{"id":632413,"date":"2025-06-02T13:09:03","date_gmt":"2025-06-02T17:09:03","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=632413"},"modified":"2026-01-28T14:12:45","modified_gmt":"2026-01-28T19:12:45","slug":"gabapentin-vs-nortriptyline-for-nerve-pain","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/gabapentin-vs-nortriptyline-for-nerve-pain\/","title":{"rendered":"Gabapentin vs. nortriptyline: Which works better for nerve pain?"},"content":{"rendered":"

Often known as neuropathic pain, nerve pain is a mild to severe pain that occurs due to damage or injury to the nerves. Two of the most common medications used to treat nerve pain are <\/span>gabapentin<\/span><\/a> (brand names <\/span>Horizant, Gralise, and Neurontin<\/span>), a prescription anticonvulsant, and <\/span>nortriptyline<\/span><\/a> (Aventyl, Pamelor), a <\/span>tricyclic antidepressant (TCA)<\/span>. Each drug works differently and can come with unique side effects. Understanding how these drugs work and the potential side effects can help you decide whether gabapentin or nortriptyline is the best medication for your needs.<\/span><\/p>\n

What is gabapentin?<\/span><\/h2>\n

Gabapentin is a prescription anticonvulsant that was originally developed as an anti-seizure medication to prevent and control partial seizures. However, it is also often prescribed off-label for nerve pain, particularly for people with <\/span>postherpetic neuralgia <\/span><\/a>caused by shingles.<\/span><\/p>\n

Known as a gamma-aminobutyric acid (GABA) analogue, gabapentin works to <\/span>mimic<\/span><\/a> the way that GABA reduces the activity of neurons in the brain, calming overactive signals that can cause seizures. By reducing the activity of nerve cells in the brain, gabapentin is also able to help reduce nerve pain by attaching to certain calcium channels in the brain and spinal cord, reducing the release of signals that trigger pain and making it a go-to option for people with neuropathic pain, specifically <\/span>adults with chronic neuropathic pain<\/span><\/a> from diabetes, shingles, or even injuries.<\/span><\/p>\n

RELATED: How much is gabapentin without insurance?<\/a><\/strong><\/p>\n

Gabapentin dosages can vary by individual and should be prescribed by a healthcare provider. The prescription drug is available as a tablet, capsule, and oral solution, and may range anywhere from 50 to 600 milligrams (mg). Typically, gabapentin can be taken up to three times daily, and providers may gradually increase dosage as needed, depending on the individual\u2019s kidney function. It\u2019s common for some people to take 300 mg of gabapentin three times per <\/span>day, <\/span>but <\/span>high doses<\/span> of up to 1200 mg three times daily are possible<\/span>. <\/span>Ultimately, dosing should be left to the discretion of your healthcare provider.<\/span><\/p>\n

While gabapentin can be highly effective in treating nerve pain, there\u2019s no guarantee that it will <\/span>eliminate all nerve pain. \u201cThe medication offers significant relief from nerve pain, but cannot always eliminate it,\u201d says Shana Johnson, MD, a board-certified physician in physical medicine and rehabilitation specializing in chronic pain of <\/span>AskDrShana Physical Medicine and Rehabilitation<\/span><\/a> in Scottsdale, Arizona.<\/span><\/p>\n

Often, gabapentin is used as a part of a person\u2019s treatment method alongside other medications and therapies to target nerve pain holistically.<\/span><\/p>\n

What is nortriptyline?<\/span><\/h2>\n

Nortriptyline is a <\/span>tricyclic antidepressant (TCA) that is also used to <\/span>treat nerve pain<\/span><\/a>. Although it is primarily used in people with depression to boost serotonin production in the brain, it has also been found to be effective in treating neuropathic pain and is often prescribed off-label for such cases.<\/span><\/p>\n

\u201c[Nortriptylin<\/span>e] helps with nerve pain by increasing certain brain chemicals, mainly norepinephrine and serotonin, that help reduce how strongly we feel pain,\u201d says Harold Hong, MD, MBA, a board-certified psychiatrist and medical director with <\/span>New Waters Recovery<\/span><\/a> in Raleigh, North Carolina. \u201cIn addition, it can slightly block certain nerve signals, which adds to its pain-relieving effects.\u201d\u00a0<\/span><\/p>\n

Nortriptyline, when used to treat neuropathic pain, is typically started at an <\/span>initial dose<\/span><\/a> of 10 mg daily and may be gradually increased to 75 mg daily. It is usually given as a single dose at night time, to reduce any sedative effects during the day. Your healthcare provider can help determine your daily dosage and dosing schedule.<\/span><\/p>\n

How do they compare?<\/span><\/h2>\n

While both gabapentin and nortriptyline can help treat neuropathic pain, they work differently, and some people will respond better to one than the other.<\/span><\/p>\n

One of the most significant differences between the two drugs is their onset of action. \u201cGabapentin tends to act more quickly,\u201d Dr. Hong says. \u201cPatients often notice some relief within a few days to a week. Nortriptyline typically takes two to three weeks before full benefits are felt. So, if someone needs faster relief, gabapentin might be the better choice to start.\u201d<\/span><\/p>\n

There can also be price differences between the two drugs. Gabapentin\u2019s price often exceeds that of nortriptyline, but it’s essential to discuss your options with your healthcare provider and consult your insurance provider to determine what is covered under your plan.<\/span><\/p>\n

Gabapentin and nortriptyline are each associated with unique side effects, which should be taken into consideration before beginning either medication.<\/span><\/p>\n

Below is a breakdown of the possible side effects of gabapentin and nortriptyline:<\/span><\/p>\n\n\n\n\n\n\n
\n

Side effects of gabapentin vs nortriptyline<\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n

Gabapentin<\/span><\/td>\nNortriptyline<\/span><\/td>\n<\/tr>\n
Drowsiness<\/span><\/p>\n

Dizziness<\/span><\/p>\n

Fatigue<\/span><\/p>\n

Swelling<\/span><\/p>\n

Weight gain<\/span><\/p>\n

Changes in mood<\/span><\/p>\n

Suicidal thoughts or actions<\/span><\/p>\n

Anxiety<\/span><\/p>\n

Confusion<\/span><\/p>\n

Decreased coordination<\/span><\/p>\n

Low blood sugar<\/span><\/p>\n

Nausea<\/span><\/p>\n

Vomiting<\/span><\/p>\n

Difficulty breathing<\/span><\/p>\n

Dark urine<\/span><\/td>\n

Dry mouth<\/span><\/p>\n

Dry eyes<\/span><\/p>\n

Constipation<\/span><\/p>\n

Weight gain<\/span><\/p>\n

Dizziness<\/span><\/p>\n

Blurred vision<\/span><\/p>\n

Drowsiness<\/span><\/p>\n

Low blood pressure<\/span><\/p>\n

Changes in heart rhythm<\/span><\/p>\n

Sensitivity to the sun<\/span><\/p>\n

Anxiety<\/span><\/p>\n

Agitation<\/span><\/p>\n

Suicidal thoughts or actions<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Both <\/span>gabapentin<\/span><\/a> and nortriptyline may interact negatively with other drugs. If you\u2019re taking any of the following medications, please consult with your healthcare provider before using them in combination with gabapentin or nortriptyline:<\/span><\/p>\n\n\n\n\n\n\n
\n

Gabapentin and nortriptyline interactions<\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n

Gabapentin<\/span><\/td>\nNortriptyline<\/span><\/td>\n<\/tr>\n
\n
    \n
  • Antidepressants, such as<\/span> amitriptyline, fluoxetine, and sertraline<\/span><\/li>\n<\/ul>\n
      \n
    • Certain seizure medications, such as phenobarbital and primidone<\/span><\/li>\n<\/ul>\n
        \n
      • Antacids<\/span><\/li>\n<\/ul>\n
          \n
        • Opioids, such as hydrocodone, morphine, and oxycodone<\/span><\/li>\n<\/ul>\n
            \n
          • Central nervous system (CNS) depressants, such as antihistamines, benzodiazepines, sedatives, or muscle relaxants<\/span><\/li>\n<\/ul>\n
              \n
            • Anesthetics or muscle relaxants<\/span><\/li>\n<\/ul>\n<\/td>\n
\n