Horizant
Horizant (gabapentin enacarbil) is FDA-approved to treat restless leg syndrome (RLS) and nerve pain from shingles in adults. This medication belongs to the drug class called antiepileptics. Horizant (gabapentin enacarbil) is an extended-release tablet that's taken by mouth. It's generally taken once per day for RLS and twice per day for shingles-related nerve pain. Side effects include sleepiness, dizziness, and headache.
What is Horizant (gabapentin enacarbil)?
What is Horizant (gabapentin enacarbil) used for?
- Restless leg syndrome (RLS) in adults
- Nerve pain from shingles in adults
How Horizant (gabapentin enacarbil) works
Horizant (gabapentin enacarbil) is an antiepileptic. It's a prodrug of gabapentin. This means that Horizant (gabapentin enacarbil) turns into gabapentin after it gets absorbed into the body.
It's not clear how Horizant (gabapentin enacarbil) treats restless leg syndrome or nerve pain caused by shingles. But it has a similar structure to gamma-aminobutyric acid (GABA), a chemical in the body that calms nerves.
Drug facts
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Side effects of Horizant (gabapentin enacarbil)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Restless leg syndrome
- Sleepiness (up to 27%)
- Dizziness (up to 22%)
- Headache (up to 15%)
- Nausea (up to 7%)
- Fatigue (up to 7%)
Shingles-related nerve pain
- Dizziness (up to 30%)
- Sleepiness (up to 14%)
- Headache (up to 10%)
- Fatigue (up to 10%)
- Nausea (up to 9%)
- Swelling in arms, feet, or ankles (up to 7%)
- Trouble sleeping (up to 7%)
Less Common Side Effects
- Dry mouth
- Weight gain
- Larger appetite
- Blurry vision
- Feeling irritable
- Depression
Horizant (gabapentin enacarbil) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious allergic reaction or serious skin reaction: hives, rash, blisters, skin reddening, fever, swelling of the lips or tongue, difficulty breathing
- Suicidal thoughts or behaviors
- Breathing problems
More on Horizant (gabapentin enacarbil) side effects
The following Horizant (gabapentin enacarbil) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Clumsiness or unsteadiness
continuous, uncontrolled, back-and-forth, or rolling eye movements
More common in children
Aggressive behavior or other behavior problems
concentration problems and change in school performance
crying
false sense of well-being
hyperactivity or increase in body movements
rapidly changing moods
reacting too quickly, too emotional, or overreacting
restlessness
suspiciousness or distrust
Less common
Black, tarry stools
chills
depression, irritability, or other mood or mental changes
loss of memory
pain or swelling in the arms or legs
painful or difficult urination
sores, ulcers, or white spots on the lips or in the mouth
swollen glands
unusual bleeding or bruising
unusual tiredness or weakness
Incidence not known
Abdominal or stomach pain
blistering, peeling, or loosening of the skin
clay-colored stools
coma
confusion
convulsions
dark urine
decreased urine output
difficult or troubled breathing
dizziness
fast or irregular heartbeat
headache
increased thirst
irregular, fast or slow, or shallow breathing
itching or skin rash
joint pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
muscle ache or pain
pale or blue lips, fingernails, or skin
red skin lesions, often with a purple center
red, irritated eyes
unpleasant breath odor
vomiting of blood
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Blurred vision
delusions
hoarseness
lack or loss of strength
lower back or side pain
swelling of the hands, feet, or lower legs
trembling or shaking
Less common or rare
Accidental injury
appetite increased
back pain
bloated or full feeling
body aches or pain
burning, dry, or itching eyes
change in vision
change in walking and balance
clumsiness or unsteadiness
congestion
cough producing mucus
decrease in sexual desire or ability
dryness of the mouth or throat
excess air or gas in the stomach or intestines
excessive tearing
eye discharge
feeling faint, dizzy, or lightheadedness
feeling of warmth or heat
flushed, dry skin
flushing or redness of the skin, especially on the face and neck
fruit-like breath odor
impaired vision
incoordination
increased hunger
increased sensitivity to pain
increased sensitivity to touch
increased thirst
indigestion
noise in the ears
pain, redness, rash, swelling, or bleeding where the skin is rubbed off
passing gas
redness or swelling in the ear
redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
sweating
tender, swollen glands in the neck
tightness in the chest
tingling in the hands and feet
trouble sleeping
trouble swallowing
trouble thinking
twitching
unexplained weight loss
voice changes
vomiting
weakness or loss of strength
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Horizant (gabapentin enacarbil)
Pros
- Works well to treat both RLS and shingles-related nerve pain
- Taken once or twice per day, depending on whether you're treating RLS or nerve pain from shingles
Cons
- Can't crush or chew the tablets, so might not be a good option for people who can't swallow pills easily
- Can raise your risk of having suicidal thoughts or behavior
- No lower-cost generic available; brand name only
Pharmacist tips for Horizant (gabapentin enacarbil)
- Take Horizant (gabapentin enacarbil) with food at 5 PM. Food helps your body absorb the medication better. And if you aren't able to take Horizant (gabapentin enacarbil) at this recommend time, skip the dose and wait until the next day at 5 PM to take the medication at your usual dose.
- Swallow the Horizant (gabapentin enacarbil) tablet whole with a full glass of water. Don't chew, break, or crush it. This can damage the tablet, cause the medication to get released into the body too quickly, and put you at risk for side effects.
- Horizant (gabapentin enacarbil) commonly causes dizziness and sleepiness. These side effects can make it harder for you to think clearly and react quickly. Don't drive or do anything that you need complete concentration for until you know how this medication affects you.
- Avoid drinking alcohol while you're taking Horizant (gabapentin enacarbil). Mixing alcohol with the medication can worsen side effects like sleepiness, dizziness, and slowed breathing.
- Horizant (gabapentin enacarbil) can raise the risk of having suicidal thoughts. Contact your prescriber if you or your loved ones notice any new or worsening changes in your behavior or mood while you're taking this medication. And call 911 right away if you have any thoughts of harming yourself.
- Tell your prescriber and pharmacist about all of the medications you're taking or planning to take. Horizant (gabapentin enacarbil) can interact with some medications. Taking it with benzodiazepines or opioids can raise your risk for side effects, such as sleepiness, dizziness, and dangerously slow breathing. Check with your care team about whether your medications are safe to take together.
- Take Horizant (gabapentin enacarbil) exactly as prescribed. Don't change your dose or suddenly stop taking the medication without talking to your prescriber first. Otherwise, this can lead to withdrawal symptoms like nausea, anxiety, and sleeping problems. Speak with your prescriber if you're interested in lowering the dose or stopping the medication so they can give you instructions on how to do that safely.
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Common questions about Horizant (gabapentin enacarbil)
The way Horizant (gabapentin enacarbil) works to help with restless leg syndrome (RLS) isn't known. But there are several studies showing that Horizant (gabapentin enacarbil) works well to treat moderate-to-severe symptoms of RLS, such as sensory and motor symptoms, trouble sleeping, daytime sleepiness, and impact on daily activities. It's one of the first-choice options recommended by treatment guidelines for RLS.
It's not completely clear how long it takes Horizant (gabapentin enacarbil) to work for you because everyone can have different experiences with treatment. But a clinical study showed that people with restless leg syndrome who took Horizant (gabapentin enacarbil) started to see improvement in their symptoms, the effect on their sleep, and the impact on daily activities within 2 weeks. Another clinical study found that people with shingles-related nerve pain who took the medication felt improvement within a week of treatment. Keep in mind that it can take about a month or two to get the maximum benefit from the medication. Talk to your prescriber if you're concerned with how well Horizant (gabapentin enacarbil) is working for you.
Horizant (gabapentin enacarbil) is an extended-release form of gabapentin (Neurontin). In fact, Horizant (gabapentin enacarbil) is a prodrug of gabapentin, which means that it turns into gabapentin after it gets absorbed into the body. Horizant (gabapentin enacarbil) and gabapentin are both approved for nerve pain from shingles, but they're also approved for different additional medical conditions. Horizant (gabapentin enacarbil) is also approved for restless leg syndrome, whereas gabapentin (Neurontin) is also approved for a certain type of seizure. In addition, Horizant (gabapentin enacarbil) is taken once or twice per day but gabapentin (Neurontin) is taken up to three times per day. Talk to a healthcare professional to learn more.
It's possible for you to gain weight while you're taking Horizant (gabapentin enacarbil). Overall, it's not a common side effect, but weight gain might be more likely to happen at higher doses. In clinical studies, just up to 5% of people who took Horizant (gabapentin enacarbil) reported weight gain. Keep in mind that some people also had a larger appetite during treatment, and that could contribute to weight gain. It's not clear how much weight these people gained during treatment, though. Discuss with your care team about planning balanced and nutritious meals that include with lean proteins, whole grains, fruits, and vegetables. They can also work with you to build an exercise routine that's best for you to help manage your weight. Talk with your prescriber if you have more questions about Horizant (gabapentin enacarbil) and weight gain.
It's possible for Horizant (gabapentin enacarbil) to keep you awake. But it's generally more common for the medication to make you sleepy. In clinical studies for shingles-related nerve pain, up to 30% of people who took Horizant (gabapentin enacarbil) reported sleepiness whereas up to 7% of people who took the medication reported having trouble sleeping at night. Pay attention to how this medication affects your sleep and let your prescriber know of any changes in your sleep patterns. Your prescriber can recommend tips if it's making you too sleepy throughout the day or keeping you up at night. They might also recommend you to take a lower dose of Horizant (gabapentin enacarbil).
No, don't take Horizant (gabapentin enacarbil) with any other form of gabapentin, such as immediate-release gabapentin (Neurontin) or Gralise (gabapentin). Horizant (gabapentin enacarbil) is a prodrug of gabapentin. This means that once Horizant (gabapentin enacarbil) gets absorbed into your body, it gets broken down to gabapentin. So taking Horizant (gabapentin enacarbil) together with other forms of gabapentin can cause you to have too much gabapentin in your body. This can put you at risk for serious side effects like sleepiness, dizziness, and suicidal thoughts and behaviors.
It takes about a day for most of Horizant (gabapentin enacarbil) to leave your body after you take a single dose. This time frame is estimated based on the half-life of gabapentin. The medication can stay in the body for a longer period of time if you have kidney problems. This is because the kidneys help get rid of the medication from your system. Talk with your healthcare team if you have any specific concerns about how long Horizant (gabapentin enacarbil) stays in your body.
The federal government doesn't classify Horizant (gabapentin enacarbil) and gabapentin as controlled substances. But Horizant (gabapentin enacarbil) and gabapentin can be potentially misused because the medications can cause a "high" when they're not taken properly and when they're taken at higher doses. Some states might classify Horizant (gabapentin enacarbil) and gabapentin as controlled substances or have strict dispensing regulations for these medications. Keep in mind that state laws can change. So, it's best to speak with your prescriber or pharmacist about whether Horizant (gabapentin enacarbil) is a controlled substance in your state and how to take the medication safely.
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Risks and warnings for Horizant (gabapentin enacarbil)
Horizant (gabapentin enacarbil) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Difficulty concentrating, sleepiness, and dizziness
- Risk factors: Taking high doses of Horizant (gabapentin enacarbil) | Drinking alcohol | Taking other medications that can cause sleepiness
Horizant (gabapentin enacarbil) can sometimes make you dizzy or sleepy. This can lower your ability to think, react, and focus. These side effects should get better after a few weeks. Note that your risk for these side effects might be higher if you're also taking other medications that can make you feel sleepy, such as benzodiazepines, muscle relaxants, and sleep medications. Make sure you know how Horizant (gabapentin enacarbil) affects you before driving a car or doing activities that require your concentration. Talk to your prescriber right away if you feel too sleepy from the medication.
Suicidal thoughts or behavior
- Risk factors: Depression
Horizant (gabapentin enacarbil) can raise the risk of having thoughts of suicide or harming yourself. Sometimes, this can happen as early as 1 week after you start taking Horizant (gabapentin enacarbil). Get medical help right away if you or anyone around you notices that you have suicidal thoughts or unusual behavior (e.g., symptoms of depression, anxiety, panic attacks, feeling angry or irritated, restlessness) while you're taking this medication.
Dangerously slow breathing (respiratory depression)
- Risk factors: Taking medications that can cause slow breathing | Drinking alcohol | Medical conditions that cause breathing problems (e.g., COPD, asthma)
Your breathing can get dangerously slow if you take Horizant (gabapentin enacarbil) with other medications that can slow your body down, such as benzodiazepines and opioids. This can also happen if you drink alcohol with Horizant (gabapentin enacarbil). Call 911 as soon as possible if you or your loved ones notice that you're having trouble breathing or that you have bluish-colored lips, fingers, or toes while you're taking this medication.
Severe allergic reactions and skin reactions
Severe allergic reactions to Horizant (gabapentin enacarbil) are possible, including life-threatening reactions like facial swelling and anaphylaxis (e.g., closing of the throat). Although rare, Horizant (gabapentin enacarbil) can also cause serious skin reactions, such as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. Stop taking this medication and get medical attention right away if you have a fever, swelling in your face, trouble breathing, or changes in your skin (e.g., rash, blisters, swollen lymph nodes, skin reddening or peeling).
Risk for withdrawal symptoms
Suddenly stopping Horizant (gabapentin enacarbil) can sometimes cause withdrawal symptoms to happen. These symptoms can include nausea, anxiety, nervousness, and irregular heart rhythm. Withdrawal symptoms might be more likely to happen if you've taken the medication for a long time and you suddenly stop treatment. Don't change your dose or stop taking Horizant (gabapentin enacarbil) without talking to your prescriber first. They'll help you lower your dose slowly over time before you can stop the medication completely.
Horizant (gabapentin enacarbil) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 600mg | 30 tablets | $544.00 | $18.13 |
| 300mg | 30 tablets | $545.62 | $18.19 |
Typical dosage for Horizant (gabapentin enacarbil)
- Restless leg syndrome: The typical dose is 600 mg by mouth once daily with food around 5 PM.
- Nerve pain caused by shingles: The typical dose is 600 mg by mouth once daily with food in the morning for 3 days, then 600 mg by mouth twice daily with food.
Your dose might differ if you have kidney problems.
More on Horizant (gabapentin enacarbil) dosage
Interactions between Horizant (gabapentin enacarbil) and other drugs
More on Horizant (gabapentin enacarbil) interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acepromazine
- Alfentanil
- Alprazolam
- Amobarbital
- Anileridine
- Aripiprazole
- Asenapine
- Baclofen
- Benperidol
- Benzhydrocodone
- Bromazepam
- Buprenorphine
- Buspirone
- Butabarbital
- Butorphanol
- Calcifediol
- Calcium Oxybate
- Cannabidiol
- Carbinoxamine
- Carisoprodol
- Carphenazine
- Chloral Hydrate
- Chlordiazepoxide
- Chlorpromazine
- Chlorzoxazone
- Clobazam
- Clonazepam
- Clorazepate
- Clozapine
- Codeine
- Cyclobenzaprine
- Dexmedetomidine
- Diacetylmorphine
- Diazepam
- Dichloralphenazone
- Difenoxin
- Dihydrocodeine
- Diphenhydramine
- Diphenoxylate
- Doxylamine
- Droperidol
- Enflurane
- Esketamine
- Estazolam
- Eszopiclone
- Ethchlorvynol
- Ethopropazine
- Ethylmorphine
- Fentanyl
- Flibanserin
- Flunitrazepam
- Fluphenazine
- Flurazepam
- Fluspirilene
- Fospropofol
- Gabapentin Enacarbil
- Halazepam
- Haloperidol
- Halothane
- Hexobarbital
- Hydrocodone
- Hydromorphone
- Hydroxyzine
- Isoflurane
- Ketamine
- Ketazolam
- Ketobemidone
- Levocetirizine
- Levorphanol
- Lorazepam
- Loxapine
- Magnesium Oxybate
- Meclizine
- Melperone
- Meperidine
- Mephobarbital
- Meprobamate
- Meptazinol
- Mesoridazine
- Metaxalone
- Methadone
- Methdilazine
- Methocarbamol
- Methohexital
- Methotrimeprazine
- Methylene Blue
- Midazolam
- Molindone
- Moricizine
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Nicomorphine
- Nitrazepam
- Nitrous Oxide
- Olanzapine
- Opium
- Opium Alkaloids
- Orlistat
- Orphenadrine
- Oxazepam
- Oxycodone
- Oxymorphone
- Papaveretum
- Paregoric
- Pentazocine
- Pentobarbital
- Perampanel
- Perazine
- Periciazine
- Perphenazine
- Phenobarbital
- Pimozide
- Piperacetazine
- Pipotiazine
- Piritramide
- Potassium Oxybate
- Prazepam
- Pregabalin
- Primidone
- Prochlorperazine
- Promazine
- Promethazine
- Propofol
- Quazepam
- Quetiapine
- Ramelteon
- Remifentanil
- Remimazolam
- Remoxipride
- Secobarbital
- Sertindole
- Sodium Oxybate
- Sufentanil
- Sulpiride
- Suvorexant
- Tapentadol
- Temazepam
- Thiethylperazine
- Thiopental
- Thiopropazate
- Thioridazine
- Tilidine
- Tizanidine
- Tolonium Chloride
- Topiramate
- Tramadol
- Triazolam
- Trifluoperazine
- Trifluperidol
- Triflupromazine
- Trimeprazine
- Zaleplon
- Zolpidem
- Zopiclone
- Zotepine
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aluminum Carbonate, Basic
- Aluminum Hydroxide
- Aluminum Phosphate
- Dihydroxyaluminum Aminoacetate
- Dihydroxyaluminum Sodium Carbonate
- Ginkgo
- Magaldrate
- Magnesium Carbonate
- Magnesium Hydroxide
- Magnesium Oxide
- Magnesium Trisilicate
How much does Horizant (gabapentin enacarbil) cost?
$544.00
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