The Dangers of Combining Gabapentin and Alcohol: Side Effects, Respiratory Risks, and Safety

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What you will learn

• Gabapentin and alcohol both affect the central nervous system, so using them together can increase drowsiness, dizziness, slowed thinking, and delayed reaction time.
• Gabapentin labels warn people not to drink alcohol while taking the medication unless they have first talked with their healthcare provider.
• Older adults and people who suffer from breathing problems have greater risks of harm than other users when combining gabapentin and alcohol. Also at greater risk are those who take opioids and benzodiazepines as well as other sedative medications.
• Gabapentin may be used off-label in some alcohol use disorder treatment plans, but only under medical supervision and never as a reason to keep drinking.
• If someone finds that they cannot stop drinking after starting gabapentin, then that may indicate that there needs to be an assessment to determine whether help is needed for addiction.

If you take gabapentin and drink alcohol, it makes sense to wonder how risky the combination really is. Perhaps you were prescribed gabapentin for treating nerve pain (neuropathy). Maybe you were prescribed gabapentin for seizures, nerve pain after shingles, or another off-label reason such as certain types of neuropathic pain or anxiety symptoms. Perhaps you had a few drinks and realized you were more tired than usual. Or maybe you are trying to understand whether alcohol affects gabapentin enough that you should avoid drinking completely.

Ultimately, the truth is that gabapentin and alcohol are a dangerous combination that should never be attempted lightly. Most importantly, the worry is not a sudden, unexpected chemical reaction. The worry is that both of these substances will slow down your central nervous system, which includes the brain and spinal cord, thereby potentially making side effects worse or unpredictable.

What Is Gabapentin?

Gabapentin, sold under the brand name Neurontin and other names, is a prescription medication approved by the U.S. Food and Drug Administration for certain seizure disorders and postherpetic neuralgia. Postherpetic neuralgia is caused by nerve damage resulting from shingles.[1] Doctors may recommend gabapentin “off-label” for other conditions such as several forms of neuropathic pain, and/or for helping to manage symptoms associated with anxiety. Additionally, doctors may use gabapentin as part of a comprehensive treatment program for individuals with alcohol use disorder in specific clinical situations.

Gabapentin is often described as an anticonvulsant, meaning it is used to help treat certain seizure disorders. Nonetheless, both gabapentin and alcohol can produce drowsiness and impair motor skills, especially at the beginning of treatment, when the dosage of gabapentin is increased, or when they are used in combination with other medications. Common side effects of gabapentin include drowsiness, dizziness, lack of coordination, and fatigue. [2] These side effects matter because alcohol can cause many of the same impairing effects.

Can Alcohol Interact With Gabapentin?

Yes. Yes. Alcohol can make some gabapentin side effects stronger. According to the United States Food and Drug Administration (FDA)-approved patient guide for gabapentin, patients are advised to not consume alcoholic beverages nor take other sleeping aids and drugs causing dizziness unless discussed with their physician. [3]

This warning exists because combining alcohol with gabapentin may increase the likelihood of experiencing excessive drowsiness, dizziness, impaired coordination, delayed reaction times, and poor judgment.

As a result, someone may find themselves excessively tired after consuming only one glass of wine. Alternatively, someone may lose his or her balance, fall over, pass out, experience memory gaps during intoxication, become confused, or act in ways they normally would not, become disoriented and confused, or engage in behaviors they wouldn’t typically exhibit. Some of these effects can pose significant dangers when operating a vehicle, walking in crowded areas, traveling by subway or public transportation, babysitting children, or taking other prescription medications.

Potential Side Effects Associated With Mixing Gabapentin & Alcohol

The potential side effects of gabapentin and alcohol can vary depending upon individual characteristics. Since gabapentin can enhance the sedative effect of alcohol, the combination of these two substances may lead to overlapping side effects that may intensify compared to the side effects experienced by consuming either substance alone.

Some potential side effects associated with the consumption of gabapentin and alcohol include:

• Excessive drowsiness
• Dizziness or light-headedness
• Poor coordination
• Slowed reaction time
• Confusion
• Nausea or vomiting
• Falls or accidents
• Memory loss or gaps during intoxication
• Worsening mood or anxiety following consumption
• Shallow breathing in higher-risk situations

One of the most serious concerns is breathing difficulty, especially for people with respiratory risk factors or those taking other sedating medications. The FDA issued a public warning stating that pregabalin (Lyrica) and gabapentin (Neurontin) can induce serious breathing difficulties among individuals with respiratory risk factors (e.g., chronic obstructive pulmonary disease (COPD) or sleep apnea), particularly when taken along with opioids or other central nervous system (CNS) depressants (such as benzodiazepines). [4]

Similarly, as mentioned above, alcohol also acts as a CNS depressant. Thus, individuals who combine gabapentin and alcohol may be at an elevated risk for developing breathing complications.

Not all individuals who drink one glass of wine while on gabapentin will experience a medical emergency. Rather, this represents a potential risk factor that warrants cautious consideration. Therefore, prior to combining gabapentin with alcohol or other sedating substances, consult with your prescribing provider regarding your current dosing regimen, medical history, and other medications.

Who Has a Higher Risk When Mixing Gabapentin and Alcohol?

Individuals who experience increased risk factors when combining gabapentin and alcohol include those who:

• Take high doses of gabapentin
• Recently initiated gabapentin therapy or have recently increased their dosages
• Consume opioids, benzodiazepines, or other central nervous system depressants
• Have COPD, sleep apnea, or other respiratory illnesses
• Are elderly
• Have renal insufficiency (gabapentin is cleared through the kidneys)
• Consume large amounts of alcohol or binge drink frequently
• Have a history of substance use disorder
• Use alcohol to alleviate withdrawal symptoms, anxiety, pain, or insomnia

According to the National Institute on Alcohol Abuse and Alcoholism, there are numerous ways in which alcohol interacts adversely with many different medications. Furthermore, older adults are more likely to be taking various prescription medications. Additionally, older adults may metabolize alcohol differently than younger populations. [5] Therefore, even when gabapentin is administered strictly according to prescribed guidelines, consuming alcohol increases the chances of misjudging how impaired you are.

Should I Drink Alcohol When on Gabapentin?

A decision regarding whether it is safe to drink alcohol while taking gabapentin should be made by consulting your prescribing doctor. In general, however, it is not recommended that you automatically assume that drinking alcohol is safe when taking gabapentin.

If your provider advises you against consuming alcohol, then please heed their advice. If you have already consumed alcohol and/or gabapentin and are experiencing extreme drowsiness, dizziness, unsteadiness, confusion, or shortness of breath, seek immediate medical assistance. Please call 911 immediately if you have difficulty breathing and/or are experiencing slow or shallow breathing due to either gabapentin and alcohol or other sedatives and opioid medications.

Also note that you should not discontinue gabapentin abruptly without receiving guidance from your prescribing physician. Stopping gabapentin too quickly can pose significant risks for people taking the medication to prevent seizures. Similarly, abrupt cessation can also bring about unpleasant symptoms or relapse into previous symptoms associated with the medical problem being treated.

Why Is Gabapentin Often Discussed Within the Context of Treating Alcohol Use Disorder?

Due to conflicting information regarding whether or not gabapentin enhances safety when mixed with alcohol, it may seem confusing why gabapentin is occasionally referenced within discussions related to treating alcohol use disorder.

Studies suggest that gabapentin can assist some people with alcohol use disorder in reducing their overall amount of drinking, improving abstinence, and alleviating withdrawal symptomology such as insomnia, cravings, and dysphoria, specifically among individuals undergoing withdrawal from ethanol. [6]

However, as previously stated, this does not imply that gabapentin facilitates safe drinking habits. There is a major difference between taking gabapentin as part of an evidence-based treatment plan and taking it while continuing to drink without medical guidance. In treatment, providers consider the person’s dose, withdrawal risk, other medications, mental health, and whether detox is needed.

Symptoms associated with withdrawal from alcohol can become life-threatening in some instances. Such symptoms include but are not limited to: seizures, hallucinations, severe disorientation, fever, elevated blood pressure, or rapid heart rate. [7] Trying to self-detox from alcohol with leftover gabapentin or other prescription medications can be dangerous.

Do Signs That You Cannot Stop Drinking After Beginning Gabapentin Indicate Larger Issues?

While determining the degree of danger present when attempting to mix gabapentin and alcohol may be an important aspect of understanding the risks associated with each separately, determining whether or not you will be able to stop drinking after beginning gabapentin can indicate larger issues.

If you continue to drink after being cautioned about potential interactions with your medications, or if you experience anxiety regarding obtaining additional supplies of alcohol, or if you conceal the frequency and amount you drink, or if you rely on alcohol to facilitate relaxation, sleep, or functioning, then you may be demonstrating signs indicative of dependency and addiction to alcohol. This does not signify weakness or personality flaws. Rather, it signifies an identifiable health condition amenable to successful treatment.

Identifiable indicators suggestive of needing professional assistance for addressing alcohol use disorder include:

• Consuming more than desired
• Unable to achieve reduction in drinking
• Needing alcohol to relax, facilitate sleep, or function normally
• Withdrawal symptoms upon cessation of drinking
• Drinking despite cautions provided by healthcare providers
• Combinations of alcohol with prescription medications regardless of impact on physical or motor skills
• Concern expressed by loved ones
• Overall functioning negatively impacted by use of alcohol

If gabapentin use, alcohol use, withdrawal symptoms, or difficulty controlling either substance have become concerning, you can speak with the team at Ascendant NY for an assessment to determine whether medical detox, residential treatment, intensive outpatient care, or another level of support may be appropriate.