Gabapentin Alternatives: Possible Substitutions to Know

By Arielle Mitton
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September 13, 2022

Gabapentin is an anticonvulsant medication used to control seizures in people with epilepsy. It’s also used to treat restless legs syndrome and relieve nerve pain in conditions like postherpetic neuralgia, a chronic pain condition in people who have had shingles.

It’s not completely clear how gabapentin works, but it seems to reduce unusual excitement in the brain for people with seizures and helps in pain management by changing how the body senses pain.

Gabapentin is also prescribed off-label for diabetic neuropathy (nerve damage from diabetes), trigeminal neuralgia (severe facial pain), generalized anxiety disorder, hot flashes, and chronic lower back pain. 

While gabapentin is effective for various conditions and types of pain, some people experience unpleasant side effects while taking it. Common side effects include weight gain, sexual dysfunction, and mood changes.

It can also cause serious side effects like severe and long-lasting stomach pain, hallucinations, and suicidal thoughts. In addition, the U.S. Food and Drug Administration (FDA) warns that gabapentin can cause breathing problems.

If you’ve been taking gabapentin and suffer from side effects, you might be looking for safer medications. In this article, I’ll talk about gabapentin alternatives, precautions to take before switching, and side effects to look out for. I’ll also talk about when you should see a doctor. 

Gabapentin Alternatives 

Usually, gabapentin alternatives are prescription drugs with similar mechanisms of action.

Pregabalin

Pregabalin (Lyrica) is a prescription-only medication closely related to gabapentin. It’s only suitable for adults (under age 65) and should not be given to children. It is used to treat nerve pain, anxiety disorders, and epilepsy. 

Pregabalin treats seizures in epilepsy by decreasing abnormal activity in the brain, and treats anxiety by preventing your brain from releasing chemicals that cause anxiety. For nerve pain, it changes the way pain signals travel through your brain, providing relief. 

Pregabalin is available as capsules, tablets, or liquids. The usual pregabalin dose is 150-600 mg daily, split into two or three doses, taken with or without food. 

This medication takes up to a few weeks to work, so don’t stop taking it if you don’t see effects right away. If you’re taking pregabalin for epilepsy, missing doses can cause seizures. Pregabalin and gabapentin have some similar side effects.

Common side effects of pregabalin include tiredness, dry mouth, dizziness, anxiety, and bloating. Less common side effects are double vision, wheezing, difficulty breathing, chest pain, muscle pain, and swelling of the eyes, nose, mouth, or neck. 

Amitriptyline

Amitriptyline (Elavil) is a tricyclic antidepressant medication used to treat neuropathic pain, prevent migraine headaches, and treat postherpetic neuralgia (hot, stabbing pains after a shingles infection that may last for months or years). 

Amitriptyline comes in tablets. For nerve pain, your doctor may recommend that you start on a low dose of 10-25 mg daily. It may take up to eight weeks to notice the full effects of amitriptyline. 

Common side effects include nausea, vomiting, dry mouth, constipation, and changes in sex drive. More serious side effects include slow speech or trouble talking, hives, tongue or face swelling, seizures, hallucinations, and suicidal thoughts. If you feel those symptoms, seek emergency medical help immediately. 

Carbamazepine

Carbamazepine (Carbatrol) is an anticonvulsant medication used to treat seizures in people with epilepsy. It can also be used to treat trigeminal neuralgia (facial nerve pain) and restless legs syndrome. 

Carbamazepine helps with seizures by reducing unusual electrical activity in the brain. Carbamazepine dosage depends on what you’re taking it for. For epilepsy, doctors may start with 200 mg, twice per day, and adjust the dose depending on treatment needs. 

Side effects of carbamazepine include dizziness, uncontrollable shaking, and constipation. More serious side effects are dark urine, difficulty breathing, and a life-threatening allergic reaction called Stevens-Johnson syndrome. 

Phenytoin

Phenytoin (Epanutin) is used to treat seizures and trigeminal neuralgia. It’s available by prescription and in chewable tablets. For epilepsy, the dose for phenytoin is 200-500 mg a day, taken as a single dose or in two doses.

Children ages 12-17 take 300-400 mg in two doses. Dosage for children under 12 depends on their weight. Common side effects of phenytoin are nausea, dizziness, constipation, and headaches.

More serious but less common side effects include Stevens-Johnson syndrome, a severe disorder of the skin and mucous membranes in which the top layer of skin dies.  

Valproate 

Valproate (Depakote) is used to treat epilepsy and partial seizures. The tablet dosage for epilepsy is 10-60 mg per kg of body weight per day. Your doctor will decide the best dosage for you. 

Side effects of valproate include diarrhea, dizziness, hair loss, and mood swings. More serious adverse effects include hives and liver damage within the first six months of therapy.

Duloxetine

Duloxetine (Cymbalta) is a selective serotonin reuptake inhibitor (SSRI) used to treat pain from diabetic neuropathy (nerve damage that can happen in people with diabetes) and pain from fibromyalgia (a condition that causes muscle pain, tiredness, and trouble with sleep) in adults and children 13 years or older. 

The recommended starting and maintenance dose is 60 mg once a day, with or without food. Side effects of this medication include heartburn, constipation, dry mouth, vomiting, and increased urination.

Other side effects include unusual bruising or bleeding, unsteady walking, seizures, hallucinations, and suicidal thoughts. 

Clonazepam

Clonazepam (Klonopin) is a benzodiazepine medication used to control seizures and relieve panic attacks. Clonazepam is taken orally, either as a regular tablet or as a special tablet that disintegrates quickly in the mouth. 

The starting dose for epilepsy is 1 mg taken at night. Your doctor may gradually increase this dose depending on what you need. It can also be prescribed to children, with doses depending on their age. 

Clonazepam can cause side effects like dizziness, increased saliva production, changes in sex drive, and frequent urination. Other side effects include breathing problems, swelling of the eyes and face, and difficulty swallowing. 

Lamotrigine

Lamotrigine (Lamictal) is used to treat seizures in people with epilepsy. Lamotrigine comes as tablets, chewable tablets, and orally disintegrating tablets.

The tablets can be used alone, or in combination with other medications. For epilepsy, the usual dose for adults and children older than 12 is 100-700 mg daily, taken in one or two doses.

The dose for children younger than 12 is based on their weight. Side effects include drowsiness, constipation, weight loss, and uncontrollable shaking. Other side effects are rashes, irregular heartbeat, and seizures. 

Levetiracetam

Levetiracetam (Keppra) is an anticonvulsant medication used to treat seizures and epilepsy in adults and children one month and older. The dose for adults and children over 12 is 250-3000 mg daily, taken as one or two doses.

Levetiracetam dosage for children under 12 depends on their weight. Side effects include weakness, aggression, vomiting, and constipation. Other side effects are seizures that may be worse than before, and swelling of the face, tongue, and eyes. 

Topiramate

Topiramate (Topamax) is an anticonvulsant medication for different types of seizures. It can also be used to prevent migraine headaches. Dosage for epilepsy is usually 100-200 mg a day in two doses, though your doctor may start you on a lower dose. 

Side effects include uncontrollable eye movements, numbness, weakness, weight loss, unusual bleeding, and constipation. Some people experience serious side effects like worsened seizures, memory problems, and vision loss. 

Precautions Before Switching

If gabapentin isn’t working as well as you’d like and you want to switch, talk to your healthcare provider first. They’ll recommend the best alternative, and tell you how you can safely switch to other medications. 

Do not stop taking gabapentin suddenly—doing so can worsen your seizures. Instead, switch from gabapentin to the new alternative gradually under the guidance of your healthcare provider. 

Side effects to look out for

If you stop taking gabapentin, you may experience some withdrawal symptoms. These symptoms can start within 12 hours to a week after you’ve stopped taking gabapentin, and can last up to 10 days.

Symptoms to look out for include: 

  • Headaches
  • Dizziness 
  • Anxiety 
  • Insomnia 
  • Nausea
  • Fatigue
  • Agitation 
  • Sensitivity to light 
  • Irregular heartbeat 
  • Sweating 
  • Pain

People who take gabapentin for seizures and abruptly stop taking it may also experience worsened seizures and, in some cases, uncontrollable seizures

When to See a Doctor

Do not switch from gabapentin to other available alternatives on your own. Talk to your doctor before you stop taking gabapentin; together, you can decide on an alternative to take. Your doctor will let you know the correct dosage for your new medication, and help you transition from gabapentin safely. 

Also see your doctor if you’re having any symptoms that make you uncomfortable. They’ll be able to help you and determine if it’s something serious. 

How K Health Can Help 

Did you know you can have a primary care doctor online?

Check your symptoms, explore conditions and treatments, and if needed, text with a healthcare provider in minutes through K Health. 

K Health’s AI-powered app is HIPAA compliant and is based on 20 years of clinical data.

Frequently Asked Questions

Is there an over-the-counter equivalent to gabapentin?
No. Gabapentin is a controlled substance and there are no over-the-counter equivalents. All gabapentin alternatives are prescription medications.
What is the best tablet for nerve pain?
The main medicines recommended for nerve pain are amitriptyline, duloxetine, gabapentin, and pregabalin.
Which is better for pain, gabapentin or amitriptyline?
One study showed that gabapentin had better results for pain when compared with amitriptyline.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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Arielle Mitton

Dr. Mitton is a board certified internal medicine physician with over 6 years of experience in urgent care and additional training in geriatric medicine. She completed her trainings at Mount Sinai Hospital and UCLA. She is on the board of the Hyperemesis Research Foundation to help women suffering from hyperemesis gravidarum.

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