Gabapentin alternatives: What can I take instead of gabapentin?

Gabapentin is an anti-epileptic drug but is also prescribed off-label to treat a variety of conditions. Get the full list of gabapentin alternatives here.

By Marquissa Beverly, DPM | Mar. 3, 2022

Medical conditions such as seizures and neuropathic pain from viral infections (i.e. herpes) may be managed with the anticonvulsant gabapentin. Gabapentin is an anti-epileptic drug whose brand names include Gralise, Horizant, and Neurontin. Gralise is approved by the United States Food and Drug Administration (FDA) for nerve pain only, not for the treatment of epilepsy; whereas Horizant is only for nerve pain and restless leg syndrome. Neurontin is approved by the FDA for seizures in patients as young as three in addition to nerve pain.

Gabapentin also has an off-label use for diabetic neuropathy, fibromyalgia, bipolar disorder, postmenopausal hot flashes, essential tremors, anxiety, idiopathic neuropathy pain, mood disorders, irritable bowel syndrome, alcohol withdrawal, nausea and vomiting, migraines, headaches, interstitial cystitis, itching, insomnia, post-traumatic stress disorder, and chronic cough. Gabapentin does not bind to gamma amino butyric acid (GABA) receptors although this was its initial planned design. Currently, its mechanism of action for analgesic and anticonvulsant effects is unknown.

Alternatives to opioid painkillers are regularly being sought out due to potential opioid addiction and other serious adverse effects. Gabapentin is a popular pain medication alternative for chronic pain management, and it is not a controlled substance. Unfortunately, there are some serious adverse effects associated with the use of gabapentin which may include suicidal thoughts, depression, and breathing problems. Your complete medical history should be reviewed with your healthcare specialist to help avoid any of these serious side effects. If there is a concern or a history of unwanted side effects while using gabapentin, the decision may be made to choose an alternative.

What can I take in place of gabapentin?

If gabapentin is not helping with your healthcare needs or is causing adverse reactions with its use, there are several alternative prescription drugs that can be used in its place. These medications may have fewer side effects and may provide more desirable results for the treatment of seizures and neuropathic types of pain. Other options are listed in the table below:

Compare gabapentin alternatives
Drug name	Uses	Side effects	Dosage	Coupons
Gabapentin (Gralise, Horizant, Neurontin)	Partial seizures, post-herpetic neuralgia, restless leg syndrome	Depression, suicide, dry mouth, dizziness, nausea, vomiting, diarrhea, back pain, shortness of breath	300-1200 mg three times a day	Get gabapentin coupons
Carbatrol (carbamazepine)	Seizure, nerve pain	Suicide, arrhythmia, vomiting, nausea, dizziness	200-600 mg twice a day	Get Carbatrol coupons
Cymbalta (duloxetine)	Fibromyalgia, depression, anxiety, neuropathic pain, musculoskeletal pain	Suicide, depression, seizures, headache, nausea, fatigue, weight loss	60 mg daily	Get Cymbalta coupons
Depakote (valproate)	Seizures, bipolar disorder, migraines	Suicide, hallucinations, vomiting, diarrhea, dizziness	30-60 mg/kg/day divided two to three times daily (seizure management)	Get Depakote coupons
Dilantin (phenytoin)	Seizures	Suicide, nausea, vomiting, dizziness, constipation, headache	300-400 mg divided two or three times daily	Get Dilantin coupons
Elavil (amitriptyline)	Depression, neuropathic pain, fibromyalgia, post-herpetic neuralgia, migraines	Seizures, suicide, drowsiness, nausea, vomiting, constipation, dizziness	25-150 mg every night at bedtime	Get Elavil coupons
Epitol (carbamazepine)	Seizures, nerve pain	Suicide, liver damage, dizziness, nausea, vomiting, constipation, blurred vision	Seizure: 800-1200 mg divided two to four times a day Nerve pain: 200-400 mg two times a day	Get Epitol coupons
Keppra, Keppra XR (levetiracetam)	Seizures	Suicide, depression, headache, vomiting, fatigue, dizziness, nausea	500 mg twice a day	Get Keppra coupons
Klonopin (clonazepam)	Seizures, panic disorder	Shortness of breath, suicide, dizziness, fatigue, constipation	0.5-5 mg three times a day (seizure management)	Get Klonopin coupons
Lamictal (lamotrigine)	Bipolar, seizures, migraines	Suicide, depression, headache, nausea, vomiting	100-400 mg daily	Get Lamictal coupons
Lidoderm (lidocaine topical patch)	post-herpetic neuralgia	Seizures, coma, application site redness, swelling, and pain	Up to 3, 5% patch no more than 12 hours a day	Get Lidoderm coupons
Lyrica (pregabalin)	Neuropathic pain, nerve pain, seizures, fibromyalgia	Suicide, shortness of breath, seizures, withdrawal symptoms, weight gain, nausea, headache	50-225 mg two to three times daily	Get Lyrica coupons
Tegretol , Tegretol XR (carbamazepine)	Seizure, nerve pain	Suicide, withdrawal symptoms, dizziness, drowsiness, nausea, vomiting, constipation, blurred vision	200-1200 mg divided two to four times a day	Get Tegretol coupons
Topamax (topiramat)	Seizures, migraines	Suicide, dizziness, weight loss, nausea, fever, fatigue	100-200 mg twice a day	Get Topamax coupons
Trileptal (oxcarbazepine)	Seizures, neuralgia, bipolar disorder	Dizziness, headache, nausea, vomiting, fatigue, diarrhea	600-1200 mg twice a day	Get Trileptal coupons
valproic acid	Seizures	Suicide, bleeding, headache, nausea, vomiting, dizziness	30-60 mg/kg/day divided two to three times	Get valproic acid coupons

Other alternatives to gabapentin

Aptiom (eslicarbazepine acetate)
Aspercreme Lidocaine Foot Pain Cream (lidocaine topical cream)
Aspercreme Lidocaine No Mess (lidocaine topical solution)
Aspercreme Lidocaine Pain Relieving Cream (lidocaine topical cream)
Aspercreme Lidocaine Patch (lidocaine topical patch)
Capzasin Quick Relief Gel (capsaicin/menthol topical)
Capzasin-HP (capsaicin topical)
Drizalma Sprinkle (duloxetine)
Elepsia XR (levetiracetam)
Equetro (carbamazepine)
Fycompa (perampanel)
Ibuprofen
Icy Hot Max Lidocaine Cream (lidocaine/menthol topical)
Icy Hot Max Lidocaine No Mess (lidocaine/menthol topical)
Icy Hot Max Lidocaine Patch (lidocaine/menthol topical)
Mexiletine
Onpattro (patisiran)
Phenytek (phenytoin)
Qutenza (capsaicin topical)
Salonpas Hot (capsaicin topical)
Salonpas Lidocaine Pain Relieving Gel Patch (lidocaine topical patch)
Salonpas Lidocaine Plus (benzyl alcohol/lidocaine topical)
Salonpas Lidocaine Pain Relieving Gel Patch Hot (capsaicin/menthol topical)
Spritam (levetiracetam)
Tegsedi (inotersen)
Vimpat (lacosamide)
WellPatch Warming Pain Relief (capsaicin topical)
Zonegran (zonisamide)
ZTlido (lidocaine topical patch)

Top 5 gabapentin alternatives

1. Cymbalta

Cymbalta is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SNRI). It is approved for the management of depression, anxiety, neuropathic pain, fibromyalgia, and musculoskeletal pain. Similar to gabapentin, prescribing Cymbalta for neuropathic pain may result in some serious side effects. Examples include depression, suicide, and seizures if this medication is discontinued too abruptly. The standard dose for Cymbalta is 60 mg daily with the maximum dosage being 120 mg daily.

2. Elavil

Elavil is a tricyclic antidepressant commonly used in place of gabapentin for various types of nerve pain. It is only FDA-approved for the treatment of depression but has an off-label use for neuropathic pain. Elavil and gabapentin have similar side effects like vomiting, nausea, and dizziness. The standard dose for Elavil for the treatment of neuropathic and post-herpetic neuralgia pain is to start with 25 mg at night before bedtime. It can be gradually increased if needed, but the maximum dosage is 150 mg daily.

3. Klonopin

Klonopin is a benzodiazepine that is approved for the treatment of seizure and panic disorders in adults and children. This controlled substance has the potential for addiction and must be monitored closely. Common side effects similar to gabapentin include drowsiness, dizziness, and depression. Klonopin’s standard dosage is 0.5 mg three times a day.The maximum dose is 20 mg per day.

4. Lidoderm

Lidoderm is a local anesthetic that blocks nerves in the body to reduce pain. It is used for the treatment of post-shingles pain similar to gabapentin. When compared to gabapentin, Lidoderm’s common side effects mostly involve various skin irritations. Typically a 5% patch will be used but no more than three patches within 12 hours.

5. Lyrica

Lyrica is a controlled substance and anticonvulsant like gabapentin. It is approved for the management of fibromyalgia and nerve pain from diabetes, post-herpetic infection, or spinal cord injury. Lyrica has similar side effects as gabapentin with some being more serious such as shortness of breath, suicidal thoughts, and depression. For neuropathic pain, it is prescribed 50 mg three times a day and can be gradually increased if needed. The initial dosage provided for spinal cord injuries includes 75 mg twice a day but can be increased to a maximum amount of 300 mg twice a day. The maximum amount of Lyrica that can be given is 600 mg daily.

Natural alternatives to gabapentin

Due to various side effects from gabapentin and other similar pharmaceuticals, many may prefer natural treatments for pain management. Although many natural remedies and supplements may appear safe, each individual is different and results may vary. Side effects can occur with these supplements just as with the use of pharmaceuticals. There may be potential drug interactions when combining natural treatments, so it is important to seek medical advice before initiating any supplements. Remember there is limited data and clinical studies when it comes to using natural alternative treatments. Some examples of natural pain relievers with similar effects to gabapentin include:

Cayenne—there are some clinical trials that show Capsicum annuum in the herb cayenne is useful for the treatment of neuropathic pain and post-herpetic neuralgia.
Vitamin B12—post-herpetic neuralgia and neuropathy are conditions that can be managed naturally with vitamin B12. It is believed that this supplement promotes myelination and improves the efficiency of the electrical transmission of nerves.
Zinc—a natural trace element found in the central nervous system and is known to regulate pain.
Exercise—there is research showing exercise-such as yoga- is beneficial against nerve pain especially related to spinal cord injuries. People who participate in yoga are shown to take less pain medication for chronic pain.

How to switch to a gabapentin alternative

If you have not been experiencing the relief you had hoped for with gabapentin, there are several natural and pharmaceutical options available to you. Before any changes are made, discussions on how to properly begin new treatments should be reviewed with your healthcare provider. The following steps should be taken first before any changes to your medications occur:

Review all side effects currently experienced while taking gabapentin with your provider.
Discuss the amount of pain relief not being achieved while taking the medication.
If there are any difficulties with taking the medication during its recommended times, this should also be disclosed.
Study other treatment options that you may be interested in so an open discussion can be had with your provider.
Review costs associated with the alternatives to ensure they are viable financial options.

When an alternative is found for the replacement of gabapentin, it is important that gabapentin is slowly tapered off. If being used for the treatment of seizures, gabapentin cannot be abruptly stopped as it can cause increased episodes of seizures. Withdrawal symptoms have also been linked with suddenly discontinuing gabapentin. When a gradual transition plan is made with your healthcare provider, this reduces the potential of complications when stopping gabapentin. Gradual reduction of this medication is important so that the new alternative treatment can be started safely.