Family member and prescription drug

[Jifmicroliquid]

I don’t know where else to turn for help because it’s probably not a problem that requires help at this stage, but it’s causing massive amounts of stress to our family

A very close family member who I will call Y is prescribed gabapentin for a degenerative back problem. They only take this in the evening because it affects them very badly and just 1 tablet makes them have a personality transplant. They slur, lie, become forgetful and clumsy and behave like a totally different person. They have done things like leaving the oven on, the bath running etc, when they have had this drug.
Y does not live alone and her behaviour when under the influence is causing massive problems with her family, who intensely dislike the person she becomes and the atmosphere she brings to every evening. Family members are now retreating to bedrooms early to remove themselves from the situation but one family member has to stay around to ensure Y doesn’t burn the house down.
It’s important here to point out that Y has had a problem with alcohol in the past. Even a small amount causes the same personality transplant and after a few awful months last year, they agreed to stop drinking (which they mostly have) but basically the Gabapentin has replaced the alcohol.

As a family we have tried sitting with Y when she is sober to explain how her behaviour is impacting the family. We have suggested they go back to the GP to try and get the tablets changed to something that might suit her better. Or we ask that she takes the Gabapentin just before bed. When sober, she seems to understand and agree with this. Says she doesn’t understand why the tablets affect her that way and promises she will go back to the GP or not take them until before bed. We’ve had all the promises, all the ‘I won’t touch them again, I’m so sorry’. A few weeks ago she did something really stupid while under the influence and was very upset and promised not to take them again.

This lasts a couple of days, evenings return to normal and the family come back together… and then she takes them again. She can’t help herself.
There has been no attempt to contact the GP to see if there are any alternatives.

Has anybody been in a similar situation? I don’t know what more we can do.

She’s taking a prescribed medication. She isn’t ‘under the influence’ or ‘not sober’.

Are you sure she isn’t drinking? I say this as someone who actually is sober (from alcoholism). I’ve taken Gabapentin for pain in the past. I didn’t take a massive dose, but I definitely didn’t have this sort of reaction (though I’ve heard it can cause fatigue and make people a bit woozy). The aggression though sounds like someone who has relapsed. That’s just my immediate thought.

If this was my family member, I would call the GP myself and express concerns about the effects of the dosage they are on. It may prompt a medication review.

Thank you for the reply. I suppose I just call it ‘under the influence’ because I can’t think of another way to describe it.

I do think it is just the tablets, though I don’t know for sure. She certainly has hidden drinking in the past and used to get caught swigging from the bottle with her head in the cupboard. This was around the time it all came to a head about her drinking. She doesn’t have to drink much alcohol to have the same reaction as the tablets seem to do to her. Just half a glass of wine makes her behave like she’s steaming drunk and she’s always been the same. It’s really strange and she now agrees that her and alcohol don’t mix.

She is genuinely the loveliest and most caring human being you could ever meet by day, to the point that you wouldn’t believe it was the same person in the evening once she has taken her tablets. I think this is why it is causing such friction, because it’s like a Jekyll and Hyde thing and it’s extremely upsetting to see.

Is she either taking more than prescribed, or taking it with alcohol?

Also how long has she been taking it for? If she's only just started taking it, it may start to affect her less as she gets used to it, while hopefully still having the pain killing effect

As a person who works in pharmacy and takes gabapentin myself, I've never ever came across a person having this amount of side effects and so severaly. Maybe for the first couple of weeks while the body gets used to the new drug, but not to that extreme.... how long has she been on it for and at what dose? I'd be leaning more towards thinking she's back on the drink or taking more than prescribed of the medication

She used to take 2 tablets but now apparently takes 1. She could barely walk without stumbling when she took 2 and some of her most dangerous behaviour occurred around this time. I would still say that her behaviour from taking 1 tablet is similar to that of a person who has had several alcoholic drinks. When we confront her about her behaviour and ask if she’s taken her tablets, her standard reply is “I’ve only taken 1”.

She started taking them about 18 months ago and it has been causing problems ever since. When she did mix them with alcohol (there was a crossover time), it was really awful.

As a family we are finding it so distressing, but it probably sounds so trivial that 1 or 2 tablets is causing this. I wish I could explain the change in her but it’s like a stranger inhabits her body and she talks absolute nonsense.

Interestingly in the morning she has zero memory of conversations or anything that happened. You can have a big row with her and by morning she has forgotten and acts totally normally with you and you just know she has no recollection of it. When you ask if she remembers the conversation we had at the dining table, she will look blankly at you. Then she goes quiet because it dawns on her how much she is being affected because she has no clue what’s happened. Thats when the “it won’t happen again, I’m so sorry” talk starts.
Except it happens again that evening.

Record her behaviour. You have the option to show it to her.

Make notes. Send notes to her GP, offer them the video and ask them to consider a medication review. They won't necessarily engage with you, but they do need to know what's going on.

I take Amitriptyline. Before gabapentin, she was prescribed Amitriptyline and she behaved strangely on this, but not to the extent that the gabapentin does. At the time we were amazed that she was on the same dose as me on the same tablets but behaving like she was absolutely plastered. But she said it did nothing for her pain so she went back to the GP and that’s how she ended up on Gabapentin.

Normally I would totally agree that such a low dose couldn’t cause effects like this, but if you saw her after just half a glass of wine, you would be really shocked. I don’t know if she just has a very low tolerance or something? I’ve never seen anything like it in my life.

I took gabapentin for a week.

I was like this. It was really, really, really bad.

My then H took me to the gp and we got something else.

Thank you. This is actually what another family member has suggested we do.
Would I just email her GP?

It does worry me that she’s going to have an accident or cause an accident.

I took gabapentin 3 times a day for about 3 months for post hepatic neuralgia. I had absolutely no symptoms like that, at all. I know everyone is different and people can be affected differently, but I was told I might feel drowsy, or woozy or lightheaded. But nothing like you're describing was even mentioned as a possibility.

I really would be suspicious it's something else she's taking or drinking.

Is it even helping her pain if she's taking such a low dose only once a day? I'm not surprised she's taking it earlier than bedtime, if that's what she's doing, she must be in agony - it's quite a short acting painkiller, it's usually taken 3 times a day to keep it at a level that's controlling pain.

I wouldn’t think it can be doing anything for the pain at such a low dose, but she seems so out of it that it’s definitely doing something.

I have tried to word it to her that if she goes to the GP again, maybe she can have something that she can actually take the full dose off and it might help the pain more. A win win situation. But I genuinely think she is a bit addicted to the way it makes her feel.
Though I’m starting to wonder if she’s just so sensitive to drugs that this would happen whatever she took.

Oh that’s quite interesting, maybe it does just affect people in a strange way.

Do you mind if I ask if you find you are quite sensitive to the effects of alcohol too?

I have taken this med in the past and it did feel very strong initially (felt drunk, dizzy, couldn’t think properly etc) but i got used to this over a few days. I can see how someone would feel like this but in the long term it sounds weird, surely she’d self report and have a dose change or switch meds. I was closely monitored until my dose was correct and side effects stabilised.

When she's clear minded ask for another family member to hold onto the med and they give it out just before bed. Keep it under lock and key. It's a safety hazard. Either that or they need to find somewhere else to live.

10 - 1 she's drinking.

@Jifmicroliquid

I had an accident 10 years ago and have been on painkillers etc since so no alcohol for 10 years.

But yes, before that it only took a couple of drinks and I was under the table.

She does also take other medications for things like a thyroid issue, depression and a couple of other health problems, so perhaps it’s not agreeing with other meds she has?

Thank you all for your advice, I shall certainly take it all on board and speak to the family about it.

I can remember understand the drugged up look, when I first started taking gabapentin my late dp said I looked like a heroin addict, I was stoned & dribbling. I've been on it for over 15 years now & am on a much higher dose with no side effects. You may want to suggest that your relative goes back to the doctor & discusses if swapping to pregablin would be better, it is from the same family of drugs but sometimes one suits better than the other.

My mum was hospitalised several times and utterly confused with that awful stuff. We had no idea what was causing the slurring, falling and confusion until a family friend told us it could be that.
Got it sorted with a doctor and she was taken off it and all of those symptoms stopped. She is teetotal and took it correctly.

My mum recently was trialled on gabapentin for pain and after one tablet she said she felt completely out of it and could only sit in her chair. She couldn’t really have a conversation or do anything. My mum immediately decided not to take any more as she did not like feeling that way.
Do you think that maybe this person feels like being able to blame this behaviour on medication is more acceptable? She is getting a similar feeling to alcohol maybe, but it’s “allowed” because it’s medication. That may explain the reluctance to actually change the tablet.

Can you or another family member accompany her to a medication review at GP or pharmacy, just to look for any contra-indications or accidental over prescribing. I had some bloods tested recently and Dr said you've got some kidney damage that I'd expect to see from over use of Ibuprofen or other NSAI medicines. Don't take any more. I was bewildered as I rarely take an Ibuprofen. Got home and reached for the analgesic gel that I use several times a day. Oh. It must be that, bugger. I barely considered it as a medicine. So it's easily done in ignorance. Get a review.

I was on gabapentin for a few months. I was like Y like a personality transplant. I was prescribed it for neuopathic pain.

Like Y I was slurring, forgetful, clumsy and sometimes stumbling around and like a totally different person ditto to leaving the oven on, the bath running etc. I was difficult to reason with and verbally aggressive at times and my partner realised that the sudden change happened just as I started this medication. I would also split up with him several times a day but when he would leave the room, I was confused as to why he was upset, forgetting that I had just split up. I don't remember the majority of this time. It's a blank to me.

I tried to persevere with it and around the one month mark I was at 300mg per day as prescribed by GP who was the aware of the previous from my partner speaking to her but because I don't always react as I should to meds, we were trying to stick with it. My partner was in weekly contact with the GP and we had seen her together several times during this time.

When I hit 300mg, the problems got a lot worse suddenly and I became homicidal and suicidal. The homicidal was towards my partner. I do love him really.

So I would spend an hour or 2 each evening telling him all the ways I wanted to kill him and then I'd go to sleep, apparently I was pretty creative in my methods. That went on for 4 or 5 days and then I turned to face the wall in an almost catatonic state, I didn't sleep eat drink or speak just lay staring at the wall.

Long story short I was taken off it over a couple of weeks in a psych unit and while I remember very little that time. It was due to the gabapentin and gp never asked me to persevere with any medication again.

I was then tried on lamotrigine to help with pain, poor partner got the brunt of it again as I spent two weeks hiding under the bed because of the hit squad who was out to get me. That was another admission to a psych ward to come off it. Symptoms went within 48 hours of stopping the medication..

I was also tried on Lyrica which is similar to gabapentin and a couple of other things along the same type of lines and each of those got me and another trip to the psych ward. I don't react as Im meant to a lot of meds and over an 18 month period I had five admissions all due to prescribed medication.

There was never any alcohol involved during these cases. I do have an occasional drink but I don't go over 14 units in a year so it wasn't a big factor.

It does sound like an extreme reaction. Could someone else take charge of her medication and give it to her just before bed? Otherwise does she take a lot of other medication - could it be an interaction?

I would expect the GP to change the med in those circumstances. She could try Lyrica - I know some people also react badly to this but it is supposed to have fewer side effects compared to Gabapentin. I take 250mg Lyrica a day in divided doses and yes it makes me tired, I have some brain fog and can be a little dizzy. But nothing extreme!

It sounds like they are in the addiction stage of gabapentin. Memory loss is a side affect of gabapentin addiction. And if she's taking it for 18 months I would bet she is taking more that the required dose.

Edit to add: This is not a medication to just be stopped as it can have dangerous consequences. It would need to be stopped very slowly with the GP observation.

Really appreciating the advice and it’s interesting (though scary) to hear it has had a similar impact on other people.

I am going to have another chat with Y today, find out what dosage she takes and see if she will hand them over to someone to monitor when she takes them. Last night we had a pretty big bust up about it, but I know she won’t remember a thing this morning.