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Wednesday, May 18, 2011

Gabapentin: Withdrawal Symptoms After Abrupt Discontinuation

The anticonvulsant gabapentin, which was discovered over 40 years ago by the Japanese who were initially searching for an antispasmodic or muscle relaxant,  is commonly used to treat neuropathic pain, possibly helping relieve symptoms of burning pain, shooting pain, hyperesthesia, and allodynia.

As per Medscape (June, 2010):

Patients who have abruptly discontinued gabapentin have reported symptoms of anxiety, diaphoresis, irritability, agitation, confusion, tachycardia, catatonia, and status epilepticus.[16–22] The symptoms that have been associated with gabapentin withdrawal tend to mimic some of the same withdrawal symptoms associated with ethanol and benzodiazepine withdrawal, possibly because gabapentin augments GABA levels, as does ethanol and benzodiazepines.
In the setting of treating neuropathic pain, gabapentin can be tapering fairly quickly, but cautiously, monitoring for the above symptoms. I have seen it tapered and discontinued a number of ways with success:
  • 50% of the total daily dose for 1 week, then stop.
  • Decreasing by 25% weekly (or even every 3 to 4 days) would be a more cautious approach.
What experiences can share from your practice?

***

On another note with respect to gabapentin, is that is becoming more widely know as a medication with a potential for abuse.

From BC Poison Control Centre:
It is becoming increasingly evident that gabapentin may be subject to abuse in particular  populations.  Case reports describe gabapentin misuse in patients with prior histories of substance abuse and dependency; either to deal with cravings or abstinence symptoms, or as a  substitute for substances such as cocaine.  Drug users seeking pleasurable effects (e.g., euphoria) abuse gabapentin at various doses, and are willing to share their experiences.  Pharmacists should  be alert to the potential abuse or misuse of prescription drugs, and may be surprised (and somewhat disconcerted) at the information readily available through sites such as Erowid.

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Pharmacy History

"The earliest known compilation of medicinal substances was ARIANA the Sushruta Samhita, an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC. However, the earliest text as preserved dates to the 3rd or 4th century AD.
Many Sumerian (late 6th millennium BC - early 2nd millennium BC) cuneiform clay tablets record prescriptions for medicine.[3]

Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, and the Edwin Smith Papyrus of the 16th century BC.

The earliest known Chinese manual on materia medica is the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui tomb, sealed in 168 BC. Further details on Chinese pharmacy can be found in the Pharmacy in China article."

From Wikipedia: http://en.wikipedia.org/wiki/Pharmacy#History_of_pharmacy

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