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Misc Gabapentin: withdrawals? mechanism of action? benzo cross-tolerance/dependence?

I never really knew people felt that shitty from gabapentin withdrawals. I get way way worse withdrawal from even tiny doses of benzos compared to the 1800 mg of gabapentin I'm on. It makes me wonder if the withdrawal is worse for people taking it for pain. Not only is it less severe than opiate or benzo wd for me, it's also over very quickly. Sometimes people are especially susceptible to WD from certain meds. I've seen people report long lasting WD (years) from dopamine agonist after a couple months of use where other people barely notice anything when they quit taking them. Tolerance also decreases rapidly too. If I go a day without dosing, the next day I get extremely intense effects from the gabapentin.

Edit- It's been mentioned but gabapentin does effect glutamate decarboxylase as well. Scroll down this link a little to find a fascinating chart that detail gabapentin's effects on glutamate and GABA metabolism:http://books.google.com/books?id=HA...&q=Glutamate decarboxylase gabapentin&f=false

Toz said:
Even though I used gabapentin to get off opiates and had recently gotten off benzos, I know the withdrawal is from neither of those because it simply doesn't fit. Those don't cause vision problems/nerve pain. Besides, I tried resuming both with no success.
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I'm skeptical that the combination of opiate and benzo PAWS didn't have anything to do with it. People almost always associate the entirety of their discomfort with the last drug they used. the definition of nerve pain I looked up seems very similar to opiate WD hyperalgesia.

Chromophobia said:
What's interesting for me is one of the professors discussing gabapentin withdrawal made a rough estimate for benzodiazepine-gabapentin equipotency at 1000 milligrams/5 milligrams clonazepam. If that's remotely true then coming off a 3,600 milligram habit of gabapentin, could be likened to coming off a 12.5 milligram clonazepam habit.
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I find this figure extremely doubtful. The WD from 1000 mg of gabapentin is like a vacation compared to WD from 1 mg clonazepam for me. Keep in mind that even if this figure was somehow accurate, the BA of gabapentin is inversely proportionate to the daily dose.

Chromophobia said:
I used to take them intermittently when I was young, usually at doses of 3000 milligrams pregabalin, sometimes more, sometimes less. It was OTC where I used to live (until 2012 when it became scheduled due to emergency room visits from withdrawal and kidney failure) so practically everyone used to take it. Sometimes I would take 10 grams pregabalin in a night, others used to do 15-20 grams easily. There are many generic kinds that come in 16 pill blister packets of 300 milligrams pregabalin capsules now which wasn't the case before, which led to an incline in its abuse because of the price dropping significantly. I left it for a year and then fractured my shoulder during a rugby match at school, so I was prescribed 75 milligrams twice daily and I stuck to that for about 6 months. I had never done benzodiazepines at the time and was not addicted to any drugs. When I stopped all hell broke loose, it was simply inhumane. The doctors at that time, (which really hasn't changed that much) didn't know anything about pregabalin/gabapentin withdrawals.
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These doses you're mention are absurd, 10 grams in one night? I would say your propensity to severe WD was a byproduct of previously reckless use sensitizing you to it.
 
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queenbee2 said:
I would like to just add my quick two cents:

I have taken Gabapentin off and on for over 4 years for nerve damage/pain from a thoracotomy. I take 300mg 2x per day. I stop taking it for weeks at a time sometimes and have never experienced anything even resembling withdrawals. I am not on a very high dosage because if I take more, I start to experience odd side effects like double vision and edema in my legs.
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Thanks for sharing that queenbee2. It's good to hear that not everyone feels gabapentin is extremely dependence-causing, I don't want to give myself psychosomatic withdrawals out of fear! :)

Those side effects are fairly common with gabapentin. I find the side effects (although I don't get edema) to limit the amount that I take as well. And also the fact that tolerance seems to build quickly if I have it affecting me constantly, so I only take it once a day usually.

I have to say, it's hard to know what the actual likelihood of serious withdrawal symptoms from gabapentin is, since most people reporting severe withdrawal symptoms were taking pregabalin and are just assuming it's exactly the same for gabapentin, and/or had other drug use complicating things. I don't want to just believe doctors who erroneously claim it's impossible to get withdrawal symptoms from gabapentin (which clearly isn't true given that there are even published case reports), but I'm also hesitant to believe some of the outlandish-sounding claims I have heard from certain users such as, "gabapentin withdrawal is guaranteed to be worse than methadone and benzo withdrawal combined".
 
^pretty much sums up the way I feel too. From what I saw in this thread, it could be from very unorthodox use of gabapentin combined with pregablin use in chromaphobia's case or other confounding factors like opiate and benzo use in toz's case. Opiate induced hyperalgesia can become a conditioned response, this could be especially likely when dealing with an excess of AMPA and NMDA activity in the aftermath of benzo discontinuation. Add in disturbed excitatory/inhibitory balance and possible hyperalgesia from gabapentin WD thrown in and it could have been a perfect storm that created strongly conditioned hyperalgesia. It's hard for me to imagine gabapentin WD being worse than benzo withdrawal and I think people that experience that are probably far more vocal about it than those that have more mild experiences.
 
^While everything you say maybe true. Keep in mind that I was only using pregabalin very casually in the beginning and there was a one year time period between my recreational use and medical use of it, and that many of the people, kids especially who have been confronted with this withdrawal, had no access to benzodiazepines, gabaergics, or drugs for that matter, yet suffered catatonia or drug inflicted epilepsy. It's not really a matter of being vocal anymore, the withdrawal with all it's severity has been confirmed objectively, throughout the internet, and throughout the medical world, despite other factors that might be involved. I think you should attempt to look through the pregabalin megathread, or the thread that Toz has posted to get an idea of the severity of withdrawals that people are going through.

Even this one for a short and sweet one:

http://www.bluelight.ru/vb/threads/531159-Lyrica-Withdrawal

Every case of withdrawal has factors that contribute to it, whether it be physical health, mental health, poly-drug use, etc, but that can't stop one from identifying the major culprit in every one.

While the estimation might be incorrect, in one case report that I posted, a patient was irresponsive to 50 milligrams of lorazepam after heavy pregabalin abuse, which I think is absolutely absurd considering the heaviest of alcohol withdrawals can be satisfied with that dose of benzodiazepine.

In terms of GAD I've seen conflicting studies IIRC.

gabapentin withdrawal is guaranteed to be worse than methadone and benzo withdrawal combined
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I think that's too bold of a statement, while it is a good mix of both, especially due to extreme sensitivity to painful stimuli as the above poster mentioned, even though hyperalgesia assosiciated with nerve pain disorders are completely different than those from acute pain, the guaranteed part is false.
 
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^I wouldn't want anyone to think I'm trivializing the WD symptons they went through with gabapentin or pregablin. I don't doubt that it does involve a great deal of suffering. The symptoms I've seen people describe seem on par with benzo withdrawal but I've seen nothing to indicate that the symptoms are routinely worse than benzo WD. Lorazepam prob isn't the best choice to deal with gabapentin WD bc that does nothing to address the calcium channel that pregablin effects. Both preg and gabapentin are documented to increase GABA which would effect both GABA A and B receptors. Comically high doses of benzos are required to control baclofen WD (a selective GABA B agonist) or GHB (a mixed GHB agonist/GABA B agonist despite baclofen having a WD that's very simlar to benzo WD. Lorazepam only addresses one system that preg effects. I wouldn't say that mean a high dose of preg equals the same WD as 50 mg of lorazepam bc they shouldn't be compared in that context anyway. A very slow taper similar to that employed for benzos should be the standard treatment IMO. A slow taper would probably minimize PAW just like it does for benzos.

As you said, gabapentin was pushed as a treatment for everything under the sun illegally Despite that widespread use, I wouldn't say there's nearly as much reports of extremely severe WD as there are for benzos. Seizures seem to mainly occur in the highest dose ranges for gabapentin. I tend to think that these responses aren't the norm. I've known a few people in my life that takes benzos and a couple people that take pregablin. The ones on pregablin seemed to fare better than the ones on benzos. I feel it's hard to quantify suffering and I think saying it's worse than benzo wd or it's worse than opiate WD seems like an exaggeration. Everything I've seen people describe seems like almost the same WD I got from benzos but not worse. If you polled everyone on gabapentin or pregablin and offered to trade their dependence for a large opiate or a large benzo dependence, I don't think there would be many takers. I don't think taking it for 4 weeks and experiencing WD in excess of 7 months like Toz is that common of an experience and I worry people might be discouraged away from taking what I consider very useful medications.
 
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Comically high doses of benzos are required to control baclofen WD (a selective GABA B agonist) or GHB (a mixed GHB agonist/GABA B agonist despite baclofen having a WD that's very simlar to benzo WD.
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Pregabalin/gabapentin are used to control baclofen, GHB, and alcohol withdrawal to stop apoptosis and excitotoxicity by inhibiting glutamate. Benzodiazepines are almost useless in controlling GABA-B withdrawals, since GABA-A and GABA-B share no cross tolerance.

I feel it's hard to quantify suffering.
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I agree with you there, but I can guarantee you it's by no means an exaggeration. I think the drugs used to treat neuropathic pain are limited, this is where these drugs can come into play, or as very effective withdrawal aids, but as the years progress I assure you that it will exhibited to a further extent than it is already, that the potential for dependence and withdrawal from them is on par if not worst with benzodiazepines and opioids.

This is the only drug I will never be able to leave for the rest of my life, and sadly I can say that with certainty.
 
^That's basically my whole point though. Benzos don't work for baclofen so why would they work for gabapentin which has a completely different MOA. Gabapentin is in no way a perfect treatment for alcohol or ghb withdrawal either besides minimizing neurotoxicity and the symptoms to a limited extent.

It sounds like you've been through a horrible time with it but I think the way it depends on the way a person's body reacts to it like anything else. I've been on 1800 mg gabapentin for quite a while and could jump off without a sweat. The whole worse than opiate WD has been way overused so that's why I'm desensitized to it. I wish there was a way to actually know the percentage of people that experience severe WD from pregablin or gabapentin like the statistics they have for benzos. Like I said, I'm mainly worried about people who could enjoy a higher quality of life but get scared off before they even give it a shot. Something will eventually come along that's a better choice but for now I think the pros can out way the cons for a lot of people.
 
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I worry about this type of physical dependence and how fast it builds by taking 150-300mg (mostly 300mg/day) of Lyrica daily, which is equivalent to around 900mg gabapentin daily.

I've been taking Lyrica or Gabapentin when I'm out of Lyrica once a day for about 4 months now, while on 0.5-0.75mg clonazepam and 5mg diazepam with the occasional prn 0.125-0.25mg alprazolam. Am I digging myself in a deep hole? I am barely functioning as I have finally found the perfect dose, with a bunch of microdosed adjuncts like mirtazapine (1.5mg/day) and lexapro (0.75mg/day), and regular-dosed adjuncts like hydroxyzine (30mg/day) and chelated Mg (800mg/day).

I have been using gabaergics for about 3 years now, as I've been clean from diazepam after an iatrogenic depdence on diazepam/alprazolam occured in 2010-2011, and after a slow Valium taper I was benzo free for 12 months, before I had several crisis moments that made me realize a low-ish maintenance dosage of benzos/pregabalin is MUCH better than suffering or getting to the point where I need large (addicting) doses of benzos to calm down after a serious panic attack.

My goal is to get to taper down a bit to 0.25-0.5mg clonazepam, 100-150mg lyrica, 2.5mg diazepam, and the occasional 0.125mg alprazolam, but I've realized that quality of life is much too important to rush tapers and not let your brain heal properly. I also want to add CBT now that I'm on benzos and can actually approach my traumatic experiences without falling in to a state of panic. To top it off, I also want to see a second behavioral psychologist, for additional CBT and a second opinion and perhaps talk therapy as well.
 
I'm also one of the unlucky people who had severe withdrawal from pregabalin.

To all of the posters whose messages say "I took gabapentin/pregabalin and had no withdrawal. Therefore, you must be lying, or you are experiencing some kind of psychosomatic event". Right. I love to spend my time making up all of these withdrawal symptoms. I have such a great time writing down these crazy things, just for fun!". Either you have no compassion, or you are a troll, trying to stir up trouble. For whatever reason, this happened to me. Lyrica withdrawal made me feel like something was deeply wrong with me, for many months.
 
^Gabapentin and Pregabalin affect people very differently. There actually are persons who do not get (or only very minor) withdrawal symptoms, me included.
Others, apparently depending on dosage and time, experience nasty symptoms so you just can't generalize it.

And to take over your argumentation: Why should anyone make up stories of getting off these medications without problems? ;)

There is another Thread about Gabapentin-Withdrawal which contains some polarizing posts. It is not just black and white.
 
I take 450mg of Pregabalin daily. I skip some doses and take some breaks and trip on it every once in awhile. I take it for anxiety because it works for a much longer period than benzos and because while tolerance does develop fairly rapidly, a very brief break will restore it to full potency while benzo tolerance lasts ages for me.

Chromophobia makes some vaiid points here. While bioavailability issues make gabapentin far less potent there is just too much documentation of severe withdrawals in some users to ignore it. Pregabalin, however, is a pretty unique animal. No dose of gabapentin I have ever taken, and I've taken very high doses, can produce the unbelievably euphoric, visual, tactile feast of a Pregabalin trip. It takes 1,000mg for me to trip, and any lower doses feel indistinguishable from gabapentin. There aren't degrees here. Escalating the dose will give you a stronger but recognizable high, identical to the gabapentin high, but once you cross over the threshold and actually trip, you might as well be experiencing an utterly different drug. Dose the same amount the next day, however, and you'll just get familiar stimulating, dissociating buzz you could get from gabapentin.

I think in doses high enough to trip, Pregabalin is the most recreational prescription substance I have ever tried (and there's few I haven't). I think the potential for dependence, severe withdrawal, and achieving the trip will ultimately make this a far more restricted substance.
 
longbeachone said:
I'm also one of the unlucky people who had severe withdrawal from pregabalin.

To all of the posters whose messages say "I took gabapentin/pregabalin and had no withdrawal. Therefore, you must be lying, or you are experiencing some kind of psychosomatic event". Right. I love to spend my time making up all of these withdrawal symptoms. I have such a great time writing down these crazy things, just for fun!". Either you have no compassion, or you are a troll, trying to stir up trouble. For whatever reason, this happened to me. Lyrica withdrawal made me feel like something was deeply wrong with me, for many months.
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I think some people are just skeptical about certain posters on here who basically go around saying stuff like "Never ever take gabapentin/pregabalin, the withdrawals are the worst in the entire world and are guaranteed to be way more horrible and longer lasting than benzos and opiates combined, you will get withdrawals even if you only take it for a week and you will definitely have crippling PAWS for years!"

It's not to say they're lying about having withdrawal symptoms, just that the way they are presenting it is hyperbole and they are acting like their experience is universally applicable to everyone, which is simply not the case. Everyone is different and particularly when someone is coming off a bunch of drugs close to the same time that can make it hazy as to what caused what, plus you have to factor in what pre-existing issues or previous dependences they had, quantity/duration of use, etc. Plus I don't think pregabalin (Lyrica) and gabapentin should necessarily be automatically lumped together, it seems like people seem get physically dependent/withdrawals easier with pregabalin.

There is nothing wrong with people sharing that their experience was to have no withdrawals, that doesn't mean they are claiming no one does (unless they did in fact say that it's impossible for others to - although I can't always really blame them because that is what so many doctors say and they may have been told that. I literally had a doctor tell me "gabapentin never causes any withdrawal syndrome whatsoever". Clearly the info is not really out there yet.)
 
You are right, I'm overly sensitive because it sucked so much. I actually went through Fentanyl withdrawal once (its prescribed, but hot flashes were making the patches fall off constantly) and it scared the living sh*t out of me. I literally lost control of my body, went to the ER, freaking out! But after three days, I was okay. Lyrica knocked me down for months. Today for the very first time since I took my final dose two weeks ago I had none of the one thing that hadn't gone away...sweating. I wasn't sweating like a little bit, but big drops rolling down my face and body, drenching me. So, no PAWS. I think I've beat it. It took six months of tapering, but it's finally over. YAHOOOOOOO!!!!!!
 
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I feel as if this thread never recieved one single satisfying answer. What causes the horrible withdrawal from gabapentin/pregabalin? Why do some people not experience it? I mean, no one uses benzos/opiates for a year and then simply shrugs it off without any withdrawal whatsoever. People use gabapentin/pregabalin in insane doses compared to some of us (me) and they never suffer. I, on the other hand, use it as directed only and suffer PAWS for years and now I have to reinstate this fucking shit medicine because the withdrawal doesn't ever go away.

I want clarification! Especially before I take more pills of something I know I will never be able to get off untill the day I die if I ever take another pill again...
 
It's definitely something that's not known with anywhere near enough certainty. From my personal experience, it definitely seems like there's no cross tolerance between gabapentin and benzos. I've actually taken breaks from my benzos while continuing to take gabapentin, and my tolerance decreased. It actually seemed to decrease faster than normal. But I suffered a physical traumatic brain injury when I was 16, which is what caused my perminant GAD, so I sometimes have a very different reaction to anxiety meds. For example, I can take 20mg of klonopin and experience no effects (not even reduced anxiety) from it, but xanax and ativan work for me. From what my doctor told me, apparently gabapentin increases your brains natural production of gaba to run through your receptors. That would mean that if you continue to take gabapentin, it could make your gaba receptors adapt to the extra production, and then coming off of it would be just as hard as coming off benzos, but if you continue to take gabapentin and add benzos, the benzos shouldn't feel any weaker from having taken gabapentin. Again, this is based on what my doctor told me, and I have no strong evidence that disproves what he told me, but I also don't have any strong evidence to back it up. It could be an outdated, incorrect hypothesis of it's mechanism of action, or it could be a widly, currently agreed on hypothesis. I hate to say "just try it out yourself and find out," but there's really no other way to actually know right now.
 
I had very unpleasant withdrawals after 2 weeks on a low-moderate therapeutic dose of gabapentin. it didn't even help my anxiety after the first week but now I'm stuck on it. fuck.
 
I have had horrible withdrawals from running out of gabapentin. My doctor told me that it was a safe drug that was not addictive. In the beginning I took it as prescribed, 300mg, four times a day. After about six months I started abusing it. I took my last dose earlier today so I will be going through the horrible withdrawals again. My anxiety is already getting worse just thinking about it. I would rather go through opiate withdrawal 50 times than deal with this nasty drug.
 
I've never had any wds from very low dose pregabalin (3x25mg per day) and it does wonders for anxiety/all kinds of pain. I do believe some people will get wd and or need much more thatn that for any positive effects.
 
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