Treatment effects of gabapentin for primary insomnia

OBJECTIVES:

The prevalence of insomnia is very high in our society. Although pharmacological treatment of insomnia is available, most hypnotics have been shown to alter sleep architecture and have many adverse effects. Gabapentin was originally designed for antiepileptic therapy; however, some studies reported that its use increases slow-wave sleep in healthy volunteers or patients. Our goal was to evaluate the benefits of gabapentin in the treatment of primary insomnia in patients.

METHODS:

Eighteen patients with primary insomnia participated in the study. They received gabapentin treatment for at least 4 weeks. All patients received polysomnography, a biochemical blood test, and neuropsychological tests before and after the treatment period. All measures were analyzed with Student t test to examine the treatment effects of gabapentin, except that the measures of heart rate variability were analyzed with analysis of variance.

RESULTS:

Polysomnographic study revealed increased sleep efficiency and slow-wave sleep, decreased wake after sleep onset, and spontaneous arousal index after gabapentin treatment. The biochemical blood test revealed decreased prolactin levels in the morning after treatment. Electroencephalographic power spectral analysis showed increased delta-2 and theta power in sleep stage 1 and decreased sigma activity power in sleep stages N2 and N3 after gabapentin treatment. Heart rate variability analyses also showed a significant increase in normalized high frequency percentage in sleep stages N2 and N3 and low frequency-high frequency ratio in sleep stage N2 after treatment. In addition, neuropsychological tests revealed the elevation of visual motor processing speed after gabapentin treatment.

 

CONCLUSIONS:

Gabapentin enhances slow-wave sleep in patients with primary insomnia. It also improves sleep quality by elevating sleep efficiency and decreasing spontaneous arousal. The results suggest that gabapentin may be beneficial in the treatment of primary insomnia.

Author information

Department of Neurology and Sleep Center, Chung Shan Medical University and University Hospital, Tai-Chung, Taiwan.

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Gabapentin Side effects

The most common side effects of gabapentin in adult patients include dizziness, fatigue, drowsiness, weight gain, and peripheral edema (swelling of extremities).[40] Gabapentin may also produce sexual dysfunctionin some patients, symptoms of which may include loss of libido, inability to reach orgasm, and erectile dysfunction. Gabapentin should be used carefully in patients with renal impairment due to possible accumulation and toxicity. What side effects can Gabapentin cause?

Neurontin can be used to treat Fibromyalgia, Migraine, sleep and restless legs syndrome

Studies have also found the drug to have a substantial analgesic effects on diabetic neuropathy, postherpetic neuralgia, migraine, and other neuropathic pain conditions, as well as beneficial effect on sleep and restless legs syndrome. On the basis of these findings, the researchers suspected that gabapentin might also ease fibromyalgia pain. 

For treating the chronic pain and other symptoms of fibromyalgia, the anticonvulsant gabapentin (Neurontin) proved safe and effective, researchers here reported.

In a 12-week randomized, double-blind clinical trial, patients taking gabapentin displayed significantly less pain, better sleep, and less fatigue than placebo controls, Lesley M. Arnold, M.D., of the University of Cincinnati, and colleagues reported in the April issue ofArthritis and Rheumatism.

However, the drug had no effect on acute pain points or depression, the researchers reported.

Although gabapentin, which was used off-label for fibromyalgia, has little, if any, effect on acute pain, it has shown a robust effect on pain caused by a heightened response to stimuli related to inflammation or nerve injury in animal models of chronic pain syndromes, Dr. Arnold said.

Studies have also found the drug to have a substantial analgesic effects on diabetic neuropathy, postherpetic neuralgia, migraine, and other neuropathic pain conditions, as well as beneficial effect on sleep and restless legs syndrome. On the basis of these findings, the researchers suspected that gabapentin might also ease fibromyalgia pain.

The study, supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, included 150 mainly white fibromyalgia patients (90% women). Of these, 75 took gabapentin at dosages of 1,200 to 2,400 mg daily for 12 weeks, while there were 75 placebo controls.

The study was conducted at three outpatient research centers in the U.S., from September 2003 to January 2006.

The mean pain severity scores, measured by the Brief Pain Inventory (BPI), decreased in both groups but more so among the gabapentin patients (P = 0.015). The estimated difference between groups at week 12 was – 0.92 (95% confidence interval -1.75, -0.71).

Of the gabapentin-treated patients, 51% achieved a response at the endpoint compared with 31% of the placebo patients (P=0.014).

gabapentin overviewGabapentin compared with placebo also significantly improved the BPI average pain interference score, as well as a series of other scores. These included the Fibromyalgia Impact Questionnaire total score, the Clinical Global Impression of Severity Improvement, the Patient Global Impression of Improvement, the Medical Outcomes Study (MOS), the Sleep Problems Index, and the MOS Short Form 36 vitality score.

However, the drug had no effect on acute pressure-point pain or depression (the Montgomery Asberg Depression Rating Scale), the researchers reported.

Overall, the drug was well-tolerated. Of the 150 patients, 19 dropped out due to adverse events, with no significant difference between the treatment groups.

The gabapentin patients reported dizziness, sedation, lightheadedness, and weight gain significantly more often that did the placebo-treated patients. Notably, the researchers said, there was no significant difference in weight change in the two groups as measured in the clinic, although edema may have explained some of the patients’ perceptions. Most treatment adverse events, they reported, were mild to moderate in severity.

The pathophysiology of fibromyagia is unknown, but evidence suggests that it is associated with aberrant central nervous system pain processing, the researchers said.

The drug appears to be effective in reducing abnormal hypersensitivity induced by inflammatory responses or nerve injury. Yet unlike many other pain syndromes, there is no physical evidence of inflammation or CNS damage.

One possible explanation, Dr. Arnold said, is that gabapentin’s effects involve binding to a specific subunit of voltage-gated calcium channels on neurons. This binding, she said, reduces calcium flow into the nerve cell, which reduces the release of some signaling molecules involved in pain processing.

In discussing the study’s limitations, the researchers said that because the study was short, the results may not generalize to longer treatment periods, and long-term efficacy should be studied in future clinical trials.

Also, because the study was relatively small, they said it may have lacked the power to detect potentially relevant differences between the groups. Finally, they wrote that the results may not apply to patients with some comorbid psychiatric disorders, such as bipolar disorder, or to patients with other painful musculoskeletal disorders.

“In this, the first randomized, placebo-controlled study to evaluate gabapentin in the treatment of fibromyalgia, the results demonstrated that gabapentin, taken for up to 12 weeks, is effective and safe in the treatment of pain and other symptoms associated with fibromyalgia,” Dr. Arnold concluded.

Gabapentin may be useful in the treatment of comorbid anxiety in bipolar patients, (however not the bipolar state itself). Gabapentin may be effective in acquired pendular nystagmus and infantile nystagmus, (but not periodic alternating nystagmus). It is effective in hot flashes. It may be effective in reducing pain and spasticity in multiple sclerosis. Gabapentin may reduce symptoms of alcohol withdrawal (but it does not prevent the associated seizures). Use for smoking cessation has had mixed results. Gabapentin is effective in alleviating itching in renal failure (uremic pruritus)  and itching of other etiologies. It is well-established in the treatment of restless leg syndrome. (A prodrug form, gabapentin enacarbil, is also effective.)  Gabapentin is effective in insomnia.

Uses

Gabapentin is used with other medications to prevent and control seizures. It is also used to relieve nerve pain following shingles (a painful rash due to herpes zosterinfection) in adults. Gabapentin is known as an anticonvulsant or antiepileptic drug.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by yourhealth care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

Gabapentin may also be used to treat other nerve pain conditions (such as diabetic neuropathy, peripheral neuropathy, trigeminal neuralgia) and restless legs syndrome.

How to use gabapentin

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking gabapentin and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor. Dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight.

If you are taking the tablets and your doctor directs you to split the tablet in half, take the other half-tablet at your next scheduled dose. Discard half tablets if not used within several days of splitting them. If you are taking the capsules, swallow them whole with plenty of water.

It is very important to follow your doctor’s dosing instructions exactly. During the first few days of treatment, your doctor may gradually increase your dose so your body can adjust to the medication. To minimize side effects, take the very first dose at bed time.

Take this medication regularly to get the most benefit from it. This drug works best when the amount of medicine in your body is kept at a constant level. Therefore, take gabapentin at evenly spaced intervals at the same time(s) each day. If you are taking this medication 3 times a day to control seizures, do not let more than 12 hours pass between doses because your seizures may increase.

Do not take this medication more often or increase your dose without consulting your doctor. Your condition will not improve any faster and the risk of serious side effects may increase.

Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.

Antacids containing aluminum or magnesium may interfere with the absorption of this medication. Therefore, if you are also taking an antacid, it is best to take gabapentin at least 2 hours after taking the antacid.

Different forms of gabapentin (such as immediate-release, sustained-release, enacarbil sustained-release) are absorbed in the body differently. Do not switch from one form to the other without consulting your doctor.

Tell your doctor if your condition does not improve or if it worsens.

Gabapentin can not be used for a long time. You must exercise or take balanced nutrition to relieve your pain. Please try nu skin products by joining nu skin distributor network.