Gabapentinoid misuse, dependence and breathing problems

Gabapentin and pregabalin belong to a group called gabapentinoids. They calm overactive nerve signalling, which makes them useful in nerve pain, some forms of epilepsy and, for pregabalin, generalised anxiety. They are prescription-only medicines and controlled drugs under UK law, a status introduced because of misuse concerns.

For many patients, they are appropriate and effective. The issue addressed here is not that they should be avoided, but that the same sedating and mood-altering effects that help symptoms can attract misuse and cause harm when combined with other substances.

The NHS pages for both medicines state that some people can become addicted and have withdrawal symptoms when they stop. Misuse can mean taking more than prescribed, taking them for the relaxed or euphoric feeling, taking someone else's supply or combining them with other drugs. Problems are more common in people with a history of substance misuse, and in those taking opioids.

In January 2026 the MHRA listed on its Drug Safety Update an item on improving the information supplied with gabapentinoids, benzodiazepines and z-drugs, describing a review of the warnings about addiction, dependence, withdrawal and tolerance. We have only seen the listing for that update, so check the MHRA publication itself for its full advice. The direction of travel, however, is toward clearer warnings in leaflets and prescribing information.

Signs that use may be becoming a problem include needing more for the same effect, strong preoccupation with the next dose, running out early, feeling anxious or unwell between doses and continuing despite harm. These are reasons to talk to the prescriber rather than reasons for shame.

The MHRA's October 2017 Drug Safety Update reported that gabapentin may rarely cause severe respiratory depression, with trouble breathing and shallow breaths that may need emergency care. It described the risk as affecting up to 1 in 1,000 patients, and noted 50 Yellow Card reports of respiratory depression or breathlessness between February 1996 and September 2017, of which 17 involved opioids. The risk exists even without opioids.

The groups it identified as at greater risk were older people, those with compromised respiratory function or respiratory disease, patients with neurological disease, those with kidney impairment, people taking other central nervous system depressants and those using opioids. The updated patient leaflet advised seeking medical help if breathing becomes difficult or shallow.

Most of those groups are common among people who receive gabapentinoids, which is why prescribers consider dose adjustments and monitor closely when starting, increasing or combining them with sedating medicines. The NHS pregabalin page asks patients to tell the doctor before starting if they take strong opioids, and notes that pregabalin can make drowsiness and dizziness from other medicines worse.

Many side effects are mild and fade, but several deserve attention.

The NHS advice is clear: do not stop suddenly. For pregabalin, it says stopping suddenly can cause serious problems, including seizures if you have epilepsy, anxiety, trouble sleeping, nausea, pain and sweating. Gradual dose reduction under medical supervision is the safe route, and the plan should fit the amount and length of use.

If you have been taking more than prescribed, be honest with the prescriber, because the safe way to reduce depends on what you are actually taking. Support may include a slower taper, help from a local drug and alcohol service and psychological support. Cutting down alone from a high, unprescribed intake carries risk.

• Never double up on missed doses to catch up.

• Do not swap with friends or family; prescriptions are individual.

• Keep a record of how much you take and when.

• Ask for a review if the medicine is no longer helping the original problem.

The NHS advises that if you have taken more pregabalin than prescribed you should seek emergency care via A&E or 999 if you have drowsiness, confusion, agitation, seizures or loss of consciousness, and otherwise contact NHS 111. Take the packaging with you. The risk of stopped or slowed breathing is much higher if opioids, alcohol or benzodiazepines are also involved, so tell staff everything that was taken.

For someone who is hard to wake or breathing very slowly, call 999 immediately and place them on their side if breathing. Support for dependence is available from GPs and local drug and alcohol services without judgement.

Prescribers weigh the history of substance misuse, other sedating medicines, age, kidney function and breathing problems before and during treatment. Reviews check whether the medicine is still helping, and whether the dose can be reduced. Prescriptions are limited in quantity because of the controlled drug status. Reporting suspected reactions through the Yellow Card scheme, which the NHS also encourages, helps regulators keep track of rare harms.