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LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-.

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LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].

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Last Update: July 30, 2020.



Gabapentin is a unique anticonvulsant that is used as adjunctive therapy in management of epilepsy and for neuropathic pain syndromes. Therapy with gabapentin is not associated with serum aminotransferase elevations, but several cases of clinically apparent liver injury from gabapentin have been reported.


Gabapentin (gab" a pen' tin) is a structural analogue of gamma-aminobutyric acid (GABA), but demonstrates little or no interaction with GABA receptors and does not appear to alter GABA uptake, synthesis or metabolism. While initially believed to act on the GABA-ergic neurotransmitter system, the actual mechanism of action of gabapentin as an anticonvulsant and agent for neuropathy is unknown. Gabapentin was approved for use in the United States in 1993 and is a widely used medication with more than 18 million prescriptions filled yearly. Current indications include add-on therapy for partial seizures which do not have adequate control with other anticonvulsants, and to reduce neuropathic pain from diabetic and postherpetic neuropathy. Gabapentin is available as capsules or tablets of 100, 300, 400, 600 and 800 mg and in oral solution for pediatric use generically and under the brand names Neurontin and Gabarone. The recommended initial dose for adults is 300 mg three times daily increasing as needed to a maximum dose of 1800 mg daily. The most common side effects of gabapentin are dose related and include dizziness, somnolence, tremor, ataxia, blurred vision, anxiety, and gastrointestinal upset or nausea. Rare, but potentially severe adverse events include hypersensitivity reactions such as angioneurotic edema, drug rash with eosinophilia with systemic manifestations (DRESS syndrome) and Stevens-Johnson syndrome.


Limited data are available on the hepatotoxicity of gabapentin. In clinical trials in diabetic neuropathy and epilepsy, therapy with gabapentin was not associated with an increased frequency of serum aminotransferase elevations or liver toxicity. Rare individual case reports of liver injury from gabapentin have been published, although the causal relationship of gabapentin with the liver injury was not always clear. The latency to onset in these reports was 1 to 8 weeks and associated with cholestatic pattern of enzyme elevations. Fever and rash have been described but not autoantibody formation. Reported cases have been mild to moderate in severity and self-limited in course. In view of the wide-scale use of gabapentin, liver injury with symptoms or jaundice is clearly quite rare.

Likelihood score: C (probable cause of clinically apparent liver injury).

Mechanism of Injury

The apparent absence or low rate of significant hepatotoxicity from gabapentin may be due to its minimal hepatic metabolism and rapid urinary excretion.

Outcome and Management

The case reports of hepatic injury due to gabapentin were followed by complete recovery without evidence of residual or chronic injury. No cases of acute liver failure or chronic liver injury due to gabapentin have been described. There is no information about cross reactivity with other compounds having similar structure (pregabalin). In general, gabapentin is well tolerated in patients with hypersensitivity reactions to other anticonvulsants.

Drug Class: Anticonvulsants



Gabapentin – Generic, Neurontin®




Product labeling at DailyMed, National Library of Medicine, NIH


Gabapentin 60142-96-3 C9-H17-N-O2 image 135006562 in the ncbi pubchem database


References updated: 30 July 2020

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    (Review of adverse event reports to the FDA between 2014 and 2018 identified ~2.9 million reports, 1034 for SJS/TEN, the most common class of drugs being anticonvulsants with 17 of 34 having at least one report, those most frequently linked being lamotrigine [n=106], carbamazepine [22], levetiracetam [14], phenytoin [14], valproate [9], clonazepam [8], zonisamide [7], gabapentin [4] and pregabalin [4]; no mention of accompanying liver injury or whether attribution was as a single agent or one of several).
  • Cano-Paniagua A, Amariles P, Angulo N, Restrepo-Garay M. Epidemiology of drug-induced liver injury in a University Hospital from Colombia: Updated RUCAM being used for prospective causality assessment. Ann Hepatol. 2019;18:501–7. [PubMed: 31053545]
    (Among 286 patients with liver test abnormalities seen in a single hospital in Colombia over a 1 year period, 17 were diagnosed with drug induced liver injury, the most common cause being antituberculosis therapy [n=6] followed by anticonvulsants [n=3, 1 each due to phenytoin, gabapentin and valproate]).


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