Gabapentin is a drug that doctors sometimes prescribe off-label to reduce hot flashes during menopause. Instead of affecting hormones, experts think 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 it can be effective in reducing their frequency.

However, using gabapentin comes with some risks that people need to know before taking it. There are also some risks of taking it alongside some other medications.

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

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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

GABA analogs contain a derivative of GABA, a neurotransmitter. In the body, GABA is responsible for slowing down nerve activity. GABA analog drugs work differently, although scientists are not sure exactly how.

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

Experts are not certain how gabapentin helps with hot flashes, but they believe it may 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. Because of this, gabapentin also works for males who have hot flashes due to hormone therapy for prostate cancer.

Gabapentin appears to be effective for 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 could reduce hot flashes in comparison with a placebo.

However, compared with estrogen, gabapentin was still less effective for treating hot flashes. Between gabapentin and antidepressants, researchers found no differences.

However, an older 2011 study showed that gabapentin can be as effective as hormone therapy within 12 weeks of treatment. Another older study in the Journal of Research in Pharmacy Practice 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 at reducing hot flashes within around 4 weeks of taking it consistently. And while some may feel a benefit sooner than this, it may take longer for other individuals.

The 2011 study found that gabapentin had similar effects to estrogen for reducing hot flashes after 3 months of treatment.

Since gabapentin is not FDA-approved for hot flashes, information on dosages comes from doctors’ experiences and clinical studies.

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

Other studies have used doses as low as 100 mg and 300 mg per day and still 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 this in mind, doctors may start with the lowest dose and see how a person tolerates it. If necessary, they may increase the dosage.

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

  • dizziness
  • drowsiness
  • swelling in the limbs

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

Rarer and more serious adverse effects can include:

Therefore, it is vital that friends and family are aware of this drug’s potential adverse effects and know how to spot the signs that a person may be considering suicide.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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

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

People can also absorb less gabapentin if they also take antacids that contain 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 the medication for managing seizures, doctors will wean people off the drug to prevent seizures. Weaning off a medication involves progressively lowering the dose until the person stops taking the drug entirely.

It is unclear if people taking gabapentin for hot flashes need to wean off the drug, but doctors have reported typical withdrawal symptoms after someone stops 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 an oral pill.

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

The following table lists estrogen treatment options for hot flashes:

Brand nameGeneric nameType of drug
Climaraestradioltransdermal patch
Brand name discontinuedmicronized estradioloral
Estrace creammicronized estradiolcream
Estringestradiol ringvaginal ring
Femringestradiol acetatevaginal ring
Premarinconjugated estrogenoral
Premarin vaginalconjugated estrogencream
Vagifemestradiolvaginal tablet

While many people tolerate HT well, some prefer nonhormonal options. Certain antidepressants, and a blood pressure medication known as clonidine, have shown effectiveness in reducing hot flashes.

Lifestyle changes may also help reduce hot flash frequency and intensity, while others may make it easier to cope when they occur. People can try:

  • avoiding alcohol and caffeine
  • avoiding spicy food and any other hot flash triggers they notice
  • reducing stress and practicing relaxation techniques
  • drinking cool liquids
  • wearing loose, light layers of clothing that are easy to remove
  • using a fan at night or while working
  • maintaining a moderate weight

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

However, there are some risks that come with gabapentin. It can cause dizziness or drowsiness, particularly in the first few weeks of taking it. It also increases the risk of suicidal thoughts, and some may experience withdrawal symptoms when they stop taking it.

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