Gabapentin cost: how to pay less for gabapentin and pregabalin

What gabapentin treats

Gabapentin is used to help control some seizures in people with epilepsy and to relieve the nerve pain of postherpetic neuralgia, the burning pain that can last after shingles. An extended-release form, Horizant, treats restless legs syndrome. Doctors sometimes prescribe it for other uses, such as diabetic nerve pain and hot flashes (MedlinePlus).

It comes as capsules, tablets, extended-release tablets and an oral solution. The regular forms are usually taken 3 times a day, with no more than 12 hours between doses. Extended-release tablets can’t be substituted for other forms (MedlinePlus). Ask your pharmacist whether a different strength or form of the generic costs less for the same daily dose, and don’t switch without your prescriber’s OK.

Gabapentin vs. pregabalin

Pregabalin is a related drug used for nerve pain from diabetes, shingles and spinal cord injury, for fibromyalgia and for some seizures (MedlinePlus). It’s sold as Lyrica and Lyrica CR (FDA).

MedlinePlus says pregabalin may be habit-forming and that it may take several weeks to feel its full benefit (MedlinePlus). If cost is the problem, ask your doctor whether the other drug is a reasonable option, then compare prices for both.

Safety rules that also protect your wallet

• Breathing problems. FDA warns that gabapentin and pregabalin can cause serious breathing difficulties in people who also take opioids or other drugs that slow the central nervous system, people with COPD and older adults. Get help right away for confusion, extreme sleepiness, slow or shallow breathing, unresponsiveness or bluish skin (FDA). In an emergency, call 911.
• Don’t stop suddenly. Stopping abruptly can cause anxiety, trouble sleeping, nausea, pain and sweating. Your doctor may lower the dose gradually over at least a week (MedlinePlus). Refill early enough that cost doesn’t force a gap.
• Antacids and alcohol. Take gabapentin at least 2 hours after antacids such as Maalox or Mylanta. Alcohol can add to the drowsiness it causes (MedlinePlus).
• Mood changes. In studies, about 1 in 500 people who took anti-seizure drugs had suicidal thoughts or behavior (MedlinePlus). If you or someone you know is in crisis, call or text 988.

Prevent the shingles pain in the first place

Postherpetic neuralgia follows shingles. CDC recommends 2 doses of the Shingrix vaccine for adults 50 and older and for adults 19 and older with weakened immune systems, and says it’s more than 90% effective at preventing shingles (CDC). With Medicare Part D, the shingles shot costs you nothing (Medicare.gov).

How to pay less

• Choose the generic. FDA says generic prices tend to drop as more companies make the same drug (FDA).
• Compare cash prices. Prices for the same prescription can differ from one pharmacy to the next. Check a free discount card such as RxGo before you fill.
• On Medicare? If your income is limited, apply for Extra Help. Drugs bought with a discount card instead of your plan don’t count toward your plan’s out-of-pocket limit (Medicare.gov).
• No insurance? HRSA-funded health centers charge on a sliding scale. Find one near you.