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A small number of post-marketing cases
report gabapentin misuse and abuse.
Some individuals describe ‘euphoria,
improved sociability, a marijuana-
like ‘high’, relaxation and sense of
calm.’ Other patients report feeling
Patients involved in misuse and abuse
were using gabapentin at doses greater
than those recommended, to relieve
symptoms of withdrawal from other
substances, and for unapproved uses.
Patients should be assessed for drug
abuse history before prescribing
gabapentin. Prescribers and pharmacists
should monitor patients for the
development of tolerance, unauthorised
escalation of dosing, and requests for
early refills or other aberrant behaviour.
Prescribers may consider testing for
gabapentin in urine drug screens if
abuse is suspected.
People abuse it because of effects
including euphoria, improved
sociability, a marijuana-like high,
relaxation and a sense of calmness.
Because the medication has not been
studied to great lengths for its abuse
potential, the syndrome caused in
those who take it recreationally is not
as well-defined as with other drugs
of abuse. The drug’s effects can vary,
depending upon the user, dosage, past
experience, psychiatric history, and their
expectations. However it is becoming
more understood that gabapentin abuse
is a legitimate concern. Many people
who abuse it are unaware of its negative
Gabapentin abuse has a number of
dangerous side effects. If an individual
takes the drug in higher or more frequent
doses, the side effects can become
much more intense. They include blurry
or double vision, uncontrollable eye
movements, itchy red eyes, dizziness,
headache, uncontrollable shaking of
a body part, anxiety, memory gaps,
fatigue, problems with coordination,
nausea, vomiting, diarrhoea, dry mouth,
heartburn, increased appetite, weight
gain, fever, flu-like symptoms and pain in
the ears, back, and joints.
In some instances it may cause seizures
which can be extremely dangerous,
especially for someone who has never
Significant evidence exists for
gabapentin abuse. It possesses the
ability to potentiate the illicit effect
of buprenorphine/naloxone. Cocaine
users are known to have substituted
gabapentin for cocaine, reporting a laid
back feeling of relaxation.
Some gabapentin withdrawals are
similar to alcohol or benzodiazepine
withdrawal (including catatonia)
while others experience symptoms
that include agitation, confusion,
diaphoresis, elevated vital signs and
seizures. It may reduce cocaine craving
or decrease withdrawal symptoms
during methadone-assisted opioid
Carbamazepine may decrease alcohol
Neurological manifestations such as
ataxia, seizures and altered senses
or cardiac manifestations including
tachycardia, hypotension and ventricular
extra-systoles can be presented by an
overdose of this drug.
If anyone doubts that these practices
actually happen they need simply to
Google search any drug name and
search for the words ‘Recreational Use
Drug Forum’. Sites like these supply
detailed advice. They disclose drug
abuse and often encourage illicit drug
The possible abuse of these medications
does not provide evidence of a
widespread problem. However,
pharmacists need to be aware that a
minority of customers may abuse certain
In the final part of this series we will
discuss the effects of skeletal muscle
relaxants and other medications including
clonidine, cimetidine and loperamide.
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