Alternatives to Gabapentin: Possible Substitute for Nerve Pain

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Medically reviewed by Dr. Ola Tarabzuni

Key Takeaways

  • Gabapentin is commonly used for epilepsy and neuropathic pain, but alternative medications can be considered.
  • Pregabalin, duloxetine, amitriptyline, and carbamazepine are alternative medications for nerve pain.
  • Consult a healthcare professional before switching medications to ensure a safe transition.


Recently, gabapentin‘s many uses and promising effects have made it a topic of intense interest. It is also known by the brand names Neurontin and Gralise. It is an anticonvulsant used to treat epilepsy and prevent or reduce the severity of seizures. It is, however, used to treat a variety of conditions, including neuropathic pain, restless legs syndrome, fibromyalgia, and nerve-related pain.

Pregabalin (Lyrica), duloxetine (Cymbalta), amitriptyline (Elavil), and carbamazepine (Tegretol) are some alternatives of Gabapentin. Each medication has its own set of uses, side effects, and dosing instructions. This blog provides an overview of gabapentin alternatives for nerve pain.

Alternatives to Gabapentin

When finding alternatives to gabapentin, several options are worth considering. These alternative medications can be used for similar purposes, such as managing epilepsy, neuropathic pain, and other conditions.

Here are more details about the alternatives to Gabapentin:

Pregabalin (Lyrica)

Pregabalin has benefits similar to gabapentin, another medication used for similar purposes, but it may have its side effects and dosing considerations. Pregabalin, also known by the brand name Lyrica, is a medication used to treat epilepsy and neuropathic pain, including diabetic neuropathy and fibromyalgia. The mode of action involves reducing abnormal brain electrical activity and calming overactive nerve signals.

Pregabalin Side effects

Pregabalin is a medication used to treat a wide variety of conditions, but it can have unwanted side effects in some people. Pregabalin’s common adverse effects include gaining weight, dizziness, dry mouth, and excessive sleepiness. 

Other, more serious side effects, such as swelling in the extremities, allergic reactions, mood changes, and alterations in behavior, are less common but nonetheless important to be aware of.

Pregabalin Dosage

To achieve therapeutic effect while minimizing side effects, Pregabalin treatment is typically initiated at a low dose and increased gradually under the supervision of a healthcare professional.

Pregabalin comes in a variety of dosages and preparations. Tablets of 2.5 mg, 165 mg, 330 mg, and a 20 mg/ml oral solution are all available. Capsules come in a range of strengths, from 25 milligrams to 300 milligrams. The diagnosis being treated determines the exact dose that will be prescribed.

Duloxetine (Cymbalta)

Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) like duloxetine raise levels of happy neurotransmitters in the brain. Duloxetine, also known as Cymbalta, is a medication that is used to treat a variety of conditions, including diabetic peripheral neuropathy and fibromyalgia. It’s also commonly used to manage depression and anxiety.

Side Effects of Duloxetine

Common unwanted effects include nausea, constipation, drowsiness, and dry mouth. There are, however, a number of less common but potentially more serious side effects to keep in mind. These include fluctuations in blood pressure, liver issues, and the possibility of serotonin syndrome. Seek immediate medical attention if you experience any of these less common side effects or if you have any concerns about your medication.

Dosage of Duloxetine

According to National Health Service(NHS), Duloxetine 60 mg daily is considered effective against nerve pain. The 60 mg Duloxetine dose can be increased to twice daily.

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Amitriptyline (Elavil)

Tricyclic antidepressants (TCAs) like amitriptyline (Elavil) are effective in treating depression. The primary use of amitriptyline is for the treatment of depression, but it has also shown promise in alleviating neuropathic pain and migraine headaches.

Amitriptyline increases levels of neurotransmitters in the brain, like serotonin and norepinephrine, which aid in mood regulation and pain relief. Amitriptyline can help reduce the intensity and frequency of nerve-related pain by affecting these neurotransmitters.

Side Effects of Amitryptiline

Common side effects may include: 

Less common but more severe side effects may include:

  • Changes in heart rhythm
  • Allergic reactions
  • Mood changes

Dosage Of Amitryptiline

Under medical supervision, the dosage is typically started low, between 10 and 25 mg, and increased over time.

Read More: How Does Gabapentin Help Nerve Pain?

Carbamazepine (Tegretol)

Carbamazepine, also known by the brand name Tegretol, is an anticonvulsant and mood stabilizer medication used to treat various neurological and psychiatric conditions for decades. Because of its similar mechanism of action and efficacy in treating specific conditions, it is considered an alternative to gabapentin in some situations.

Carbamazepine and gabapentin are prescribed to patients experiencing epileptic seizures and neuropathic pain, respectively. However, whereas gabapentin primarily modulates specific calcium channels in the brain, carbamazepine exerts its effects via various mechanisms, including sodium channel blocking and decreased excitatory neurotransmitter release.

Because of the variety of its mechanisms of action, carbamazepine may be more effective in some cases of epilepsy and neuropathic pain that do not respond well to gabapentin. Carbamazepine’s primary use is in the management of epilepsy, but it also has a place in the management of neuropathic pain.

Side Effects of Carbamazepine

Common side effects may include: 

Less common but more severe side effects may include:

  • Allergic reactions
  • Blood disorders
  • Liver problems

Under medical supervision, the dosage is usually started low and increased over time.

The table below better summarizes the information about alternatives to Gabapentin:

Alternative MedicationUsesBenefitsSide EffectsDosing Considerations
Pregabalin (Lyrica)Epilepsy, neuropathic pain (diabetic neuropathy, fibromyalgia)Similar benefits to gabapentin.Dizziness, drowsiness, weight gain, dry mouthDosage varies based on condition, starts low, and increases gradually under medical supervision
Duloxetine (Cymbalta)Neuropathic pain (diabetic peripheral neuropathy, fibromyalgia), depression, generalized anxiety disorderEffective for pain and mood disorders.Nausea, dry mouth, drowsiness, constipationDosage varies based on condition, starts low and increases gradually under medical supervision
Amitriptyline (Elavil)Neuropathic pain, migraines, depressionEffective for pain and mood disordersDrowsiness, dry mouth, constipation, blurred visionDosage varies based on condition, starts low and increases gradually under medical supervision
Carbamazepine (Tegretol)Epilepsy, neuropathic painPrimarily used for epilepsy, it can also manage neuropathic painDizziness, drowsiness, nausea, rashDosage varies based on condition, starts low, and increases gradually under medical supervision

What is the long-term damage from Gabapentin?

When taken as directed, gabapentin is generally well-tolerated and safe. Like any medication, however, it is not without its risks and side effects.

The most common adverse reactions to Gabapentin, as reported by the National Institutes of Health’s journal StatPearls, include:

  • Fatigue
  • Dizziness
  • Headache

Long-term use of gabapentin may be associated with some considerations as:

Dependence and Withdrawal

If you’ve been taking gabapentin regularly, you may develop a physical dependence on it. If you suddenly stop taking it, you may experience withdrawal symptoms like anxiety, insomnia, nausea, and sweating. Therefore, it’s essential to follow your healthcare professional’s instructions when discontinuing gabapentin.

Cognitive Effects

Some individuals may experience cognitive side effects from long-term gabapentin use, such as drowsiness, dizziness, confusion, and difficulty concentrating. It is essential to assess how these side effects may affect daily activities that require mental alertness, such as driving or operating machinery.

Mood Changes

Gabapentin has been associated with mood changes in some individuals, including an increased risk of suicidal thoughts or behaviors. Talk to your doctor right away if you take gabapentin and notice any changes in your mood or mental health.

Kidney Function

Rare cases of kidney damage or dysfunction have been reported with long-term use of gabapentin, particularly in individuals with pre-existing kidney conditions.Kidney function testing may be required on a routine basis.

Respiratory Depression

In rare instances, gabapentin may cause respiratory depression, especially when combined with other medications that have a similar effect, such as opioids. This risk is higher in individuals with underlying respiratory conditions or when high doses of gabapentin are used.

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Read More: Does Gabapentin Aid in Sleep and Anxiety?

Precautions Before Switching

It is important to speak with a medical professional before making any changes to your current medication regimen.

Here are some situations in which it is recommended to consult a healthcare professional:

Current Medication Regimen

Discuss a medical professional if you are taking gabapentin or any other medication. They can evaluate your situation, medical history, and medication regimen to guide switching to an alternative medication.

Underlying Medical Conditions

Before switching medications, especially if you have a history of health problems. It may be necessary to make adjustments to a patient’s medication regimen in light of certain medical conditions.

Allergies or Sensitivities

Communicating with your doctor about any allergies or sensitivities you may have to drugs or ingredients is crucial. They can help identify potential allergens or interactions to ensure the alternative medications that suit you.

Side Effects or Adverse Reactions 

If you have experienced any concerning side effects or adverse reactions to gabapentin or any other medications, it is essential to seek immediate medical attention.

Individual Response to Medications

Everyone’s response to medications can vary. If you have had a poor response or inadequate symptom relief with gabapentin, it is essential to discuss this with your healthcare professional. They can consider alternative medications that may be more effective for your condition.

Dosing and Titration

Switching to an alternative medication may require specific dosing adjustments and a titration plan. Proper dosing and titration of a new medication require open communication between the patient and the healthcare provider.

Consult a doctor

Professional medical advice should never be ignored when it comes to health concerns. If you need a prescription filled or have any other health-related questions, don’t hesitate to contact Your Doctors Online.

With the help of Your Doctors Online, you can contact qualified medical experts who offer sympathetic assistance, and show you the way to better health.

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FAQs About Alternatives to Gabapentin

Can you buy gabapentin over the counter?

No, gabapentin is a prescription medicine and is unavailable over the counter (OTC) in most countries.

Which is better for pain, gabapentin or amitriptyline?

Both gabapentin and amitriptyline can be effective in managing pain. However, there are a several factors to consider when deciding between the two, such as the source of the pain, the patient’s response, and any negative effects.

What is the best tablet for nerve pain?

Pregabalin and Gbaapentin are known to be the most effective against nerve pain.

Your Doctors Online uses high-quality and trustworthy sources to ensure content accuracy and reliability. We rely on peer-reviewed studies, academic research institutions and medical associations to provide up-to-date and evidence-based information to the users.

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  • American Family Physician. Substituting gabapentin for opioids has significant downsides
  • Harvard Medical School. Drugs that relieve nerve pain
  • WebMD. Gabapentin and Lyrica for Pain Control
  • Baldwin DS, Ajel K, Masdrakis VG, Nowak M, Rafiq R. Pregabalin for the treatment of generalized anxiety disorder: an update. Neuropsychiatr Dis Treat. 2013;9:883-92. doi: 10.2147/NDT.S36453. Epub 2013 Jun 24. PMID: 23836974; PMCID: PMC3699256.
  • Bockbrader HN, Budhwani MN, Wesche DL. Gabapentin to pregabalin therapy transition: a pharmacokinetic simulation. Am J Ther. 2013 Jan;20(1):32-6. doi: 10.1097/MJT.0b013e318250f80e. PMID: 23018586.
  • Wiffen PJ, Derry S, Bell RF, Rice AS, Tölle TR, Phillips T, Moore RA. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017 Jun 9;6(6):CD007938. doi: 10.1002/14651858.CD007938.pub4. PMID: 28597471; PMCID: PMC6452908.

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