Does Gabapentin rekindle benzo withdrawal?

[[Wr...]]

Hi. I have about 10 months clean of benzos, z-drugs, and alcohol. With classic benzobuddies paranoia I'm terrified to take any of these things and bring back the horrible symptoms.

 

Is it possible for gabapentin to set me back? I understand that it has a very low action (high IC50) on the GABA-A and GABA-B receptors, but is instead thought to work by blocking voltage-gated calcium channels. This has a similar inhibitory effect to GABAergics... but since it doesn't actually operate on the GABA receptors (which are downregulated or have their genetic expression changed) will gabapentin bring back the symptoms? Will it contribute to additional kindling of withdrawal if I ever w/d again?

 

I'm hoping someone is familiar enough with the biochemistry to know whether these mechanisms are related.

[Guest [ba...]]

Seems like all of the specifics for gabapentin's mode of action have not been worked out, but it seems to me that it results in the accumulation of higher levels of GABA instead of acting as an antagonist or a PAM (positive allosteric modulator) to GABAA (benzos are PAMs).  So I've considered it a reasonable approach to dealing with some of the benzo withdrawal symptoms.  But there are many who would disagree.

 

I took 300mg gabapentin (at bedtime) for a couple of months following my (c/t) jump.  I felt that it helped me sleep better.  Maybe it relaxed me just a bit.  I simply stopped taking it after a couple of months, and didn't experience anything terrible.  My sleep suffered a bit for a week, and I was just a bit more irritable, but I figured it was because of the loss of the therapeutic action (and not due to any dependence/withdrawal).  I was only 3 months past my c/t.  I still had benzo withdrawal symptoms.  I just wanted to see how I'd do without the gabapentin, but then I never reinstated it.

 

However, there are individuals in the forum who have had more difficulty with it.  Like most meds, some people will benefit, but some won't.  fwiw - I didn't feel like it had any kind of kindling effect on me. 

[[Wr...]]

Oh, interesting. I didn't consider that blocking voltage-gated calcium channels could prevent GABA from being absorbed and result in higher levels of GABA which could wreak havoc with GABAA/GABAB receptors. I'll be careful then...

[[fa...]]

The action of gabapentin isn't fully understood, but much research suggests it increases glutamate decarboxylase (GAD) levels in pre-synaptic GABA cells.  GAD, along with co-factors like B12 and calcium, converts glutamate or glutamine into GABA. This increase in GAD produces more GABA neurotransmitters for release at the terminal. The end result is increased synaptic GABA available for receptor binding.

 

This tends to have a down-regulating effect.

 

Any voltage-gated calcium channel blockade with gabapentin would result in fewer excitatory action potentials, thereby enhancing the effects with GABA.

Gabapentin's therapeutic value is usually met with mixed reviews. The med can take weeks to reach full efficacy and must be tapered slowly when deciding to discontinue.

 

If you're 10 months post-taper, I'd stay the course and not interfere.

 

 

 

 

[[li...]]

hey there, my dr put me on gabapentin to help with my w/d.  it did take several weeks to kick in. i am down to 300mg right now and although i feel it may soften side effects while tapering i have also experienced cognitive, vision side effects along with anxiety, daily crying spells, anxiety, depression and anhedonia.  i know i am addicted to it as feel worse when try to taper.  will this med affect my brain negatively in the long wrong or is it fairly safe.  i feel so bad right now i cannot tell what is what. but in such a dark place i am terrified of more w/d symptoms.  should i wait until i feel better and less symptomatic before i begin to taper. just hate being addicted to so many pills and still in a  clonazepam long hold taper and ongoing c/t from long-term antidepressant withdrawal just 3 months out.  any thoughts appreciated...........

[[Re...]]

hey there, my dr put me on gabapentin to help with my w/d.  it did take several weeks to kick in. i am down to 300mg right now and although i feel it may soften side effects while tapering i have also experienced cognitive, vision side effects along with anxiety, daily crying spells, anxiety, depression and anhedonia.  i know i am addicted to it as feel worse when try to taper.  will this med affect my brain negatively in the long wrong or is it fairly safe.  i feel so bad right now i cannot tell what is what. but in such a dark place i am terrified of more w/d symptoms.  should i wait until i feel better and less symptomatic before i begin to taper. just hate being addicted to so many pills and still in a  clonazepam long hold taper and ongoing c/t from long-term antidepressant withdrawal just 3 months out.  any thoughts appreciated...........

 

I posted the following on the other stream that you also commented on regarding gabapentin......

 

Hey there Lilla.

 

First of all, my heart goes out to you.  Those symptoms are tough.  I'm holding a bit on my taper (3rd day of holding) and then I'll resume shortly.  I have stabilized every time I have held.  Sometimes it took longer than others.  My longest hold with gabapentin was almost a month when I went from 500mg down to 200 waaaaaaay too fast.  I went up and held at 300mg for about 4 weeks.  My shortest hold has been about a week. 

 

I don't see in your signature your use history and tapering information so that makes it difficult to compare experiences.  How long have you been on gabapentin?  What was your highest dose and the duration of that dosing schedule?  How long have you been tapering and how have you been tapering?  What is the amount you've been reducing per reduction?  All of these things may influence how we regard your particular issue and how we are able to offer opinions.

 

The reality is that gabapentin influences the glutamate - gabba system (even if by different mechanism than benzos) and so the potential for withdrawal is real and no less important than someone using benzos.  I have only had success tapering gabapentin by treating it just the same as a benzo.  I do measured and controlled cuts in a daily micro taper and hold when necessary.  I'm down to 50mg AM and 50mg PM, or 100mg per 24 hours.  That's getting into the very low dose range for gabapentin but I still have to be very careful.  I was feeling well enough to get a little exercise yesterday and only 2 hours after my bike ride my symptoms spiked.  Anxiety went way up (which is not typical for me), and my nerve pain went up such as burning as well as muscle twitching.  I am only cutting 2mg per day (1mg off each dose) and yet it catches up with me sometimes, as it did over the last few days.  It seems my sweet spot is to cut no more than about 1.5% to 1.6% per day, although my current pace is a little less than 2% per day (1 - ((50mg/51mg) x 100) = 1.96%.  This is significantly faster than 10% per month, or even every 2 weeks.  Now that I am into the very low doses, I may have to slow down my pace a bit, just as one does with benzos. 

 

Anyway, that's me.  Try to create a signature to give us your benzo and gabapentin dosing and cutting information and then we can all be of better service. 

 

-RST