Neurology
Gabapentinoids
Pregabalin and gabapentin — Used for nerve pain, some seizures and anxiety — now controlled drugs because of misuse risk.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
Gabapentinoids are mainly used for neuropathic (nerve) pain, as add-on treatment for some types of epilepsy, and — in the case of pregabalin — for generalised anxiety disorder.
How it works
They bind to a subunit of calcium channels in the nervous system, reducing the release of excitatory neurotransmitters. This calms overactive pain and seizure pathways.
In practice
In practice the headline change is that both pregabalin and gabapentin are now controlled drugs in the UK, reflecting real risks of dependence, misuse and diversion — and the danger of respiratory depression when they are combined with opioids or other sedatives. So they are prescribed with a clear indication and review date, titrated up and down slowly, used cautiously in renal impairment (where the dose must be reduced), and avoided as a casual add-on. Counsel patients not to combine them with opioids or alcohol.
Examples
Practical use
How to take it & use it well
- Take your gabapentinoid regularly as prescribed; doses are usually built up gradually to reduce side effects.
- Do not stop suddenly, as abrupt withdrawal can cause anxiety, sweating and, rarely, seizures; any reduction should be gradual.
- Be cautious about driving or operating machinery, especially when starting or increasing the dose, as these medicines cause drowsiness.
- As controlled drugs, keep them secure, do not share them, and follow the rules if travelling abroad with them.
- Tell your prescriber about any opioid painkillers you take, as the combination can be dangerous.
Common uses
- Neuropathic pain
- Add-on therapy for focal epilepsy
- Generalised anxiety disorder (pregabalin)
Monitoring
- Pain or seizure control and benefit versus continued need
- Signs of misuse, sedation or low mood
- Renal function (for dose adjustment)
Weighing it up
Advantages & disadvantages
Advantages
- They can ease nerve pain that does not respond well to ordinary painkillers.
- Pregabalin is also used for generalised anxiety and certain epilepsies.
- They offer a non-opioid option for some types of long-term pain.
- Dosing once or a few times a day can fit into daily routines.
Disadvantages
- They commonly cause drowsiness, dizziness and sometimes weight gain.
- They can be misused and cause dependence, which is why they are controlled drugs.
- Combined with opioids or other sedatives they can dangerously slow breathing.
- Stopping abruptly can cause withdrawal symptoms.
Key safety principles
What to watch for
- Controlled drugs — real risk of dependence, misuse and diversion.
- Serious risk of respiratory depression with opioids, alcohol or other sedatives.
- Reduce the dose in renal impairment; taper on stopping to avoid withdrawal.
Key interactions
What to avoid or check alongside
- Combined with opioids the risk of severe drowsiness and life-threatening breathing problems rises sharply.
- Taken with alcohol or other sedatives, drowsiness and unsteadiness increase.
- Antacids can reduce the absorption of gabapentin if taken too close together.
- Other medicines that depress the nervous system add to sedation and the risk of falls.
- Care is needed in reduced kidney function, as levels can build up and worsen side effects.
Patient & carer advice
- Do not combine with strong painkillers (opioids) or alcohol without advice
- Do not stop suddenly — the dose must be reduced gradually
- Drowsiness and dizziness are common at first — take care driving
Use with
Related clinical calculators
Dose and risk decisions for this class often depend on renal function, weight or bleeding/stroke risk. These tools help:
Answers
Gabapentinoids: frequently asked questions
Why are gabapentinoids controlled drugs?
Because they can be misused and cause dependence, pregabalin and gabapentin are classed as controlled drugs in the UK, with extra rules on prescribing, storage and travel.
Can I take a gabapentinoid with opioids?
Only with great caution and specialist advice. Together they can dangerously slow breathing. Tell your prescriber about all your painkillers so the risk can be managed.
Do gabapentinoids make you drowsy?
Yes, drowsiness and dizziness are common, especially at the start or after a dose increase. Take care with driving and machinery until you know how they affect you.
Can I stop a gabapentinoid suddenly?
No. Stopping abruptly can cause withdrawal symptoms and rarely seizures. The dose should be reduced gradually under your prescriber's guidance.
What are gabapentinoids used for?
They treat nerve pain and certain epilepsies, and pregabalin is also used for generalised anxiety disorder.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
Related guides
Need a custom medicines or prescribing resource?
We build evidence-led clinical references, calculators and decision aids for teams.