What happens when you take alcohol with gabapentin?
Gabapentin, sold as Neurontin, Gralise, and Horizant, is approved for epilepsy and postherpetic neuralgia and widely prescribed off-label for chronic pain, anxiety, restless legs syndrome, and alcohol use disorder itself. Alcohol is a central nervous system depressant. Combining the two produces additive sedation, dizziness, slowed reaction time, and — most dangerously — respiratory depression.
In December 2019, the FDA issued a Drug Safety Communication warning that gabapentin (and the related drug pregabalin) can cause serious, life-threatening respiratory depression when combined with CNS depressants. The FDA specifically cited alcohol, opioids, benzodiazepines, antihistamines, and older adults with reduced lung function as situations where the risk is greatest. The communication required label updates for all gabapentinoids.
Why is this important?
Gabapentin used to be considered low-risk because it does not cause classic opioid-style sedation in healthy young adults at therapeutic doses. The 2019 FDA action changed that picture. Post-marketing reports identified deaths from respiratory depression in patients taking gabapentin along with alcohol or opioids, and case-control studies found a substantial increase in opioid overdose risk among patients co-prescribed gabapentin.
The patients at highest risk are:
- Older adults (over 65)
- People with chronic lung disease (COPD, severe asthma, restrictive lung disease)
- People with sleep apnea (treated or untreated)
- Patients on opioids, benzodiazepines, muscle relaxants, antihistamines, or sleep aids
- People with a history of substance use disorder
- Patients with reduced kidney function (gabapentin is renally cleared; accumulating blood levels increase risk)
Gabapentin is also commonly used to treat alcohol use disorder, which creates a difficult clinical scenario. If a patient relapses on alcohol while taking gabapentin for alcohol cravings, the combination can be especially dangerous — they may consume alcohol on top of a medication that amplifies its sedating and respiratory depressant effects.
Beyond respiratory risk, the combination markedly worsens cognitive impairment, falls (especially in older adults), motor incoordination, and impaired driving. Gabapentin alone can cause dizziness in 17 to 28% of patients in clinical trials; adding alcohol multiplies this risk. Gabapentin can also worsen alcohol withdrawal-related mood changes and is itself associated with euphoria and misuse in some patients.
What should you do?
Avoid alcohol while taking gabapentin. This is not a soft recommendation — the FDA has explicitly flagged the combination as life-threatening for vulnerable patients. Be especially strict if you are over 65, have any lung disease, sleep apnea, kidney disease, or are also taking opioids, benzodiazepines, muscle relaxants, or sleep aids.
If your prescriber has cleared you for occasional drinking on a low gabapentin dose, keep it to one standard drink, never combine with any other depressant, do not drive afterward, and have someone with you the first time you try it. Watch for warning signs that require urgent care: severe drowsiness, slow or shallow breathing, blue lips or fingertips, confusion, unresponsiveness, or fainting.
If you are taking gabapentin for alcohol use disorder, the combination is especially concerning because a relapse drink can be more dangerous than the same drink would have been before treatment. Talk to your prescriber about a clear plan for managing relapses safely (including naloxone availability if you also use opioids).
Which specific products are affected?
The warning applies to all gabapentin products: Neurontin capsules, tablets, and oral solution, Gralise extended-release tablets, Horizant (gabapentin enacarbil) extended-release tablets, and all generic gabapentin formulations. Doses from 100 mg up to 3600 mg per day all carry the same warning. The closely related drug pregabalin (Lyrica) carries an essentially identical FDA warning.
Alcohol means any ethanol beverage — beer, wine, hard seltzer, spirits, fortified wines, cocktails. Other CNS depressants that compound the risk include opioids (oxycodone, hydrocodone, morphine, fentanyl, tramadol, codeine), benzodiazepines (alprazolam, lorazepam, clonazepam, diazepam), Z-drugs (zolpidem, eszopiclone), muscle relaxants (cyclobenzaprine, baclofen), sedating antihistamines (diphenhydramine, hydroxyzine), and cannabis. Combinations of three or more depressants are particularly dangerous.
The bottom line
The FDA has explicitly warned that gabapentin combined with alcohol or other CNS depressants can cause fatal respiratory depression, particularly in older adults and patients with lung disease. The combination also produces marked sedation, falls, and impaired driving. Avoid alcohol on gabapentin, be especially strict if you take opioids or benzodiazepines, and know the warning signs of respiratory depression so you can act quickly if they appear.