Compare Neurontin (Gabapentin) with Alternatives: What Works Better for Pain, Seizures, and Anxiety

Neurontin, the brand name for gabapentin, has been a go-to prescription for millions dealing with nerve pain, seizures, and anxiety. But as side effects pile up - dizziness, weight gain, brain fog - people are asking: Gabapentin really the best option? Or are there safer, more effective alternatives out there?

What Gabapentin Actually Does

Gabapentin was originally developed as an anti-seizure drug in the 1990s. It works by calming overactive nerves in the brain and spinal cord. Today, it’s prescribed off-label for conditions like diabetic nerve pain, post-shingles pain (postherpetic neuralgia), restless legs syndrome, and even social anxiety. The FDA only approved it for seizures and nerve pain, but doctors use it widely for other issues because it’s cheap and widely available.

But here’s the catch: studies show gabapentin doesn’t work well for everyone. A 2023 review in The Lancet Neurology found that only about 30-40% of patients with nerve pain saw meaningful relief. And side effects? Nearly half of users report drowsiness, swelling, or trouble concentrating. For older adults, the risks climb even higher - falls, confusion, even kidney strain.

Top Alternatives to Gabapentin

If gabapentin isn’t cutting it, or if side effects are too much, here are the most commonly used and researched alternatives.

Pregabalin (Lyrica)

Pregabalin is gabapentin’s close cousin - same class of drug, same mechanism, but stronger and faster. It’s FDA-approved for the same conditions: nerve pain, seizures, fibromyalgia. But unlike gabapentin, pregabalin has more predictable absorption. You don’t need to take it three times a day. Once or twice is often enough.

Studies show pregabalin works better for some types of nerve pain. A 2022 trial in Pain Medicine found that 55% of patients on pregabalin reported at least 50% pain reduction, compared to 41% on gabapentin. But it’s not cheaper - Lyrica costs nearly triple the price of generic gabapentin. And it’s more likely to cause weight gain and dizziness.

Carbamazepine (Tegretol)

Carbamazepine has been around since the 1960s. It’s one of the oldest seizure meds, but it’s also a top pick for trigeminal neuralgia - that sudden, stabbing facial pain. For this specific condition, carbamazepine often beats gabapentin.

It’s not without risks. It can lower white blood cell counts, cause liver issues, and interact with dozens of other drugs. Blood tests are needed every few months. But for people who don’t respond to gabapentin, it’s a proven backup. Many neurologists in the UK start with gabapentin, then switch to carbamazepine if pain returns.

Topiramate (Topamax)

Topiramate is primarily used for epilepsy and migraine prevention. But it’s also used off-label for nerve pain and anxiety. What makes it different? It doesn’t cause weight gain - in fact, many people lose weight on it. That’s a big plus for those struggling with gabapentin-induced weight gain.

Side effects? Brain fog, tingling in hands and feet, trouble finding words. It’s not ideal for people who need sharp focus, like drivers or office workers. But for someone with chronic pain and obesity, topiramate might be the better trade-off.

Duloxetine (Cymbalta)

Duloxetine is an SNRI antidepressant - not an anti-seizure drug. But it’s FDA-approved for diabetic nerve pain and fibromyalgia. It works by boosting serotonin and norepinephrine, two brain chemicals that help regulate pain signals.

A 2021 meta-analysis in JAMA Neurology found duloxetine was just as effective as gabapentin for nerve pain, but with fewer drowsiness-related side effects. People on duloxetine reported better sleep quality and less mental fog. The downside? It can cause nausea, dry mouth, and sometimes increased blood pressure. And like all antidepressants, it takes 2-4 weeks to kick in.

Physical Therapy and Non-Drug Options

Medication isn’t the only path. For many, combining drugs with physical therapy, acupuncture, or mindfulness reduces reliance on pills entirely.

A 2024 NHS trial tracked 500 people with chronic back pain. Half got gabapentin. The other half got weekly physiotherapy plus cognitive behavioural therapy (CBT). After six months, both groups had similar pain relief - but the non-drug group had fewer side effects and lower dropout rates.

For people with restless legs or mild anxiety, simple changes help: regular walking, avoiding caffeine after 3 PM, magnesium supplements. These aren’t magic bullets, but they’re low-risk and often overlooked.

How to Choose the Right Alternative

There’s no one-size-fits-all answer. Your best option depends on your condition, your body, and your lifestyle.

• If you have facial nerve pain (trigeminal neuralgia) → Try carbamazepine first.
• If you gained weight on gabapentin → Topiramate or duloxetine might help.
• If you need quick, strong relief → Pregabalin works faster and more reliably.
• If you’re older or at risk of falls → Avoid gabapentin and pregabalin. Try duloxetine or non-drug options.
• If anxiety is your main issue → Duloxetine or CBT may be better than gabapentin, which has limited evidence for anxiety.

Always talk to your doctor before switching. Stopping gabapentin suddenly can cause seizures or severe withdrawal - even if you’ve only been on it a few weeks. Tapering down over weeks is essential.

What Doctors Are Saying Now

In the UK, the National Institute for Health and Care Excellence (NICE) updated its guidelines in early 2025. They now recommend gabapentin and pregabalin only as second-line treatments for nerve pain - after trying antidepressants like duloxetine or non-drug therapies.

Why? Because the long-term risks are clearer now. Studies show people on gabapentin for over a year have higher rates of falls, fractures, and cognitive decline. The NHS is pushing to reduce prescriptions, especially for older adults.

Many GPs now start with duloxetine or physical therapy. Gabapentin is still prescribed, but it’s no longer the default.

Real Stories: What Worked for Others

Marjorie, 68, from Bristol, had diabetic nerve pain for five years. Gabapentin helped at first, but she started falling. Her doctor switched her to duloxetine. Within six weeks, her pain dropped by 60%. She lost 8 pounds. No more dizziness.

James, 42, had post-shingles pain. Gabapentin gave him brain fog. He tried topiramate - the tingling was annoying, but his mind cleared. He now walks 5 miles a day and doesn’t need pills on weekends.

These aren’t outliers. They’re examples of people who found better fits after gabapentin didn’t work.

When to Stick With Gabapentin

That said, gabapentin still has a place. If you’re young, healthy, and respond well with minimal side effects - stick with it. It’s affordable. It’s been used safely by millions.

But if you’re experiencing side effects, or if it’s not working after 6-8 weeks, don’t just power through. Ask your doctor about alternatives. There’s a better option out there for you.

Next Steps: What to Do Now

If you’re on gabapentin and it’s not working, or if side effects are getting worse:

1. Write down your symptoms: What’s improving? What’s getting worse?
2. Check your dosage - are you on the lowest effective dose?
3. Ask your doctor about switching to duloxetine, topiramate, or pregabalin.
4. Request a referral to physiotherapy or pain management if you haven’t already.
5. Don’t stop gabapentin on your own. Ask for a tapering plan.

The goal isn’t just to reduce pain - it’s to live better. There are options. You just need to ask for them.