Gabapentin and Alcohol: Risks, Interactions, and What to Know
Author:
Blossom Editorial
Gabapentin and alcohol both slow activity in the central nervous system, and taking them together can have additive effects on drowsiness, dizziness, and impaired coordination. In certain situations, particularly when other sedating medications or lung problems are involved, the combination can also affect breathing.
Gabapentin is widely prescribed in the United States, and since alcohol use is also common, people often wonder if it's safe to take them together. In most cases, avoiding alcohol while taking gabapentin is often the safest approach. Understanding what actually happens when the two overlap makes it much easier to have a useful conversation with your provider.
Key Takeaways
The main risk is additive sedation: Gabapentin and alcohol are both central nervous system (CNS) depressants, and combining them can intensify drowsiness, dizziness, confusion, and loss of coordination. This can contribute to an increased risk of falls and unsafe driving.
Breathing problems are a serious concern in higher-risk situations: The FDA warned in December 2019 that serious breathing difficulties can occur with gabapentin when it is combined with other CNS depressants or used by people with reduced lung function or older age.
Do not stop gabapentin on your own: Gabapentin prescribed for seizures should not be discontinued abruptly. Neither is it safe to skip doses for a drink. Any change to your dose or schedule should come from your prescriber.
What is Gabapentin?
Gabapentin is an anticonvulsant medication that received FDA approval in 1993 and has been available as a generic medication in the United States since 2004. It is sold under brand names including Neurontin, Gralise, and Horizant, though most prescriptions are filled with generic gabapentin.
The FDA has approved gabapentin for postherpetic neuralgia, a type of nerve pain that can occur after shingles. It is also used as add-on therapy for partial onset seizures in adults and children age 3 and older. In practice, it is prescribed more broadly than its approved uses, including off-label for restless legs syndrome, various neuropathic pain conditions, and certain psychiatric symptoms.
That broader use is one reason questions about alcohol use come up so frequently. Not all people taking gabapentin are taking it for epilepsy, and they may not have been given specific guidance about drinking. Gabapentin is also used off-label for anxiety symptoms and for depressive symptoms, and in both contexts alcohol use is worth discussing openly.
What Happens When You Mix Gabapentin and Alcohol?
The interaction is primarily pharmacodynamic, meaning the two substances act on the same system rather than interfering with each other’s metabolism. Here is what that looks like in practice.
Both Substances Depress the Central Nervous System (CNS)
Alcohol is a CNS depressant, and gabapentin can also cause CNS-depressant effects such as drowsiness, dizziness, and impaired coordination. In fact, drowsiness and dizziness are among the most frequently reported side effects of gabapentin. When gabapentin is taken with alcohol or other sedating substances, these effects may become more pronounced.
The FDA labeling for Neurontin instructs that patients be carefully observed for signs of CNS depression, such as sleepiness and sedation, when gabapentin is used with other drugs that have sedating properties because of the potential for additive or synergistic effects.
Practically, this means a smaller amount of alcohol may affect you more than you expect. Coordination, reaction time, judgment, and balance can all be affected more than they would be by either substance alone. Driving or operating machinery under these conditions can become significantly more dangerous, and the risk of falls may also increase, particularly for older adults.
Federal guidance on mixing alcohol with medicines notes that combining alcohol with sedating medications can produce drowsiness, fainting, loss of coordination, and breathing difficulties.
Breathing Problems in Higher-Risk Situations
Breathing problems are the most serious concern and are especially relevant for people with certain risk factors. In December 2019, the FDA issued a drug safety warning that serious breathing difficulties may occur in people taking gabapentin or pregabalin who have respiratory risk factors, such as opioid use, other medicines that depress the central nervous system, underlying respiratory conditions such as COPD, or older age.
The FDA review identified 49 case reports of respiratory depression involving gabapentinoids submitted between 2012 and 2017, of which 12 resulted in death, and all of those cases involved at least one risk factor. However, these reports cannot establish how often respiratory depression occurs among all people taking gabapentin.
There is less evidence of serious breathing difficulties in otherwise healthy people taking gabapentin alone, although the FDA also cited a trial in healthy adults in which gabapentin increased pauses in breathing during sleep. Alcohol is itself a CNS depressant, so combining it with gabapentin can add to the overall sedating effects.
Who Faces the Highest Risk
The combination is not equally risky for everyone. Risk may be higher for people who:
Take opioid pain medications, benzodiazepines, sleep aids, muscle relaxants, or sedating antihistamines alongside gabapentin.
Have COPD, sleep apnea, or another condition that reduces lung function.
Are age 65 or older, since both sensitivity to sedation and fall risk can increase with age.
Have reduced kidney function, because gabapentin is cleared by the kidneys and can accumulate when kidney function is impaired.
Drink heavily or frequently rather than occasionally.
Have a history of substance use disorder.
National guidance on alcohol and medication interactions suggests that about 40% of U.S. adults took a medication in the past year that could interact negatively with alcohol.
This estimate rises to about 80% among adults age 65 and older who also took a similar medication. Older adults may face higher risk because of age-related changes in how the body responds to the medication and because they are more likely to take multiple medications overall.
Why Gabapentin is Sometimes Used for Alcohol-Related Treatment
There is a point of confusion worth clearing up. Gabapentin is sometimes prescribed specifically to help people reduce or stop drinking, which can make it seem as though the two can be mixed safely. However, these are different situations.
Gabapentin has been studied as an off-label treatment for alcohol use disorder, particularly for symptoms that make early sobriety difficult, such as insomnia, irritability, and anxiety.
A randomized clinical trial published in 2020 found that gabapentin reduced drinking among adults with alcohol use disorder who also had significant alcohol withdrawal symptoms. They suggested that the group taking gabapentin showed higher abstinence rates than the placebo group. An earlier randomized trial reported similar findings for alcohol dependence.
Gabapentin is not FDA-approved for alcohol use disorder, and this use involves medical supervision. Being prescribed gabapentin to help you stop drinking does not mean it is safe to drink while taking it. If this is your situation, follow the specific guidance from your prescriber rather than relying on information you read online.
Gabapentin Misuse and Alcohol
Gabapentin was long considered to have little potential for misuse. It is not a federally controlled substance, though some states have scheduled it independently. Evidence collected over the past decade is mixed.
A systematic review estimated gabapentin misuse at around 1% in the general population. The rates were much higher among people with gabapentin prescriptions and among people who misuse opioids. The review also found that when gabapentin was misused, it was frequently taken in combination with other substances, including opioids, benzodiazepines, and alcohol. A separate systematic review reported comparable findings and identified a history of substance use disorder as an important risk factor.
This matters when considering alcohol because combining multiple CNS depressants can increase the risk of excessive sedation and other serious effects.
How Long After Taking Gabapentin Can You Drink?
There is no officially recommended waiting period, and any specific number you encounter online is an estimate rather than a guideline. The answer depends on your dose, your dosing schedule, your kidney function, your age, other medications, and why you were prescribed gabapentin in the first place.
Gabapentin is usually taken two or three times a day, which means there is rarely a long period when none is active in your system. This makes “waiting it out” a less practical strategy than it might seem.
A more useful question for your prescriber is whether drinking is advisable for you at all, and if so, what to watch for. They can factor in your kidney function, your full medication list, and your reason for taking gabapentin in a way that general guidance cannot. The same caution applies to other psychiatric medications, including the interaction between Lexapro and alcohol.
When to Seek Medical Attention
Some symptoms warrant immediate help rather than waiting to see whether they pass. Call 911 or seek emergency care if you or someone else experiences:
Slow, shallow, or difficult breathing
Extreme sleepiness or difficulty staying awake
Unresponsiveness, or being difficult to rouse
Confusion or disorientation
Bluish coloring of the lips, fingers, or toes
Fainting or a fall resulting in injury
Do not leave someone alone to “sleep it off” if they show these signs. If you are unsure whether a situation is an emergency, the Poison Help line at 1-800-222-1222 is available 24 hours a day.
Talking to Your Prescriber
This conversation goes better when you are specific and honest about your alcohol intake and medications. Useful information to bring includes:
How much and how often you typically drink, described in actual drinks rather than general terms.
A complete list of your medications and supplements, including anything sedating.
Your reason for taking gabapentin and your current dose and schedule.
Whether you have kidney problems, lung problems, or sleep apnea.
Any episodes where you have felt unusually sedated or unsteady.
Prescribers ask about alcohol as part of routine care, and an accurate answer helps them provide more appropriate guidance. If drinking has become difficult to control, sharing that with your provider can also open the door to other effective treatment options.
How Blossom Health Can Help
Blossom Health is a psychiatry-first telehealth practice that connects people with board-certified psychiatric providers for virtual visits covered by in-network insurance. Providers on the team can prescribe, so questions about medication interactions, dose adjustments, and alcohol use can be discussed directly during psychiatric care.
The intake process is straightforward. You enter your state and insurance plan, pick an appointment time, and confirm a few details. Many people are seen within days, and the first visit is usually an hour-long video session covering your history, current medications, symptoms, and goals.
If your provider determines that a different type of care would serve you better, including specialized substance use treatment, they can help you explore those options. Check availability in your state and get started here.
Medical Disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or medication interaction. Never start, stop, or change a prescribed medication without consulting your provider. In a medical emergency, call 911. If you are experiencing a mental health crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988. For substance use treatment referrals, the SAMHSA National Helpline is available at 1-800-662-4357.
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