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Horizant

gabapentin enacarbil
Used for Postherpetic Neuralgia, Restless Leg Syndrome
Used for Postherpetic Neuralgia, Restless Leg Syndrome

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.

Reviewed by:
reviewer
Robert Chad Hakim, PharmD, BCCCP
reviewer
Kristianne Hannemann, PharmD
Last reviewed on July 10, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostAlternativesLatest newsImagesReferencesPricesMedicare
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What is Horizant (gabapentin enacarbil)?

What is Horizant (gabapentin enacarbil) used for?

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.

Are you looking for information on gabapentin immediate-release (Neurontin) or Gralise (gabapentin) instead?

Drug Facts

Common BrandsHorizant
Drug ClassAntiepileptic
Controlled Substance ClassificationControlled in some states. See FAQs below.
Generic StatusNo lower-cost generic available
AvailabilityPrescription only

More on Horizant (gabapentin enacarbil) essentials

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What are the 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%)

Other Side Effects

  • Dry mouth
  • Weight gain
  • Larger appetite
  • Blurry vision
  • Feeling irritable
  • Depression

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

Source: DailyMed

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The following 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

anxiety

concentration problems and change in school performance

crying

depression

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

chest pain

chills

cough

depression, irritability, or other mood or mental changes

fever

loss of memory

pain or swelling in the arms or legs

painful or difficult urination

sore throat

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

diarrhea

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

nausea

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

cold or flu-like symptoms

delusions

dementia

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

constipation

cough producing mucus

decrease in sexual desire or ability

dryness of the mouth or throat

earache

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

frequent urination

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

runny nose

sneezing

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

weight gain

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.

pros-and-cons

Pros and cons of Horizant (gabapentin enacarbil)

thumbs-up

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

thumbs-down

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

Pharmacist tips for Horizant (gabapentin enacarbil)

pharmacist

  • 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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                faqs

                Frequently asked questions about Horizant (gabapentin enacarbil)

                How does Horizant (gabapentin enacarbil) help with restless leg syndrome (RLS)?
                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.
                How long does it take Horizant (gabapentin enacarbil) to work?
                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.
                What is the difference between Horizant and gabapentin?
                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.
                Does Horizant (gabapentin enacarbil) cause weight gain?
                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.
                Can Horizant (gabapentin enacarbil) keep you awake?
                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).
                Can you take Horizant (gabapentin enacarbil) and gabapentin together?
                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.
                How long does Horizant (gabapentin enacarbil) stay in your system?
                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.
                Is Horizant (gabapentin enacarbil) a controlled substance?
                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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                What are the 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.

                risk-warning

                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.

                  risk-warning

                  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.

                    risk-warning

                    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.

                      risk-warning

                      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-warning

                      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.

                      dosage

                      Horizant (gabapentin enacarbil) dosage forms

                      Typical dosing 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 forms

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                      interactions

                      Interactions between Horizant (gabapentin enacarbil) and other drugs

                      Horizant (gabapentin enacarbil) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Horizant (gabapentin enacarbil). Please note that only the generic name of each medication is listed below.

                      More on Horizant (gabapentin enacarbil) interactions

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                      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.

                      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
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                      What are alternatives to Horizant (gabapentin enacarbil)?

                      There are a number of medications that your doctor can prescribe in place of Horizant (gabapentin enacarbil). Compare a few possible alternatives below.
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                      latest news

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                      images

                      Horizant (gabapentin enacarbil) images

                      White Oval Gs Lfg - Horizant 600mg Extended-Release Tablet
                      This medicine is White, Oval Tablet Imprinted With "Gs Lfg".White Oval Gs Lfg - Horizant 600mg Extended-Release Tablet

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                      References

                      Best studies we found

                      Azurity Pharmaceuticals, Inc. (formerly Arbor Pharmaceuticals). (2023). Horizant- gabapentin enacarbil tablet, extended release [package insert]. DailyMed.

                      Burke, R. A., et al. (2012). Review of the treatment of restless legs syndrome: Focus on gabapentin enacarbil. Journal of Central Nervous System Disease.

                      Chan, A. Y. L., et al. (2023). Gabapentinoid consumption in 65 countries and regions from 2008 to 2018: A longitudinal trend study. Nature Communications.

                      View All References (5)

                      Chincholkar, M. (2020). Gabapentinoids: Pharmacokinetics, pharmacodynamics and considerations for clinical practice. British Journal of Pain.

                      Patel, P. R., et al. (2023). Partial epilepsy. StatPearls.

                      Raouf, M., et al. (2017). Rational dosing of gabapentin and pregabalin in chronic kidney disease. Journal of Pain Research.

                      Silber, M. H., et al. (2021). The management of restless legs syndrome: An updated algorithm. Mayo Clinic Proceedings.

                      Thomas, B. M., et al. (2013). Gabapentin enacarbil extended release for the treatment of postherpetic neuralgia in adults. Therapeutics and Clinical Risk Management.

                      GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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