If you’re living with myasthenia gravis (MG), you know how important it is to carefully manage your medications. Myasthenia gravis is a chronic (long-term) autoimmune disorder that causes muscle weakness, especially in the muscles you control voluntarily, like those in your face, arms, and legs. This happens because the immune system disrupts the signals between nerves and muscles, making it harder for your brain to tell your muscles what to do.

One medication you may have heard about is gabapentin, which is often prescribed to treat nerve pain, seizures, and other conditions. However, is gabapentin safe for people with myasthenia gravis? This article will explore the potential risks and benefits.

What Is Gabapentin?

Gabapentin is used to treat seizures and nerve pain. Doctors commonly prescribe this medication for:

• Neuropathic (nerve) pain — Helps manage pain from nerve damage, such as diabetic neuropathy (nerve pain from uncontrolled diabetes) and postherpetic neuralgia (pain after shingles)
• Seizures — Used as part of a treatment plan for epilepsy
• Restless legs syndrome — Helps reduce uncomfortable sensations and the urge to move the legs
• Off-label uses — Sometimes prescribed for anxiety, migraine, or other conditions not officially approved by the U.S. Food and Drug Administration (FDA)

Gabapentin works by calming overactive nerves in the brain and body. It doesn’t cure the underlying condition but helps reduce symptoms such as pain or abnormal electrical activity in the brain. Specifically, gabapentin attaches to certain proteins called calcium channels in the nervous system, lowering the release of neurotransmitters — chemical messengers that signal pain or seizures. This process makes gabapentin useful for nerve-related conditions, but it also raises questions about how it might affect disorders that affect nerves and muscles, like myasthenia gravis.

Understanding Myasthenia Gravis

Before exploring how gabapentin might affect myasthenia gravis, it’s important to understand what myasthenia gravis is and how it works. Myasthenia gravis is an autoimmune disease, which means the immune system mistakenly attacks the body’s own tissues. In myasthenia gravis, the immune system targets neuromuscular junctions, the connection points between nerves and muscles. These junctions act like tiny bridges that let nerve signals tell muscles to move.

In people with myasthenia gravis, the immune system blocks or damages receptors for acetylcholine (ACh), a chemical that helps muscles contract. When acetylcholine receptors are blocked, muscles don’t get the proper signals, leading to weakness and fatigue (extreme tiredness that does not improve with rest). This weakness can affect the eyes, face, throat, arms, legs, and even breathing muscles.

MG symptoms can get worse with activity and improve with rest. Common symptoms include:

• Ptosis (drooping eyelids)
• Diplopia (double vision)
• Dysphagia (difficulty swallowing)
• Slurred speech
• Weak arms or legs

Myasthenia gravis disrupts communication between nerves and muscles. Because gabapentin affects nerve signaling, it’s important to consider its potential impact carefully before starting it. You may wonder whether gabapentin could influence myasthenia gravis in helpful or harmful ways.

How Might Gabapentin Negatively Affect Myasthenia Gravis?

There’s little research on how gabapentin specifically affects people with myasthenia gravis. Most available information comes from general studies on gabapentin or case reports (individual experiences) rather than large-scale studies. Because of this, gabapentin’s effects on myasthenia gravis aren’t fully known, but it’s important to consider the potential risks.

One concern is that gabapentin could worsen muscle weakness, leading to an exacerbation (flare-up of symptoms) or, in severe cases, a myasthenic crisis, which is a medical emergency.

Gabapentin works by changing nerve signaling. In myasthenia gravis, nerve-to-muscle communication is already weakened, so gabapentin might disrupt these signals even more, potentially increasing weakness. For example, if gabapentin reduces the release of certain neurotransmitters, it may become even harder for muscles to receive the signals they need to move.

In addition, gabapentin can cause drowsiness, dizziness, and fatigue as adverse effects. For someone with myasthenia gravis, who may already experience muscle weakness and exhaustion, these side effects could make daily activities even harder.

When Might Gabapentin Be Helpful?

Despite the risks, gabapentin may still be useful for some people with myasthenia gravis, especially those who experience nerve pain or other conditions that gabapentin is known to help treat. For example, gabapentin could help relieve burning, tingling, or shooting sensations, which are common with nerve damage.

If other medications don’t work well or cause worse side effects, gabapentin might be a reasonable option. For people who can’t tolerate traditional pain medications such as opioids or anti-inflammatory drugs, gabapentin may be a potential alternative.

Because gabapentin may pose risks for people with myasthenia gravis, it’s important to discuss the treatment with a healthcare provider who understands both the condition and the medication.

What Should I Consider Before Taking Gabapentin for Myasthenia Gravis?

If you’re thinking about gabapentin, here are some important factors to keep in mind:

Consult Your Doctor

Always talk with your healthcare provider before starting or stopping any medication. They can help you weigh the risks and benefits based on your specific situation. Your doctor may also consult with a neurologist (a specialist in brain, nerve, and muscle disorders) or pharmacist to determine whether gabapentin is a safe option for you.

Monitor for Side Effects

If you do start gabapentin, pay close attention to how you feel. Watch for signs of increased weakness, greater fatigue, or other side effects like dizziness, swelling, or difficulty concentrating. Keeping a symptom diary can help you track changes and share them with your doctor.

Be Aware of Drug Interactions

Gabapentin can interact with other medications, including those used to treat myasthenia gravis. Make sure your doctor knows all the medications and supplements you’re taking. For example, combining gabapentin with muscle relaxants or other medications that cause drowsiness could increase the risk of drowsiness or weakness.

Start Low and Go Slow

If your doctor prescribes gabapentin, they’ll likely start you on a low dose and gradually increase it. This helps reduce side effects and lets you see how your body responds.

Report Any Changes

If you notice new or worsening symptoms, let your doctor know right away. They may need to change your treatment plan. For instance, if you develop significant weakness or trouble breathing, your doctor might recommend stopping gabapentin or trying a different medication.

What Does the Research Say?

Because there is little research specifically on gabapentin and myasthenia gravis, most concerns are based on what’s known about how the medication works and how MG affects the body. For example, one 2021 study suggested that medications affecting the nervous system, like gabapentin, could potentially worsen muscle weakness in people with myasthenia gravis. However, more research is needed to fully understand this relationship.

The lack of research doesn’t mean gabapentin is unsafe for everyone with myasthenia gravis, but it does mean it should be used with caution. If you’re considering gabapentin, your doctor may recommend close monitoring or trying other treatment options first. For example, physical therapy, lifestyle changes, or alternative medications might be safer ways to manage MG symptoms like pain or fatigue.

The Bottom Line: Is Gabapentin Safe for Myasthenia Gravis?

There’s no simple answer. Gabapentin might be safe for some people with myasthenia gravis, especially those managing nerve pain or other conditions that gabapentin is commonly used to treat. However, there’s a possibility that this medication could worsen muscle weakness or fatigue, so it’s important to approach it with caution.

More studies are needed to fully understand how gabapentin affects people with myasthenia gravis. In the meantime, the best approach is to work closely with your healthcare provider. Your doctor can help you weigh the risks and benefits, explore alternative treatments, monitor your symptoms, and adjust your MG treatment plan as needed.

Talk With Others Who Understand

On MGteam, the social network for people with myasthenia gravis and their loved ones, more than 2,800 members come together to ask questions, give advice, and share their stories with others who understand life with myasthenia gravis.

Are you considering taking gabapentin? Have you discussed the pros and cons with your healthcare provider? Share your experience in the comments below, or start a conversation by posting on your Activities page.