Last updated July 21, 2022, by Marisa Wexler, MS
✅ Fact-checked by Inês Martins, PhD
What is gabapentin for MS?
Gabapentin is an anticonvulsant approved by the U.S. Food and Drug Administration (FDA) to treat seizures, as well as restless leg syndrome. It’s also prescribed for long-lasting pain following a shingles infection (postherpetic nerve pain).
The medication is not formally approved for use in people with multiple sclerosis (MS), but is often used off-label to manage certain symptoms of the disease. These include:
- nerve pain
- dysesthesia (unusual sensations like numbness or tingling)
- spasticity (abnormally tight muscles and/or stiffness)
- vision problems
Gabapentin is marketed under brand names that include Neurontin, Horizant, and Gralise. While all of these medicines contain gabapentin as the active ingredient, they are not interchangeable because each has its own pharmacological properties and is approved for different conditions. Generic versions of the medication also have been available in the U.S. since 2004.
How does gabapentin work?
In MS, symptoms such as pain and spasticity arise because inflammation causes damage to the nervous system. That damage interferes with the normal transmission of chemical signals along nerve cells.
Gabapentin’s mechanism of action remains incompletely understood, but it is generally established that the therapy can enter the brain and modulate the activity of certain neurotransmitters — the chemicals that nerve cells use to communicate with each other and the rest of the body. This may help normalize neuronal activity.
The chemical structure of Gabapentin is actually similar to that of a neurotransmitter called GABA, but the medication does not bind to GABA receptors or influence GABA levels. Instead, it’s thought that gabapentin works by binding to proteins called voltage-gated calcium channels on certain nerve cells, which influence how those nerves release their neurotransmitters.
Who should not use gabapentin?
Gabapentin should not be used by anyone with a known allergy to the medication.
How is gabapentin administered in MS?
Gabapentin is an oral therapy that is available as a capsule, tablet, or oral solution. Some formulations of the drug, including Neurontin and its generics, are meant to be taken three times per day. More recently developed formulations, namely Gralise and Horizant, are designed for once-daily dosing, and should be taken with food.
People with MS who are prescribed gabapentin will usually be started on a fairly low dose — for example, 300 mg/day. The dose will then be gradually increased, with the aim of finding a level that can control symptoms without causing problematic side effects. Upon stopping treatment with gabapentin, the dosage should be gradually reduced over the course of at least one week so as to prevent any adverse reactions.
Common side effects of gabapentin
The most common side effects of gabapentin include:
- drowsiness or fatigue
- swelling in the arms and legs
- poor muscle control
Pregnancy and breastfeeding
Gabapentin has not been well-studied in pregnant people, but research done in animals has suggested that it could be toxic to a developing fetus. Gabapentin is known to be secreted in human breast milk, but the consequences for a breastfeeding infant are not known.
It’s generally recommended that gabapentin should only be used during pregnancy or breastfeeding if the benefit of treatment for the individual that is pregnant or nursing outweighs the potential risk for the fetus or newborn.
In the U.S., people who take gabapentin during pregnancy are advised to enroll in the North American Antiepileptic Drug Pregnancy Registry, which monitors outcomes for pregnancies exposed to anti-seizure medications.
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