Gabapentin side effects in women

In this article:

• What are common gabapentin side effects in women?
• Serious side effects of gabapentin
• Gabapentin and pregnancy
• Gabapentin while breastfeeding
• Gabapentin for menopause
• How to avoid gabapentin side effects
• Gabapentin interactions to be aware of

In this article

• What are common gabapentin side effects in women?
• Serious side effects of gabapentin
• Gabapentin and pregnancy
• Gabapentin while breastfeeding
• Gabapentin for menopause
• How to avoid gabapentin side effects
• Gabapentin interactions to be aware of

Gabapentin is an anticonvulsant medication that’s approved by the Food and Drug Administration (FDA) to treat seizures as well as nerve pain that can result after a shingles infection (postherpetic neuralgia) or after years of diabetes. Gabapentin is sold under the brand names Neurontin and Gralise. Off-label uses for gabapentin include the treatment of nerve pain, tremors, fibromyalgia, restless leg syndrome, alcohol dependence, and hot flashes in perimenopausal or menopausal women.

While side effects of gabapentin in women are similar to those experienced by men, hormonal variations and metabolism may cause some differences. We’ll take a closer look at the specific side effects to watch for, how gabapentin impacts pregnancy, breastfeeding, and menopause, and how you can minimize any unwanted side effects.

What are common gabapentin side effects in women?

Not everyone who takes gabapentin will experience significant side effects, and most people don’t notice many side effects at all. But there are several potential side effects to be aware of. The most common side effects of gabapentin are:

• Dizziness
• Tiredness
• Swelling of the arms and legs
• Tremors
• Weakness
• Uncontrolled eye movements
• GI upset (diarrhea, constipation, nausea, or vomiting)
• Dry mouth
• Sore throat
• Coughing
• Infections
• Loss of coordination and injuries
• Weight gain
• Trouble thinking clearly
• Depression
• Blurred or double vision

At this time, we don’t know much about how the common side effects of gabapentin are different in women versus in men. “There is no substantial evidence to suggest that the side effects of gabapentin are significantly different in women,” says Soma Mandal, MD, an internist at Summit Health. However, she says hormonal differences and variations in body composition can influence drug metabolism for women, meaning that side effects may impact women differently at times.

Eboni January, MD, an OB-GYN and a fellow of the American College of Obstetricians and Gynecologists (FACOG), agrees that gabapentin can have different side effects in women than in men due to “factors such as hormonal fluctuations, metabolism, and body composition differences.” According to Dr. January, the gabapentin side effects more commonly found in women include:

• Dizziness
• Drowsiness
• Peripheral edema (swelling of the legs and feet)

Does gabapentin cause weight gain in women?

Kecia Gaither, MD, MPH, double board-certified in obstetrics/gynecology and maternal-fetal medicine, says that women may be more likely to experience weight gain than men. Dr. Gaither also notes that women might be more likely than men to experience mood swings while taking gabapentin.

It’s also important to note the potential for gabapentin sexual side effects. Although it’s not clear whether the sexual side effects of gabapentin are greater for women, certain sexual side effects can occur in either sex. These include decreased sexual desire and trouble climaxing or achieving orgasm.

Serious side effects of gabapentin

In rare cases, gabapentin can cause serious side effects which can be life-threatening. If you experience any of the following serious side effects, you should seek urgent medical attention:

• Significant feelings of depression
• Unusual moods
• Atypical behaviors
• Suicidal thoughts
• Thoughts of hurting yourself
• Signs of a serious allergic reaction or anaphylaxis, such as swelling, hives, skin rash, vomiting, wheezing, losing consciousness, and breathing problems
• Seizures

Dr. January says that depression, anxiety, and other mood changes may impact women more than men, especially if gabapentin is combined with an opioid or a central nervous system (CNS) depressant like alcohol. “Women also seem to experience higher rates of weight gain and fluid retention, which can be particularly concerning for those with underlying cardiovascular conditions,” she adds.

Again, if you are experiencing any of these adverse side effects—including the ones more likely to impact women, like serious mood changes and fluid retention—please reach out to your healthcare provider for medical attention right away.

Gabapentin and pregnancy

As Dr. Mandal notes, gabapentin is classified as a Category C drug by the FDA for use during pregnancy. This means that risk to a fetus can’t be fully ruled out. “Animal studies have shown some risk but controlled studies in pregnant women are lacking,” Dr. Mandal says, noting that gabapentin can cross the placenta. Still, its effects on the development of the fetus are not well understood as of now. Most physicians believe that when considering giving a pregnant person a Category C medication the risk of not giving the medication needs to be compared to the possible risk to the fetus. If there are safer medication or treatment options for pregnant patients, this is often the treatment of choice. 

Overall, there doesn’t seem to be an elevated risk of fetal birth defects among mothers who took gabapentin in early pregnancy. But one study found an elevated risk of heart defects in babies whose mothers filled two or more prescriptions for gabapentin in early pregnancy. Still, the study didn’t track whether the mother actually took the medication, so it’s not clear whether the gabapentin is what caused these birth defects.

As for the miscarriage risk, Dr. Gaither says that there is limited data on whether it’s affected by gabapentin, “so professional medical advice is recommended for individual cases.” Additionally, she says that although current evidence does not strongly indicate that gabapentin affects fertility directly, it’s best to discuss the pros and cons of taking gabapentin during pregnancy with your healthcare provider and not to stop taking gabapentin suddenly.

“If used for seizure control, stopping gabapentin abruptly can be dangerous,” says Dr. January. “However, if used for pain management, anxiety, or other off-label uses, alternative medications may be considered before conception.”

If your healthcare provider determines that the risks of taking gabapentin during pregnancy outweigh the benefits, they may offer you alternative medication to take. Pregnancy-safe alternatives to gabapentin include:

• Keppra, Elepsia (levetiracetam)
• Lacmital (lamotrigine)
• Trileptal (oxcarbazepine)

Gabapentin while breastfeeding

The good news is that gabapentin doesn’t appear to negatively impact breastfeeding. Although gabapentin does pass into breast milk, it does so in very small amounts. Moreover, there aren’t reports of it having negative side effects on breastfeeding babies, nor does it seem to impact breastfeeding initiation if taken close to birth. There are also no reports of gabapentin lowering milk supply.

However, the research about gabapentin and breastfeeding isn’t very robust, so while it’s considered safe in most circumstances, you should keep an eye on your baby when you first start breastfeeding them if you take gabapentin. “If gabapentin is necessary during breastfeeding, it is generally safe, but monitoring for excessive infant sedation or poor feeding is advised,” Dr. January says.

Gabapentin for menopause

Menopause and the years leading up to it (perimenopause) can cause significant unpleasant symptoms for many women. These include hot flashes, sleep disruptions, mood swings, vaginal dryness, frequent urinary tract infections, irregular periods, and weight gain. Some women even experience an increase in ADHD symptoms.  

There is some evidence that gabapentin can treat some of those symptoms. “Gabapentin may be used off-label to treat menopausal symptoms, particularly vasomotor symptoms or associated mood disorders,” Dr. Gaither says. The research on gabapentin and menopause is mainly on its ability to help with the vasomotor motor symptoms of menopause, more commonly referred to as hot flashes and night sweats.

As helpful as gabapentin can be for menopausal women, Dr. Gaither notes that gabapentin isn’t the primary way that menopause is treated. “It is not a first-line treatment, and women are advised to discuss [treatment options] with their healthcare provider,” she says.

How to avoid gabapentin side effects

It can be helpful to have some strategies for avoiding some of the possible unpleasant side effects of gabapentin. Dr. January shared her top tips:

• Start low, beginning with a low dose and gradually increasing the dose to reduce dizziness and sleepiness.
• If gabapentin causes drowsiness, consider taking it near bedtime.
• Be aware that, the morning after taking gabapentin, you may still feel drowsy when you would like to be alert. 
• Avoid alcohol and CNS depressants, as these can worsen drowsiness and dizziness.
• Monitor yourself for mood changes. Reach out to your provider if you experience worsening depression or anxiety.
• Stay hydrated and active to reduce fluid retention and weight gain.
• If stopping gabapentin, taper off gradually since sudden discontinuation may lead to withdrawal symptoms like anxiety and increased pain sensitivity.

Gabapentin interactions to be aware of

If you are taking gabapentin, it’s important to be aware of the correct dosing and what medication interactions to avoid.

The standard and maximum doses for gabapentin are as follows:

• Adult standard dose: 300 to 600 mg taken three times daily
• Adult maximum dosage: 1,200 mg taken three times daily, not to exceed 3,600 mg per day

There are gabapentin drug interactions to be aware of. Importantly, gabapentin should not be taken with opioids or CNS depressions, such as alcohol. Antacids may make gabapentin less effective. Although there are no foods to avoid while taking gabapentin, you should ask a healthcare professional about caffeine and cannabis intake, as these may negatively impact the effectiveness of gabapentin.

What about medications typically taken by women? While there are no known interactions between gabapentin and medications like hormone replacement therapy (HRT) or birth control pills, you should discuss any medications you are taking with a healthcare provider before starting gabapentin.