Gabapentin for hot flashes: effects, risks and dosage

Gabapentin is a drug that doctors sometimes prescribe off-label to reduce hot flashes. Instead of affecting hormones, experts believe it may act on the hypothalamus, the part of the brain that regulates body temperature.

The Food and Drug Administration (FDA) has not approved the official use of gabapentin for hot flashes. However, clinical studies show that can be effective by reducing their frequency.

However, using gabapentin comes with some risks that people should be aware of before taking it. There are also risks in taking it with other medications.

In this article, we’ll explore what gabapentin is, how long it takes to work, side effects, and more.

Gabapentin is a prescription drug that doctors typically use for seizures as well as nerve pain due to the herpes zoster virus. It is part of the class of anticonvulsant medications known as gamma-aminobutyric acid (GABA) analogs.

GABA analogues contain a derivative of GABA, a neurotransmitter. In the body, GABA is responsible for slowing nerve activity. GABA-like drugs work differently, although scientists aren’t sure exactly how.

The FDA has not approved the use of gabapentin for hot flashes, but doctors can prescribe it off-label.

Experts aren’t sure about gabapentin’s effect on hot flashes, but they believe it can act on the hypothalamus. This part of the brain controls temperature regulation.

This means that, unlike other treatments for hot flashes during menopause, gabapentin does not affect estrogen levels. For this reason, Gabapentin also works for men who have hot flashes due to hormone therapy for prostate cancer.

Gabapentin appears to be effective in reducing hot flashes, although potentially not as effective as estrogen therapy.

A 2019 review and meta-analysis in the American Journal of Obstetrics and Gynecology found that out of 19 studies, many showed evidence that gabapentin may reduce hot flashes compared to a placebo.

However, compared to estrogen, gabapentin was even less effective in treating hot flashes. Between gabapentin and antidepressants, the researchers found no difference.

However, a older study from 2011 showed that gabapentin can be as effective as hormone therapy within 12 weeks of treatment. Another older study in the Pharmaceutical Practice Research Journal showed similar benefits, with participants taking estrogen reporting similar reductions in hot flashes as those taking gabapentin.

Several clinical studies have shown that gabapentin becomes effective in reducing hot flashes within about 4 weeks of taking it regularly. And while some may feel a benefit sooner than that, it may take longer for other people.

The 2011 study found that gabapentin had estrogen-like effects in reducing hot flashes after 3 months treatment.

Because gabapentin is not FDA-approved for hot flashes, dosage information comes from physicians’ experiences and clinical studies.

In a 2016 overview, the authors said that gabapentin doses for hot flashes range between 900 and 2,400 milligrams (mg) per day.

Other studies have used doses as low as 100mg and 300mg per day and always found favorable results. However, in the latter case, doses of 300 mg per day were the most effective and were similar to 0.625 mg per day of estrogen.

With that in mind, doctors can start with the lowest dose and see how a person tolerates it. If necessary, they can increase the dosage.

Gabapentin can cause side effects. Some of the most commonly reported side effects include:

  • dizziness
  • drowsiness
  • limb swelling

In one study, gabapentin side effects were more noticeable at first 1 to 2 weeks of treatment but lowered to the same levels as the placebo group over time.

Rarer and more serious side effects may include:

Therefore, it is essential that friends and family are aware of the potential adverse effects of this medication and know how to spot the signs that a person is considering suicide.

Gabapentin may interact with certain medications. Because it calms and inhibits the nervous system, this drug can amplify any other drug that acts as a depressant. This includes:

Combining gabapentin with these drugs can cause respiratory depression, which is when breathing becomes very slow and inefficient. It is a potentially fatal condition.

People may also absorb less gabapentin if they also take antacids containing aluminum hydroxide and magnesium hydroxide (Maalox). Doctors recommend taking gabapentin at least 2 hours after either of these medications.

Yes, Gabapentin can cause withdrawal symptoms, especially if a person stops taking it suddenly.

When taking medication to manage seizures, doctors will wean people off the medication to prevent seizures. Withdrawing from a drug involves gradually decreasing the dose until the person stops taking the drug completely.

It’s not known if people taking gabapentin for hot flashes need to wean themselves off the drug, but doctors have reported typical withdrawal symptoms after someone stopped a high dose. These include:

If people have concerns about this, they should speak with their doctor.

The first-line treatment option for hot flashes due to menopause is usually hormone therapy (HT).

Topical options, such as creams, gels, sprays, or patches, may have fewer side effects than taking a tablet. Vaginal tablets and rings are other options for people who do not wish to take oral pills.

However, oral HT may be more effective than topical options. Individuals may also find it helpful to take progesterone with estrogen.

The following table lists estrogen treatment options for hot flashes:

While many people tolerate HT well, some prefer non-hormonal options. Certain antidepressants and a blood pressure medication known as clonidine have been shown to be effective in reducing hot flashes.

Lifestyle changes can also help reduce the frequency and intensity of hot flashes, while others can make it easier to manage when they occur. People can try:

  • avoid alcohol and caffeine
  • avoiding spicy foods and any other hot flash triggers they notice
  • reduce stress and practice relaxation techniques
  • drink cool fluids
  • wear loose, lightweight layers that are easy to remove
  • use a fan at night or while working
  • maintain a moderate weight

Gabapentin is an anticonvulsant drug that some people use for hot flashes. Although the FDA has not approved this drug for hot flashes, it is an effective option for some people. It may be an alternative to HT for those who cannot take estrogen.

However, gabapentin carries some risks. It may cause dizziness or drowsiness, especially during the first few weeks of taking. It also increases the risk of suicidal thoughts, and some may experience withdrawal symptoms when they stop taking it.

A person can talk with a doctor about the benefits and risks of gabapentin for hot flashes.

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