As you age, even though you may have taken a medication for decades, your body may react differently to it later in life. One reason for this is that your metabolism has slowed down. Some medicines need to be processed by your liver to benefit your health; slower digestion and liver function mean it may take longer for a drug to get into your bloodstream. Later, remnants of the medicine need to be eliminated from your body by the liver and kidneys. Slowdowns at this stage mean it may take longer for a drug to leave your body, so its effects last longer.
Studies also show that certain medications are less safe for older people, and it is important that you work with your provider or pharmacist to use medications that are safe for your age. The American Geriatrics Society’s Beers Criteria lists medications that may not be safe in older people and can be used as a tool when you talk with your provider or pharmacist about using safe medications.
What is Gabapentin?
Gabapentin more commonly known by the brand name Neurontin is a medication used along with other medications to help control certain types of seizures in people who have epilepsy. Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles).
Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down). Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain.
How gabapentin works
Gabapentin belongs to the class of medications called anti-epileptics. Gabapentin works by altering electrical activity in the brain and influencing the activity of chemicals called neurotransmitters, which send messages between nerve cells. Peak concentrations of gabapentin (immediate-release) occur within 2 to 3 hours. Although gabapentin may improve sleep problems due to nerve pain within a week, it may take up to two weeks for symptom relief from nerve pain to occur.
How should gabapentin be used?
The usual recommended adult dose of gabapentin begins with 300 mg 3 times daily. Your doctor may increase your dosage depending on how well it works and how well you tolerate it. The usual maximum daily dose is a total of 900 mg to 1,800 mg divided into 3 equal doses. Occasionally, it may be necessary to increase the total daily dose to as much as 2,400 mg, however, higher doses generally cause more side effects. Gabapentin may be taken with or without food.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
This medication should not be stopped suddenly, as seizures may return. If you feel it is necessary to stop this medication, discuss the most appropriate schedule with your doctor.
It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is less than 4 hours until your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. To prevent breakthrough seizures, no more than 12 hours should pass between doses. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
How long will gabapentin take to work?
You should notice that your pain starts to improve over one to two weeks after starting gabapentin, but it may take longer in some people. However, some feel benefit straight away.
What are the likely side effects of gabapentin in elderly patients?
Elderly patients are at an increased risk of side effects and may require a dose of gabapentin that is lower than usual due to reduced kidney function. Common side effects occurring in around 10% of participants taking gabapentin, can include:
- difficulty walking
- water retention, which refers to swelling of the arms, hands, legs, and feet
Some other possible side effects include:
• a cough
• a sore throat and swollen glands
• back or chest pain
• blurry vision
• changes in mood
• flu-like or cold-like symptoms
• hoarseness and dry mouth
• increased appetite and weight gain
• memory loss
• mouth ulcers
• shortness of breath
• uncontrollable eye-rolling
• upset stomach
• urinary problems
Safety and risks
If you are taking gabapentin, talk with your doctor about any problems you experience while doing so, especially if they are severe, ongoing, or getting worse. You should also be aware of the following serious safety concerns:
- Breathing problems: In 2019, the Food and Drug Administration (FDA) issued a warning that people with respiratory risk factors who take the different brands of gabapentin may experience serious breathing difficulties.
- People who have conditions such as chronic obstructive pulmonary disease or asthma should speak with a doctor before taking gabapentin.
- Risk of suicidal thoughts or behaviors: Studies suggest that some people may experience thoughts of suicide or exhibit suicidal behaviors when taking gabapentin or other anticonvulsants. If a person or their loved one notices any changes in their mood or behavior, they should contact a doctor immediately.
What can elderly patients do to cope with the side effects of gabapentin?
In an ideal world, every older adult would have access to a reliable process for reviewing medications, ensuring that the benefits outweigh the risks and burdens, and monitoring for side effects and problems.
However, as many of us know, our healthcare system is not yet ideal for aging adults. So if you are caring for an older person and want to be proactive about checking on medications.
Many side effects can be successfully overcome by treating them with other drugs. There is a very wide range of remedies available which can help you cope with side effects. Some of these treatments will only be available from your doctor on prescription, whereas others are available over-the-counter from the chemist. In any case, before starting on any new medicine you should discuss your plans with your doctor who can advise on possible interactions between these medicines.