Gabapentin for Arthritis: Uses, Dosage, Side Effects - Verywell Health

Neurontin (gabapentin) is used to treat nerve pain. Nerve pain typically cannot be relieved using other pain relievers like anti-inflammatories. Gabapentin is sometimes used in combination with other drugs to manage pain.

Gabapentin is prescribed for controlling partial seizures in people with epilepsy. It is not a cure for the condition, but it can reduce the number of seizures for as long as it is taken. Gabapentin has also been prescribed off-label for treating conditions such as anxiety, fibromyalgia, and migraines.

While gabapentin is generally not prescribed to treat arthritis, research has found it to help manage the effects of severe knee osteoarthritis (OA). There is no evidence showing it improves pain caused by autoimmune arthritis conditions such as rheumatoid arthritis and psoriatic arthritis, though.

This article will cover gabapentin's uses and benefits (including for treating arthritis), side effects, and more.

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Gabapentin Benefits

Gabapentin works by altering electrical activity in the brain. It can also affect the activity of neurotransmitters—chemicals that send messages between nerve cells.

Gabapentin is a common drug to prevent and control seizures (uncontrolled electrical activity in the brain). It can be prescribed to both children and adults for this purpose.

It has also been prescribed to people who experience postherpetic neuralgia after a shingles infection and people with diabetic nerve pain. According to a 2017 review, gabapentin at 1,800 to 3,600 milligrams (mg) daily can provide sufficient pain relief for people with postherpetic neuralgia or diabetic nerve pain.

According to the review, a 50% pain reduction was found in people who practiced healthy habits, including sleeping well, managing mood, and improving life stressors. The researchers concluded that gabapentin was a "moderate quality" pain relief drug. They also noted limited evidence for pain relief with gabapentin for other types of nerve pain.

Gabapentin enacarbil has been used to treat moderate to severe restless legs syndrome (RLS). This neurological disorder causes an uncontrollable urge to move the legs. Gabapentin enacarbil is an extended-release prodrug of gabapentin (it is converted into gabapentin in the body) that is absorbed through the entire gastrointestinal tract.

One study published in 2016 found that treating with 600 mg a day of gabapentin enacarbil for 12 weeks significantly improved the symptoms of moderate to severe primary RLS in adults. In this study, RLS pain was also improved, along with sleep and mood. In addition, most study participants could tolerate the drug, and very few had to quit using it.

Gabapentin has also been used with OxyContin (oxycodone), an opioid pain reliever, to help control pain in people living with cancer.

One 2016 review found that gabapentin, when used in combination with a low dose of OxyContin, controls pain effectively for people with severe cancer pain. Those who took the combined treatment had an improved quality of life and experienced less nausea, vomiting, and constipation.

While gabapentin is primarily prescribed to treat seizures and nerve pain, it has also been effective for fibromyalgia, a hard-to-treat chronic pain condition. It was one of the first medicines the Food and Drug Administration (FDA) approved to treat the condition.

Before its approval, healthcare providers prescribed it off-label to manage fibromyalgia pain. The recommended starting dose for treating fibromyalgia is 300 mg. The dose may be increased by 300 mg daily until there is sufficient pain relief or adverse effects make the drug intolerable.

Gabapentin for Arthritis

Gabapentin is rarely prescribed for arthritis. However, it might be prescribed when other medications have failed or someone cannot take other recommended treatments.

A 2019 study in the journal Clinical Rheumatology evaluated the effectiveness of gabapentin and Cymbalta (duloxetine) in people with moderate to severe knee OA. The 150 study participants randomly received duloxetine 30 mg, gabapentin 300 mg, or acetaminophen 1,000 mg twice daily for 12 weeks.

Both gabapentin and duloxetine improved pain and function. The effects of gabapentin started gradually, with study participants experiencing the most improvement in the third month.

The research on gabapentin for treating other types of arthritis is limited. Some evidence suggests that gabapentin might act as an anti-inflammatory drug to reduce inflammation.

However, no studies have addressed this effect on inflammatory arthritis conditions like rheumatoid arthritis. Most of that research is related to gastrointestinal conditions that cause inflammation.

Gabapentin Side Effects

All medicines can cause side effects, including prescription drugs, over-the-counter (OTC) drugs, vitamins, and supplements. For most people, the side effects of a new treatment improve once the body has gotten used to the drug.

According to the package insert for the gabapentin brand Neurontin, common side effects of the drug include:

• Feeling drowsy or tired
• Nausea and vomiting
• Swelling of the hands and feet
• Fever
• Double vision and unusual eye movements
• Coordination troubles
• Tremors
• Viral infections
  

You should let your healthcare provider know about any side effects that bother you and that do not go away after a week or two of starting gabapentin.

Gabapentin Interactions 

Gabapentin can interact with other prescription and over-the-counter medicines, vitamins, and supplements. You should share with your healthcare provider a complete list of all your medications, including vitamins and supplements.

According to a 2017 review, morphine, caffeine, Cozaar (losartan), Edecrin (ethacrynic acid), Dilantin (phenytoin), mefloquine, and magnesium oxide might interact with gabapentin and cause adverse effects.

Precautions and Contraindications

Gabapentin might interact with some health conditions, including myasthenia gravis (an autoimmune condition that causes weakness by affecting the communication between nerves and muscles) and myoclonus (fast jerks or twitches in a muscle or group of muscles).

You should tell your healthcare provider if you are pregnant or planning to become pregnant before starting gabapentin. People who are breastfeeding should avoid taking gabapentin because it can mix with breast milk, and the effects on a breastfed infant are unknown.

Gabapentin can cause drowsiness. Exercise caution while driving or using heavy machinery. You should also limit your alcohol intake while on gabapentin as there is a risk for an adverse reaction to the drug when combined with alcohol.

Gabapentin Dosage

Gabapentin comes in capsules of 100 mg, 300 mg, and 400 mg, and tablets containing 600 mg or 800 mg of gabapentin. It is also available as an oral solution of 250 mg or 5 milliliters (mL).

The gabapentin dosage for nerve pain is 900 mg to 3,600 mg daily, split into three doses.

Epilepsy dosages are based on age. For everyone 12 and older, the dosage is 900 mg to 3,600 mg daily in three dosages. For children ages 6 to 12, the dosage is dependent on weight.

To reduce the potential for side effects, your healthcare provider will start you at the lowest dose and increase the dosing over a few days. Once they find the dose that offers the best pain relief and causes little or no side effects, you will stay at the dose.

Other Arthritis Treatment Options

Treatment for arthritis focuses on relieving pain, swelling, and stiffness and improving joint function. You will likely need to take different medicines or a combination of treatments before you find one that works best for you.

The medicines used for arthritis vary based on the type of arthritis you have. Common arthritis medications include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain and bring down inflammation. They include Advil (ibuprofen), Aleve (naproxen), Mobic (meloxicam), and Relafen (nabumetone).
• Topical pain relievers, such as those that contain capsaicin and menthol, are rubbed on the skin over achy joints. These creams and ointments are believed to interfere with the transmission of pain signals from the affected joint.
• Corticosteroids, such as prednisone, quickly reduce inflammation and pain and slow down joint damage. These medicines are available as pills or injections given in the affected joint.
• Disease-modifying antirheumatic drugs (DMARDs) slow the progression of autoimmune arthritis conditions like rheumatoid arthritis and psoriatic arthritis.

Your healthcare provider might also recommend physical therapy to help you manage the effects of arthritis. Physical therapy exercises can help improve your range of motion and strengthen the muscles surrounding the joints.

Surgery is considered when other therapies have not helped and there is significant pain or joint damage. Surgical options used to treat arthritis conditions include:

• Joint repair is a procedure in which joint surfaces are modified to reduce pain and restore joint function.
• Joint replacement removes the damaged joint and replaces it with an artificial one.
• Joint fusion repairs the small joints of the hands, wrists, ankles, or fingers. This procedure removes the ends of the affected bones in a joint and then locks them together so they heal into one rigid structure.
  

Summary

Gabapentin is used to control partial seizures in people with epilepsy and to treat nerve pain. It has also been used to treat various other conditions off-label, including fibromyalgia and restless legs syndrome. The research on its use shows it to be an effective and tolerable drug.

There is limited research on its benefit for arthritis. Research suggests it can improve pain and function in people with severe OA in the knee.

For most people who take gabapentin, side effects are mild. Gabapentin can cause adverse reactions when mixed with some medications, and it should be avoided by anyone who is pregnant, planning to become pregnant, or breastfeeding.

If you have arthritis, your treatment options are many. However, if treatments don't help, or you cannot take recommended treatments, you might consider talking to your healthcare provider about gabapentin for pain and symptom relief.

A Word From Verywell 

Arthritis is a lifelong disease, which means you will have it forever. Fortunately, most arthritis conditions are treatable, and many people experience quality of life with these conditions. It is important to see a healthcare provider as soon as you start to experience symptoms, though. The sooner you start treatment, the better your outlook will be.

Frequently Asked Questions

• Gabapentin is used to treat nerve pain, but it primarily prevents and controls seizures. It is considered an anti-seizure drug. Some research suggests that gabapentin might have anti-inflammatory benefits, but its classification has not changed.

• NSAIDs are frequently recommended for treating arthritis pain and swelling. They are available over the counter and by prescription.

• If you have been prescribed gabapentin for seizures, you will probably take it for many years. If your healthcare provider has prescribed gabapentin for nerve pain, you will need to take it for some time after the nerve pain has resolved to keep it from returning.