💊 Gabapentin – Information for Older Adults
Plain-language information about gabapentin in older adults. This page is for older Canadians and their caregivers. It does not replace advice from your own health-care provider.
Gabapentin
Nerve Pain Medication / Anticonvulsant
1. What is gabapentin used for?
Gabapentin is a medication that affects nerve signals in the body. Although it was originally developed for seizures, it's now most commonly used for nerve pain.
Gabapentin is commonly used to treat:
- Nerve pain (neuropathic pain) – burning, shooting, or tingling pain from damaged nerves
- Postherpetic neuralgia – nerve pain after shingles
- Diabetic neuropathy – nerve pain from diabetes
- Seizures (epilepsy) – often used with other seizure medications
- Restless legs syndrome – in some cases
- Anxiety – sometimes used off-label
💡 What is nerve pain?
Nerve pain (neuropathic pain) feels different from regular pain. It's often described as burning, shooting, electric, stabbing, or tingling. It happens when nerves are damaged or not working properly. Regular pain medicines like acetaminophen or ibuprofen often don't help much with nerve pain – that's why different medications like gabapentin are used.
2. How does gabapentin usually help?
Gabapentin works by calming overactive nerve signals:
Reduces abnormal electrical activity in damaged nerves
Helps quiet the "false alarms" that damaged nerves send to the brain
The calming effect can help some people sleep better
⏰ Give it time
Gabapentin may take several weeks to reach its full effect. It doesn't work immediately like a regular pain pill. Your provider will likely start with a low dose and slowly increase it. Be patient – it may take time to find the dose that works for you.
💡 Does it work for everyone?
Gabapentin helps some people significantly but doesn't work for everyone. About 30–50% of people with nerve pain get meaningful relief. If it's not helping after a fair trial, your provider may try a different approach.
3. Why gabapentin needs extra care in older adults
Gabapentin is cleared from the body by the kidneys. Since kidney function often decreases with age, older adults may need lower doses. Side effects can also be more pronounced in older adults.
In older adults, gabapentin can cause:
- Drowsiness or feeling "foggy"
- Dizziness or unsteadiness – increasing fall risk
- Confusion or changes in thinking, especially at higher doses
- Swelling in the legs or feet
👨⚕️ Because of this, health-care providers often:
⚠️ Fall risk is a serious concern
The drowsiness and dizziness from gabapentin can significantly increase the risk of falls in older adults. Falls can lead to serious injuries like hip fractures. Tell your provider right away if you feel unsteady or have had any falls or near-falls.
4. How gabapentin is usually taken
⚠️ Important
Follow your provider's instructions exactly. Gabapentin dosing is very individualized – what works for someone else may not be right for you.
In general:
Frequency depends on the form and what you're taking it for
Your provider will start low and slowly increase over days to weeks
Can be taken either way, but taking with food may reduce stomach upset
If taking multiple times daily, try to keep doses roughly evenly spaced
⚠️ Don't stop suddenly!
If you've been taking gabapentin regularly, don't stop suddenly. Stopping abruptly can cause withdrawal symptoms or, rarely, seizures (even if you don't have epilepsy). If you need to stop, your provider will reduce the dose gradually over at least a week.
❓ If you miss a dose
Take it as soon as you remember, unless it's almost time for your next dose. Don't take two doses at once. If you miss several doses, contact your provider before restarting – you may need to restart at a lower dose.
5. Possible side effects older adults may notice
Side effects are common, especially when starting or increasing the dose. They often improve over time as your body adjusts.
Very common – often improves after a few weeks
Can increase fall risk – be careful when standing
Fluid retention – tell your provider if it's bothersome
May affect vision, especially early on
Difficulty thinking clearly or memory problems
Taking with food may help
💡 Managing side effects
Many side effects are worst when you first start or increase the dose and improve over 1–2 weeks as your body adjusts. If side effects are severe or don't improve, talk to your provider – sometimes a lower dose or slower increase helps.
⚠️ Rare but serious – tell your provider right away if:
- Severe dizziness or confusion that doesn't improve
- Significant swelling in legs, ankles, or feet
- Trouble breathing, especially if taking other sedating medications
- Mood changes, depression, or thoughts of self-harm
- Signs of allergic reaction: rash, fever, swollen lymph nodes
6. When to be extra careful with gabapentin
Talk to your health-care provider and be extra careful if you have:
⚠️ Dangerous combination: Gabapentin + Opioids
Taking gabapentin together with opioid pain medicines (like codeine, morphine, oxycodone) significantly increases the risk of serious breathing problems, sedation, coma, and death. If you take both, you must be closely monitored. Never start one without telling your provider about the other.
💊 Other medications to be careful with
Tell your provider about all medications and supplements you take. Be especially careful with:
- Opioid pain medicines
- Sleeping pills (like zopiclone)
- Anti-anxiety medications (like lorazepam)
- Antihistamines that cause drowsiness
- Muscle relaxants
- Antacids containing aluminum or magnesium (take gabapentin at least 2 hours after)
7. Habits and lifestyle that may help
While taking gabapentin for nerve pain, these strategies may also help manage your condition:
If drowsiness is a problem, ask your provider about taking more of the dose at night
Remove trip hazards, use nightlights, hold railings, get up slowly
Keep a diary of pain levels to help your provider know if it's working
Don't drive until you know how gabapentin affects you
Good diabetes control, for example, can help prevent worsening nerve damage
Smoking can worsen nerve damage and pain
💡 Gabapentin is just one part of the plan
Nerve pain is often best managed with a combination of approaches – medication, physical therapy, managing underlying conditions, and sometimes psychological support. Ask your provider about a comprehensive pain management plan.
8. When to call your doctor, nurse practitioner, or pharmacist
(Non-urgent)
Contact your health-care provider or pharmacist if:
- You feel very drowsy, unsteady, or confused after starting or increasing gabapentin
- You've had a fall or near-fall
- You're not sure if gabapentin is helping your pain after several weeks
- You have new or worsening swelling in your legs or feet
- You have kidney disease and are unsure if your dose is right
- You're taking other medicines that make you sleepy and want to check if it's safe
- You want to reduce or stop gabapentin
- You notice mood changes or feel depressed
- Your pain is getting worse despite the medication
9. When to call 911 or go to the emergency department
🚨 Call 911 immediately if:
- Severe confusion or you/someone else is very hard to wake up
- Trouble breathing or very slow breathing – especially if taking gabapentin with opioids or alcohol
- Thoughts of harming yourself or others
- Seizures (especially if you stopped gabapentin suddenly)
- Severe allergic reaction – rash with fever, swelling of face/throat, difficulty breathing
- Serious fall with possible injury
If possible, do not drive yourself. Ask someone to call for you or call an ambulance.
💜 If you're having thoughts of self-harm
Gabapentin and similar medications can rarely cause mood changes or thoughts of self-harm, especially when starting. If you're having these thoughts, please reach out for help:
- Canada Suicide Prevention Service: Call or text 988 (24/7)
- Crisis Services Canada: 1-833-456-4566
- Go to your nearest emergency department
10. Questions to ask your doctor or nurse practitioner
You can print these questions and bring them to your next appointment:
⚠️ Important Disclaimer
The information on SeniorHealthGuide.ca is general and may not fit your exact situation. It is for education only.
It does not replace medical advice, diagnosis, or treatment. Only a health professional who knows your medical history can tell you what is right for you.
Never start, stop, or change any medication, or make major changes to your diet or exercise, without checking with your doctor, nurse practitioner, or pharmacist.