomes than other CNS depressants, it can still result in significant respiratory depression, where breathing becomes dangerously slow and shallow. This can progress to coma and, ultimately, death. The danger escalates dramatically when gabapentin is taken alongside other CNS depressants.
Recognizing Overdose Signs
Common overdose indicators include excessive drowsiness, dizziness, fatigue, blurred or double vision, slurred speech, and loss of coordination (ataxia).
More severe signs indicate a medical emergency. These include profound sedation, severe respiratory depression (slow, shallow breathing), blue discoloration of the skin (cyanosis), unconsciousness, or coma. Other symptoms can involve low blood pressure, a rapid heart rate, nausea, vomiting, and confusion.
Situations That Increase Risk
Several factors can significantly elevate the risk of a severe gabapentin overdose. A primary concern is the concurrent use of gabapentin with other central nervous system depressants (polypharmacy). Combining gabapentin with substances like opioids, benzodiazepines, or alcohol creates a synergistic effect, profoundly intensifying CNS depression.
This combination can lead to dangerously slowed breathing and, in severe cases, respiratory arrest. Individuals with pre-existing conditions also face increased risk. Impaired kidney function can cause drug accumulation, even at prescribed doses, leading to toxicity. Older adults and individuals with pre-existing respiratory issues, such as COPD, are more susceptible to gabapentin’s respiratory depressant effects.
Emergency Response
If a gabapentin overdose is suspected, immediate action is essential. Contact emergency medical services (e.g., 911) or a poison control center without delay. Prompt medical attention can significantly improve outcomes.
While waiting for help, stay with the person and monitor their breathing and consciousness. Provide emergency responders with relevant information, including what was taken, the approximate amount, and when it was ingested. Do not induce vomiting or administer home remedies, as this could worsen the situation.
Medical treatment typically involves supportive care: maintaining the person’s airway, providing supplemental oxygen, and assisting ventilation if breathing is compromised. Activated charcoal may reduce drug absorption if ingestion was recent. Hemodialysis might be considered for severe toxicity, especially with kidney impairment. While naloxone reverses opioid overdose, it is not an antidote for gabapentin alone; however, it may be given if opioid co-ingestion is suspected.