Gabapentin Alternatives: Options for Pain, Anxiety, and Withdrawal

Gabapentin helps a lot of people, but it isn't right for everyone. Maybe it caused side effects, didn't work well, or your doctor wants a different option. Below are practical alternatives — both prescription meds and non-drug choices — explained in plain terms so you can discuss them with your clinician.

Common prescription alternatives

Pregabalin (Lyrica) — Works like gabapentin and often helps nerve pain and some anxiety symptoms. It can be more predictable in dose, but it still may cause dizziness, sleepiness, or weight gain.

Duloxetine (Cymbalta) — An antidepressant that helps many people with neuropathic pain and fibromyalgia. It can improve mood and pain together, but watch for nausea, dry mouth, and sleep changes.

Amitriptyline or nortriptyline — Older tricyclic antidepressants often used at low doses for nerve pain and migraine prevention. They can work well but may cause dry mouth, drowsiness, or constipation.

Carbamazepine or oxcarbazepine — Used mainly for certain nerve pain types (like trigeminal neuralgia) and seizures. They’re effective for specific conditions but need blood tests and monitoring.

Topical options (lidocaine, capsaicin) — Applied to the skin over painful areas. Good when pain is localized and you want to avoid systemic side effects.

All medications come with trade-offs. Ask your doctor about likely benefits, side effects, interactions with other drugs, and whether any blood tests or dose adjustments are needed.

Non-drug and supportive approaches

Physical therapy and exercise — Targeted movement, stretching, and strengthening can reduce nerve pain and improve function. Small, regular sessions often beat sporadic hard workouts.

Cognitive behavioral therapy (CBT) — Helps change how you respond to pain and can lower pain-related anxiety. It’s practical and works well alongside medical treatment.

Mindfulness, relaxation, and sleep hygiene — Stress and poor sleep make pain worse. Simple breathing exercises, consistent sleep routines, and short mindfulness practices can help.

Interventional options — Nerve blocks, steroid injections, or TENS (electrical stimulation) can help certain types of localized pain when meds aren’t enough.

Support for alcohol-related problems — If gabapentin was used for alcohol withdrawal, other evidence-based options include naltrexone, acamprosate, supervised detox (often with benzodiazepines), and structured counseling or support groups. Talk to an addiction specialist to pick the safest route.

Want to pick the best option? Write down what helped and what didn’t, list your current meds, and bring questions to your clinician: What are the likely side effects? How long before I see benefit? Do I need tests or dose changes? That makes the visit productive and keeps your care safe.

If you want more detail on any option, check our related guides or ask a specific question — I can summarize the pros, cons, and what to ask your prescriber.