Gabapentin, widely thought harmless, carries a respiratory depression warning for use with opioids and sedatives
The gabapentin label, section 5.8: evidence from case reports, human and animal studies links it "with serious, life-threatening, or fatal respiratory depression when coadministered with CNS depressants, including opioids."
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: The 2019 FDA notice, as reported at the time, said the evidence for breathing problems in otherwise healthy people taking a gabapentinoid alone was limited; the label warning is specific to co-prescription with CNS depressants and to existing lung disease. That notice was not read for this row because it is no longer hosted.
Gabapentin is prescribed for nerve pain, seizures, and off-label for anxiety and sleep. In 2019 the FDA added a breathing warning to its label. This is what the label now says.
Significant findings
NEURONTIN prescribing information (Viatris, August 2026), section 5.8, Respiratory Depression: "There is evidence from case reports, human studies, and animal studies associating gabapentin with serious, life-threatening, or fatal respiratory depression when coadministered with CNS depressants, including opioids, or in the setting of underlying respiratory impairment."
What it asks of the prescriber: "When the decision is made to co-prescribe NEURONTIN with another CNS depressant, particularly an opioid, or to prescribe NEURONTIN to patients with underlying respiratory impairment, monitor patients for symptoms of respiratory depression and sedation, and consider initiating NEURONTIN at a low dose. The management of respiratory depression may include close observation, supportive measures, and reduction or withdrawal of CNS depressants (including NEURONTIN)."
The same label's section 5.6 is the reason not to act on this alone: "Antiepileptic drugs should not be abruptly discontinued because of the possibility of increasing seizure frequency. When NEURONTIN is being discontinued, the dose should be tapered over at least a one-week period." It adds that withdrawal symptoms, and suicidal behaviour and ideation, have been reported after discontinuation.
Worth asking
Gabapentin is often added to a regimen that already contains a benzodiazepine, an antipsychotic or an opioid, precisely because it is thought to be the safe one. The label says the risk is in the stacking. Ask the prescriber which sedating drugs you are on, whether gabapentin is being started at a low dose because of them, and what symptoms of slowed breathing to watch for. The Gomes 2017 row in this wave gives the size of the opioid risk.
Source
NEURONTIN (gabapentin): FDA-approved prescribing information, Warnings and Precautions 5.6 and 5.8 — Viatris Specialty LLC; US Food and Drug Administration (2026)
Regulator or national health body
How this was scored
- Study design
- Regulatory safety determination
- Funding
- Industry funded
- Published in
- Regulator or national health body
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 21, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "moderate evidence". Reasonable evidence with real limitations. It scores 57 out of 100 on our published rubric. One caveat travels with that badge: The 2019 FDA notice, as reported at the time, said the evidence for breathing problems in otherwise healthy people taking a gabapentinoid alone was limited; the label warning is specific to co-prescription with CNS depressants and to existing lung disease. That notice was not read for this row because it is no longer hosted. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
NEURONTIN (gabapentin): FDA-approved prescribing information, Warnings and Precautions 5.6 and 5.8 — Viatris Specialty LLC; US Food and Drug Administration (2026). Published in: Regulator or national health body. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Regulatory safety determination. Funding: Industry funded. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.