Gabapentin is widely used in the United States for a number of off-label indications, often as an alternative to opioid therapy. Increasing evidence has emerged suggesting that gabapentin may not be as benign as once thought and may be associated with substance abuse in concert with opioids.
With concerns for safety mounting, it is prudent to examine the efficacy of gabapentin across its many uses to understand the risk-benefit balance. Reviews on off-label indications such as migraine, fibromyalgia, mental illness, and substance dependence have found modest to no effect on relevant clinical outcomes.
This high-quality evidence has often been overshadowed by uncontrolled studies and limited case reports. Furthermore, the involvement of gabapentin in questionable marketing schemes further calls its use into question. Overall, clinicians should exercise rigorous appraisal of the available evidence for a given indication, and researchers should conduct larger, higher-quality studies to better assess the efficacy of Gabapentin for many of its off-label uses.
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Use only the brand and form of gabapentin that your doctor has prescribed. Check your medicine each time you get a refill at the pharmacy, to make sure you have received the correct form of this medication. Do not stop taking Gabapentin unless your doctor tells you to. If your treatment is stopped it should be done gradually over a minimum of 1 week. If you stop taking gabapentin suddenly or before your doctor tells you, there is an increased risk of seizures.
Off-label prescription use and gabapentin’s reputation
Even before gaining recent attention for its role in the opioid epidemic, gabapentin had acquired something of a dubious reputation.
While initially only approved for seizures and neuropathic pain, it was widely prescribed and marketed for other conditions and symptoms. Those include bipolar disorder, migraines, insomnia, and anxiety.
It’s also sometimes prescribed for chronic pain.
Pfizer, the developer of gabapentin, was involved in a lawsuit over their marketing of the drug for these off-label treatments.
The company eventually paid out more than $400 million in 2004 to settle fraudulent claims it made about the drug’s uses.
It’s common and legal for some drugs to be prescribed off-label. However, it’s illegal for drug companies to market drugs to treat unapproved conditions.
Gabapentin has several potential therapeutic uses and may represent a safer option versus alternative agents in some of these indications, so the intent of this analysis is not to condemn its use.
However, it is prudent to recognize that gabapentin has seen high rates of off-label use and increased prescribing in recent years, which fails to align with current evidence regarding efficacy. Indeed, most of the evidence for off-label use is limited to a few small, low-quality studies, often with data only weakly supporting use.
Higher quality evidence, which indicates gabapentin nonefficacy, is often lost in the shuffle. Given the increasing reports of abuse and evidence of potential harms associated with gabapentin use, it is important to realize the potential risks associated with this medication and weigh these risks against this lack of reliable evidence purporting its efficacy for many of its off-label uses.
Thus, we urge clinicians to apply a more stringent appraisal of the available evidence for a given indication when prescribing gabapentin off-label and call for larger, higher-quality studies to be conducted to better assess the efficacy of gabapentin for many of its off-label uses.
Neurontin is a trade mark that is owned by Pfizer company.
Gabapentin is also manufactured and marketed by other pharmaceutical companies all over the world. However it can not be marketed under the brand name Neurontin, so you can find many other medicines having absolutely the same compound, effect and safety level as Neurontin, some of those medicines are: Fanatrex, Gabarone, Gralise, Nupentin. All of these medicines are called “generics of Neurontin”.
These medicines, as they are less advertised, are much cheaper than Neurontin. However they can be hardly found at local drug stores, the only option you have, if you want to save your money and receive a high quality medicine, is to buy generic
Neurontin at our online pharmacy, which guarantees you the highest quality of the medicine, and affordable price at the same time.
When Neurontin (Gabapentin) is prescribed?
Neurontin is prescribed for the treatment of the following conditions in adults and children over 3 years:
Various forms of epilepsy. Usually doctors prescribe prescribe Neurontin for patients to help them to treat your epilepsy when a current treatment is not fully controlling his/her condition. Neurontin is used as addition to the main treatment of epilepsy.
Peripheral neuropathic pain (long lasting pain caused by damaged nerves). This disease can occur and develop in various conditions: injury, diabetes, shingles, and others.
Your doctor may prescribe you Neurontin for the treatment of other diseases, if he thinks that it is a right medicine for your case.
Before you start the treatment with Neurontin
When your doctor prescribes you Neurontin, you should necessarily inform him about the following:
If you are hypersensitive to Gabapentin
If you have any allergy
If you have any chronic or acute disease
If you are on haemodialysis
If you are taking some other medicines at the moment
If you are pregnant, breastfeeding, or plan to become pregnant or breastfeed in near future
Pharmaceutical form of Neurontin (Gabapentin)
Capsules
Neurontin is supplied in a form of capsules by 100 mg, 300 mg or 400 mg of Gabapentin.
Capsules also contain lactose monohydrate, maize starch, talc, gelatin, purified water, and sodium lauryl sulphate.
Film-Coated Tablets
Neurontin is supplied in a form of film-coated tablets by 600 mg or 800 mg of Gabapentin.
Tablets of Neurontin also contain poloxamer 407 (ethylene oxide and propylene oxide), copovidone, maize starch and magnesium stearate, opadry white YS-1-18111 (hydroxypropylcellulose, talc), candelilla wax.
Oral solution
Neurontin oral solution if supplied in bottles containing 470 ml.
Dosage of Neurontin and special recommendations
For the treatment of postherpetic neuralgia in adults, the following daily dosage is prescribed: a single 300mg dose of Neurontin on Day 1, 600 mg/day on Day 2 (divided in 2 intakes), and 900 mg day on Day 3 (divided in 3 intakes). If the effect of Neurontin is insufficient, the daily dose may be gradually increased to 1800 mg (divided in 3 intakes).
Clinical studies show that the most effective and optimal daily dosage is 1800 mg daily, doses exceeding this amount do not show improvement of the effect achieved by the daily dose of 1800 mg.
For the treatment of epilepsy, Neurontin is used in different doses for children over 3 years and for adults, the daily dose of Neurontin for adults and children over 12 years is: from 900 to 1800 mg/day taken in divided doses (three times a day), using 300 or 400 mg capsules, or 600 or 800 mg tablets. The starting dose is 300 mg three times a day.
If necessary, the daily dose may be increased using 300 or 400 mg capsules, or 600 or 800 mg tablets three times a day up to 1800 mg/day. The interval between the previous dose and increased dose should be no less than 12 hours.
For the treatment of epilepsy in children under 12 years the following dosage is prescribed: the starting dose should range from 10–15 mg/kg/day, the dose should be divided in 3 doses. In order to find the correct dose, it is recommended to increase the dose gradually in 3 days.
The optimal dose of Neurontin in patients of 5 years and older is 25–35 mg/kg/day, the maximum dose is 40mg of Neurontin taken in 3 intakes. Neurontin in children can be administered as the oral solution, capsule, or tablet, or using combinations of these formulations.
Patients with diabetes and acute renal failure should take reduced doses of Neurontin.
Neurontin is a medication that is available these days for the purpose of treating problems in relation to epilepsy. It is an anticonvulsant medication that helps you in controlling seizure symptoms. In case when you need to buy this medication, you can do that online. But you should be cautious when you buy it.
Buy this from a reputed online pharmacy store. When you take generic Neurontin there will be a cost benefit as available to you. But make sure you know that how you should take this medication and all the precautions that you need to take.
When you are on Gabapentin or Neurontin you should wear an ID card having personal info and your physicians contact number. In case of any serious complication in an emergency there can be some help that can be demanded.
Gabapentin Usage
You should use Gabapentin exactly as per your doctors advice. You should report him in case when you have some allergic reactions like hives, skin rashes and breathing problems. You should also tell your doctor if there are any side effects.
Patients having heart diseases, liver diseases and kidney diseases should be very much cautious when this medication is used. It should be taken only with doctors instructions and also there should be some amount of special medical attention that will be needed.
It is important to note that Gabapentin may give you suicidal thoughts and this can happen and you should therefore be in touch with your doctor when this medication is going on.
If you feel that the problems have worsened and there is depression, agitation, anxiety and seizures you must immediately tell your doctor about this. He may have to change the dose or at least change the medication.
It is up to the care givers to give extra attention to patients going through this phase and who are on Generic Neurontin.
It is still not known that whether this medication can be taken safely by pregnant women or not. But still, it is vital that you tell the doctor about pregnancy and plans to become pregnant so that he can guide you over the issue.
This medication can get into the blood and via that into the breast milk. Thus females who are nursing mothers should avoid generic Neurontin or Neurontin.
You should ask your doctor about all the instructions that are required to be followed when he tells you to buy this medication. You should ask about all the doubts that you have. You must also read the instruction list that comes with the medication.
It is also important to note that some doctors prescribe other medications also along with Neurontin so as to get effective treatment for the problem. It is vital to know that this epilepsy medication is not apt for children below 3 years of age. The combination drugs with Neurontin are apt for children who are above 12 years of age.
If you are aware of the mentioned precautions you can take safe steps for treatment.
This medication may create a few risks for patients who are already suffering from problems like kidney, liver or heart problems. Thus if you have any such problems or you are tasking any medication in relation to these disorders then you should tell this to your doctor in advance.
You should be very specific about the scheduled appointments. Make sure that you check your doctor regularly and this is something for your safety.
If after starting the medication you feel that the problems have worsened then in that case you should be quite cautious. You should tell about this to the doctor and he will take the required action that may be needed.
Gabapentin is a medicine that may be used for the treatment of certain seizure disorders or nerve pain.
Gabapentin is a structural analogue of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) that was first approved for use in the United States in 1993.
It was originally developed as a novel anti-epileptic for the treatment of certain types of seizures – today it is also widely used to treat neuropathic pain.
Gabapentin has some stark advantages as compared with other anti-epileptics, such as a relatively benign adverse effect profile, wide therapeutic index, and lack of appreciable metabolism making it unlikely to participate in pharmacokinetic drug interactions.
It is structurally and functionally related to another GABA derivative, pregabalin.
Experts aren’t sure exactly how gabapentin works, but research has shown that gabapentin binds strongly to a specific site (called the alpha2-delta site) on voltage-gated calcium channels. This action is thought to be the mechanism for its nerve-pain relieving and anti-seizure properties.
Gabapentin enacarbil (brand name Horizant) is a prodrug of gabapentin which has been designed to overcome the limitations of gabapentin, such as poor absorption and a short duration of action. Gabapentin enacarbil is effective for restless legs syndrome (RLS) and postherpetic neuralgia (nerve pain that occurs following Shingles).
Gabapentin belongs to the group of medicines known as anticonvulsants.
The precise mechanism through which gabapentin exerts its therapeutic effects is unclear.
The primary mode of action appears to be at the auxillary α2δ-1 subunit of voltage-gated calcium channels (though a low affinity for the α2δ-2 subunit has also been reported).
The major function of these subunits is to facilitate the movement of pore-forming α1 subunits of calcium channels from the endoplasmic reticulum to the cell membrane of pre-synaptic neurons.
There is evidence that chronic pain states can cause an increase in the expression of α2δ subunits and that these changes correlate with hyperalgesia.
Gabapentin appears to inhibit the action of α2δ-1 subunits, thus decreasing the density of pre-synaptic voltage-gated calcium channels and subsequent release of excitatory neurotransmitters.
It is likely that this inhibition is also responsible for the anti-epileptic action of gabapentin.
There is some evidence that gabapentin also acts on adenosine receptors and voltage-gated potassium channels, though the clinical relevance of its action at these sites is unclear.
Gabapentin, a prescription medication primarily used to treat seizures and neuropathic pain associated with herpes zoster, or shingles, is showing up in more drug overdoses. It’s a trend that’s worrying doctors and lawmakers.
Since the drug was first approved for use in the United States in 1993, it’s largely been considered safe with little or no potential for misuse.
But the opioid epidemic could be changing that.
Gabapentin is now so common among overdose deaths in Kentucky that lawmakers have included it as a controlled substance.
abapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.
Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles. Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.
This medicine is available only with your doctor’s prescription.
This product is available in the following dosage forms:
Capsule
Tablet
Solution
Suspension
According to data from the Louisville coroner’s office, gabapentin was found in nearly one-fourth of all overdoses. Across the state, the drug is now showing up in about 1 in every 3 overdose deaths.
The drug has been dubbed an “emerging threat” in the opioid epidemic in a national bulletin provided to narcotics officers.
You can buy generic Neurontin (Gabapentin) from any online source that is a reputed internet medicine store. This will help you get the most deserved discounts and it will surely help you save some pennies.
Even though you buy this medication from apt sources and you have surety of quality, some side effects with this medication are always there.
This happens with almost all the medications that are available in the market. Some people face less number of side effects while some patients have more side effects with some medications. Thus like every other medication even generic Neurontin comes with this package.
In 2016, it was the 10th most prescribed medication in the United States, with 64 million prescriptions.
As use of a drug grows, so does the unpredictability of side effects and potential for misuse.
“Once released as an approved drug, the number of people being prescribed the drug jumps substantially (tens of thousands to millions), and there is much more variability in the patient population and less control on how the drug is actually being taken,” said Bilsky.
A study from 2016 found that gabapentin misuse was low among the general population at just 1 percent. But that jumped to between 15 and 22 percent among people who misuse opioids.
“With decreasing availability of commonly abused prescription opioids, it has been suggested that nonmedical users of prescription opioids are substituting other licit and illicit drugs for abuse,” wrote the authors of a 2015 article on gabapentin misuse.
Gabapentin isn’t the only “safe” pain medication to show up on the radar of doctors and lawmakers in recent months, either.
As Healthline previously reported, Imodium — an over-the-counter anti-diarrheal drug — has also seen a surge in misuse. So much so that the U.S. Food and Drug Administration announced a plan to help cut down on its misuse potential.
Neither gabapentin nor Imodium is particularly good at getting someone high, so reasons for misuse are likely associated with cost and availability.
“It is hard to say what drives the person who suffers from a substance use disorder to switch between drugs and drug classes,” said Bilsky. “The current misuse of gabapentin may be another version of combining drugs to try and maximize the high.”
Before taking this medicine
You should not use gabapentin if you are allergic to it.
To make sure this medicine is safe for you, tell your doctor if you have ever had:
kidney disease (or if you are on dialysis);
diabetes;
depression, a mood disorder, or suicidal thoughts or actions;
a seizure (unless you take gabapentin to treat seizures);
liver disease;
heart disease; or
are taking an anti-depressant or sedating medication; or
(for patients with RLS) if you are a day sleeper or work a night shift.
Some people have thoughts about suicide while taking this medicine. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.
It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
Seizure control is very important during pregnancy, and having a seizure could harm both mother and baby. Do not start or stop taking gabapentin for seizures without your doctor’s advice, and tell your doctor right away if you become pregnant.
We do not suggest you take this medicine for a long time, it is the best ways to take some Health Foods to get rid of your muscle pain or headache, or even nerve pain.
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Gabapentin Pregnancy Warnings
Animal studies have revealed evidence of fetotoxicity involving delayed ossification in several bones of the skull, vertebrae, forelimbs, and hindlimbs. Hydroureter and hydronephrosis have also been reported in animal studies. There are no controlled data in human pregnancy.
To provide information regarding the effects of in utero exposure to this drug, physicians are advised to recommend that pregnant patients enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry. This can be done by calling the toll free number 1-888-233-2334, and must be done by patients themselves. Information on the registry can also be found at the website http://www.aedpregnancyregistry.org/.
AU TGA pregnancy category B1: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have not shown evidence of an increased occurrence of fetal damage.
US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
This drug should be used during pregnancy only if the benefit outweighs the risk.
AU TGA pregnancy category: B1
US FDA pregnancy category: C
Comments:
-Women on antiepileptic drugs (AEDs) should receive prepregnancy counseling with regard to the risk of fetal abnormalities.
-AEDs should be continued during pregnancy and monotherapy should be used if possible at the lowest effective dose as the risk of abnormality is greater in women taking combined medication.
-Folic acid supplementation (5 mg) should be started 4 weeks prior to and continued for 12 weeks after conception.
-Specialized prenatal diagnosis including detailed mid-trimester ultrasound should be offered.
-The risk of having a child with a congenital defect as a result of antiepileptic medication is far outweighed by the dangers to the mother and fetus of uncontrolled epilepsy.
Gabapentin Breastfeeding Warnings
Benefit should outweigh risk.
Excreted into human milk: Yes
Comments:
-The effects in the nursing infant are unknown.
-Limited information indicates that maternal doses up to 2.1 g daily produce relatively low levels in infant serum.
-Breastfed infants should be monitored for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant or psychotropic drugs.
Along with Gabapentin needed effects, Gabapentin may cause some unwanted effects.
Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Clumsiness or unsteadiness
continuous, uncontrolled, back-and-forth, or rolling eye movements
More common in children
Aggressive behavior or other behavior problems
anxiety
concentration problems and change in school performance
crying
depression
false sense of well-being
hyperactivity or increase in body movements
rapidly changing moods
reacting too quickly, too emotional, or overreacting
restlessness
suspiciousness or distrust
Less common
Black, tarry stools
chest pain
chills
cough
depression, irritability, or other mood or mental changes
fever
loss of memory
pain or swelling in the arms or legs
painful or difficult urination
shortness of breath
sore throat
sores, ulcers, or white spots on the lips or in the mouth
swollen glands
unusual bleeding or bruising
unusual tiredness or weakness
Incidence not known
Abdominal or stomach pain
blistering, peeling, or loosening of the skin
clay-colored stools
coma
confusion
convulsions
dark urine
decreased urine output
diarrhea
dizziness
fast or irregular heartbeat
headache
increased thirst
itching or skin rash
joint pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
muscle ache or pain
nausea
red skin lesions, often with a purple center
red, irritated eyes
unpleasant breath odor
vomiting of blood
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Blurred vision
cold or flu-like symptoms
delusions
dementia
hoarseness
lack or loss of strength
lower back or side pain
swelling of the hands, feet, or lower legs
trembling or shaking
Less common or rare
Accidental injury
appetite increased
back pain
bloated or full feeling
body aches or pain
burning, dry, or itching eyes
change in vision
change in walking and balance
clumsiness or unsteadiness
congestion
constipation
cough producing mucus
decrease in sexual desire or ability
difficulty with breathing
dryness of the mouth or throat
earache
excess air or gas in the stomach or intestines
excessive tearing
eye discharge
feeling faint, dizzy, or lightheadedness
feeling of warmth or heat
flushed, dry skin
flushing or redness of the skin, especially on the face and neck
frequent urination
fruit-like breath odor
impaired vision
incoordination
increased hunger
increased sensitivity to pain
increased sensitivity to touch
increased thirst
indigestion
noise in the ears
pain, redness, rash, swelling, or bleeding where the skin is rubbed off
passing gas
redness or swelling in the ear
redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
runny nose
sneezing
sweating
tender, swollen glands in the neck
tightness in the chest
tingling in the hands and feet
trouble sleeping
trouble swallowing
trouble thinking
twitching
unexplained weight loss
voice changes
vomiting
weakness or loss of strength
weight gain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Gabapentin is a prescription and we do not suggest you take it for a long time. You need take some health food or USANA CellSentials™ to make yourself more strong. If you want to make yourself happy and more beautiful without any pain, please check Celavive Skin Care and Whitening Teeth
Side effects requiring immediate medical attention
Along with its needed effects, gabapentin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking gabapentin:
More common
Clumsiness or unsteadiness
continuous, uncontrolled, back-and-forth, or rolling eye movements
More common in children
Aggressive behavior or other behavior problems
anxiety
concentration problems and change in school performance
crying
depression
false sense of well-being
hyperactivity or increase in body movements
rapidly changing moods
reacting too quickly, too emotional, or overreacting
restlessness
suspiciousness or distrust
Less common
Black, tarry stools
chest pain
chills
cough
depression, irritability, or other mood or mental changes
fever
loss of memory
pain or swelling in the arms or legs
painful or difficult urination
shortness of breath
sore throat
sores, ulcers, or white spots on the lips or in the mouth
swollen glands
unusual bleeding or bruising
unusual tiredness or weakness
Incidence not known
Abdominal or stomach pain
blistering, peeling, or loosening of the skin
clay-colored stools
coma
confusion
convulsions
dark urine
decreased urine output
diarrhea
dizziness
fast or irregular heartbeat
headache
increased thirst
itching or skin rash
joint pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
muscle ache or pain
nausea
red skin lesions, often with a purple center
red, irritated eyes
unpleasant breath odor
vomiting of blood
yellow eyes or skin
Side effects not requiring immediate medical attention
Some side effects of gabapentin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Blurred vision
cold or flu-like symptoms
delusions
dementia
hoarseness
lack or loss of strength
lower back or side pain
swelling of the hands, feet, or lower legs
trembling or shaking
Less common or rare
Accidental injury
appetite increased
back pain
bloated or full feeling
body aches or pain
burning, dry, or itching eyes
change in vision
change in walking and balance
clumsiness or unsteadiness
congestion
constipation
cough producing mucus
decrease in sexual desire or ability
difficulty with breathing
dryness of the mouth or throat
earache
excess air or gas in the stomach or intestines
excessive tearing
eye discharge
feeling faint, dizzy, or lightheadedness
feeling of warmth or heat
flushed, dry skin
flushing or redness of the skin, especially on the face and neck
frequent urination
fruit-like breath odor
impaired vision
incoordination
increased hunger
increased sensitivity to pain
increased sensitivity to touch
increased thirst
indigestion
noise in the ears
pain, redness, rash, swelling, or bleeding where the skin is rubbed off
passing gas
redness or swelling in the ear
redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
Cannabidiol, or CBD, is a derivative of marijuana that has recently become available as a prescription drug, Epidiolex.
It is FDA-approved for two rare forms of childhood epilepsy, Lennox-Gastaut and Dravet syndromes, and was fast-tracked for that indication because of the dire need for treatment in children with these intractable seizures.
Meanwhile, the same drug has been available as a supplement for the past decade, called CBD oil. Many patients take this oil for its rumored mental health benefits, and you’ll need to know the basics when they request prescriptions for it.
CBD vs THC Marijuana (cannabis) is a blend of over 100 cannabinoids, only one of which is tetrahydrocannabinol (THC), the cannabinoid that is most responsible for the high people get from consuming pot. CBD, on the other hand, does not cause a “high,” although many people consider it to be somewhat tranquilizing. CBD also does not cause some of the problems seen with THC, such as cognitive impairment, anxiety, and (more rarely) psychosis. Those dangers are particularly relevant to adolescents, where the latest data show that marijuana triples the risk of psychotic disorders (Jones HJ et al, JAMA Psych 2018;75(3):240–246). CBD has neuroprotective properties, and it may actually lower the risk of psychosis and anxiety with THC. For more information, see the table “Cannabinoids From CBD to THC” above.
CBD in psychiatric disorders In one of the most paradoxical clinical findings in recent memory, it turns out that CBD, far from causing psychosis, may actually be an effective treatment for psychosis. So far, 5 out of 7 controlled trials of CBD’s antipsychotic effects have been positive, and the latest of these is reviewed in this issue (Epidemiol Psychiatr Sci 2018;27(4):327–335). Another prescription CBD product, Arvisol, is undergoing phase I clinical trials in schizophrenia.
In addition to psychosis, there are a couple of small, placebo-controlled trials of CBD in social anxiety disorder. These looked at the drug’s acute effects when taken before a stressful social situation in 34 subjects. Compared to placebo, CBD had a significant effect, bringing anxiety down to the same levels reported by healthy controls (Blessing EM et al, Neurotherapeutics 2015;12(4):825–836).
Somnolence is the main side effect with CBD, but studies in sleep are mixed. Tolerance can develop to its sedative effects, and low doses (below 160 mg) can be stimulating (Babson KA, Curr Psychiatry Rep 2017;19(4):23). CBD does not appear to help bipolar mania or the cognitive impairments of schizophrenia.
CBD oil or Epidiolex? Are CBD oil and Epidiolex really the same drug? They are both CBD, short for cannabidiol, but where they differ is in their purity and regulatory status. Epidiolex is a Schedule V prescription drug, the lowest level of regulation for a controlled substance. CBD oil is an over-the-counter supplement. It is legal in all states as long as it’s extracted from the hemp plant, a variety of cannabis that contains little THC and produces no high.
In terms of purity, CBD oil is a gamble. In a study of 84 online products, only 30% contained the amount of CBD on the label, and 21% contained THC (Bonn-Miller MO et al, JAMA 2017;318(17):1708–1709).
The FDA keeps a running tally of unacceptable products at www.fda.gov/NewsEvents/PublicHealthFocus/ucm484109.htm. Another good source is Consumer Labs, which tests products for purity and integrity. Among their recommended options, the best-priced oils are available at elixinol.com and bluebirdbotanicals.com.
The dosages used in psychiatric research range from 300 mg/day for anxiety to 800–1,200 mg/day for schizophrenia. The epilepsy dosage, 10–20 mg/kg/day, adds up to around the same amount used in schizophrenia for most adults. Cost is an issue with CBD, prescribed or not. A 300 mg dose is $20–50/day in the over-the-counter form and around $35/day for the prescription when paying out of pocket.
CBD, Marinol, and medical marijuana CBD is in a very different category than dronabinol (Marinol) and nabilone (Cesamet), the other prescription cannabinoids. These are synthetic isomers of THC (Δ-9-THC) and are under tighter regulation than CBD (Schedule III vs Schedule V). They are only approved for nausea during chemotherapy and, in the case of dronabinol, anorexia in AIDS. As pure THC compounds without the protective effects of CBD, they may have even more psychedelic effects than marijuana (Bhattacharyya S et al, Neuropsychopharm 2010;35(3):764–774). “Medical marijuana” can refer to any marijuana component, such as CBD, or to the plant itself. It usually refers to the plant, which is legal with a prescription in 33 states and Washington DC. Each state has its own list of conditions that medical marijuana is approved for.
Side effects and drug interactions The World Health Organization concluded that CBD has “a good safety profile” (WHO, 2018). Somnolence is its main side effect, and the PDR warns of elevated liver enzymes. On drug screens, CBD can cause a false positive for THC.
CBD may raise the levels of psychiatric medications through inhibition at UGT2B7 (lamotrigine, lorazepam) and CYP2C19 (diazepam and several SSRIs and antipsychotics). CBD itself is metabolized by CYP3A4 and CYP2C19.
Risks vs benefits The FDA fast-tracked the approval of Epidiolex (CBD) because its risk-benefit profile is favorable for rare forms of epilepsy that are difficult to control with current anticonvulsants. The bar is higher for disorders with existing treatments, like psychosis and anxiety, and the data in these conditions are scarcer.
While we sort out these dilemmas, patients will no doubt experiment with the readily available CBD oil, so what should we do in the interim? We recommend the following commonsense approach.
TCPR Verdict: We don’t have much evidence to endorse or warn against CBD. Though it’s premature to prescribe CBD, we should guide patients to safer products if they are getting it on their own. That’s harm reduction, like suggesting to casual drinkers that red wine is safer than vodka
What is Gabapentin and What is the side effects of Gabapentin ?
Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.
Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles.
Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.
This medicine is available only with your doctor’s prescription.
This product is available in the following dosage forms:
Capsule
Tablet
Solution
Suspension
The only conditions for which gabapentinoid drugs are FDA-approved to manage pain are postherpetic neuralgia (both gabapentin and pregabalin [Lyrica]) and diabetic neuropathy, spinal cord injury, and fibromyalgia (pregabalin only). Nevertheless, use of these drugs has tripled during the past 15 years. This increase likely reflects gabapentinoid use for managing non–FDA-approved pain conditions, in part to avoid opioid use. In this review, researchers identified 34 placebo-controlled randomized trials (with ≈4200 patients) of gabapentinoids for noncancer, non–FDA-approved pain conditions. Most trials’ durations were 4 to 12 weeks.
Results of the Gabapentin review were as follows:
Only weak evidence supports use of gabapentin for diabetic neuropathy (only pregabalin is approved for this indication).
Minimal evidence supports use of gabapentin for nondiabetic painful neuropathies.
Studies of gabapentinoids for managing low back pain or sciatica have been largely negative.
Only minimal evidence supports a clinically meaningful benefit of off-label gabapentin use for fibromyalgia (for which pregabalin is approved).
Both gabapentin and pregabalin are approved for managing postherpetic neuralgia, but both are used often for acute zoster pain, for which studies have shown no benefit.
A small number of studies of gabapentinoid use for other pain syndromes (e.g., traumatic nerve injury, complex regional pain syndrome, burn injury, sickle cell pain) showed no clinically important benefits.
Along with its needed effects, gabapentin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
What is the side effects of Gabapentin ?
Check with your doctor immediately if any of the following side effects occur while taking gabapentin:
More common
Clumsiness or unsteadiness
continuous, uncontrolled, back-and-forth, or rolling eye movements
More common in children
Aggressive behavior or other behavior problems
anxiety
concentration problems and change in school performance
crying
depression
false sense of well-being
hyperactivity or increase in body movements
rapidly changing moods
reacting too quickly, too emotional, or overreacting
restlessness
suspiciousness or distrust
Less common
Black, tarry stools
chest pain
chills
cough
depression, irritability, or other mood or mental changes
fever
loss of memory
pain or swelling in the arms or legs
painful or difficult urination
shortness of breath
sore throat
sores, ulcers, or white spots on the lips or in the mouth
swollen glands
unusual bleeding or bruising
unusual tiredness or weakness
Incidence not known
Abdominal or stomach pain
blistering, peeling, or loosening of the skin
clay-colored stools
coma
confusion
convulsions
dark urine
decreased urine output
diarrhea
dizziness
fast or irregular heartbeat
headache
increased thirst
itching or skin rash
joint pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
muscle ache or pain
nausea
red skin lesions, often with a purple center
red, irritated eyes
unpleasant breath odor
vomiting of blood
yellow eyes or skin
Some side effects of gabapentin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Blurred vision
cold or flu-like symptoms
delusions
dementia
hoarseness
lack or loss of strength
lower back or side pain
swelling of the hands, feet, or lower legs
trembling or shaking
Less common or rare
Accidental injury
appetite increased
back pain
bloated or full feeling
body aches or pain
burning, dry, or itching eyes
change in vision
change in walking and balance
clumsiness or unsteadiness
congestion
constipation
cough producing mucus
decrease in sexual desire or ability
difficulty with breathing
dryness of the mouth or throat
earache
excess air or gas in the stomach or intestines
excessive tearing
eye discharge
feeling faint, dizzy, or lightheadedness
feeling of warmth or heat
flushed, dry skin
flushing or redness of the skin, especially on the face and neck
frequent urination
fruit-like breath odor
impaired vision
incoordination
increased hunger
increased sensitivity to pain
increased sensitivity to touch
increased thirst
indigestion
noise in the ears
pain, redness, rash, swelling, or bleeding where the skin is rubbed off
passing gas
redness or swelling in the ear
redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
runny nose
sneezing
sweating
tender, swollen glands in the neck
tightness in the chest
tingling in the hands and feet
trouble sleeping
trouble swallowing
trouble thinking
twitching
unexplained weight loss
voice changes
vomiting
weakness or loss of strength
weight gain
You can not take Prescription for a long time, you need find a way to treat your pain without prescription. Exercising is the best way to relieve your pain. because exercising can enhance your immune system and increase your muscle strength and make your nerve strong.
You can also take some natural nutritions to increase your immune system too. Some anti-aging products can also increase your immune ability. You can try USANA Products ro make you strong. I take USANA Essentials every day and I find my health get better and better. You can also try to become a usana distributor or associate and eat health organic food to get rid of your headache or nerve pain.
