Is Gabapentin Bad for Your Liver? What You Should Know

If you're taking gabapentin—or considering it—you may be wondering whether it’s safe for your liver. This is an especially important question if you're living with liver concerns like fatty liver, cirrhosis, or chronic hepatitis.

The good news? Gabapentin is generally considered liver-safe. It doesn’t get processed by your liver, which makes it a preferred choice for many people with liver conditions. However, like all medications, gabapentin isn’t completely without risks. Let’s walk through what you need to know.

What is gabapentin?

Gabapentin is a prescription medication that’s FDA-approved to treat:

• Nerve pain (such as pain after shingles or diabetic nerve pain)

• Certain types of seizures

• Restless legs syndrome (using the extended-release version, Horizant)

Many healthcare providers also prescribe gabapentin “off-label” to help manage:

• Anxiety

• Fibromyalgia

• Chronic pain

• Alcohol use disorder (AUD)

Gabapentin works by calming overactive nerves in your brain and spinal cord. Although its structure is similar to a brain chemical called GABA, gabapentin works differently—it targets calcium channels involved in nerve signaling.

How gabapentin moves through your body

One of the reasons gabapentin is considered liver-friendly is how it moves through your system.

• It does not get broken down by your liver.

• After you take it, gabapentin is absorbed in your intestines and then eliminated unchanged through your kidneys.

That’s why it’s often prescribed to people who already have liver disease or are on multiple medications that affect liver function.

Learn how to check kidney function at home if you’re taking a kidney-cleared medication like gabapentin.

Is gabapentin bad for your liver?

For most people, no.

Because gabapentin isn’t metabolized by the liver, it doesn’t typically cause liver stress or damage. In clinical studies, liver test results stayed stable even after long-term use.

That said, there are a few rare cases where people developed mild liver-related issues while taking gabapentin, such as:

• Temporary increases in liver enzymes (like ALT or AST)

• Mild liver inflammation

• Hypersensitivity reactions

In most of these situations, the liver changes went away after stopping the medication—and they were often tied to other health issues or drugs.

If you’re worried about liver safety, here’s how to recognize the early signs your liver is healing.

A rare but serious risk: DRESS syndrome

Gabapentin has also been linked—very rarely—to a condition called DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms).

DRESS is a severe immune reaction that can appear weeks to months after starting a medication. It may affect multiple organs, including the liver and kidneys.

Symptoms of DRESS may include:

• Fever

• Rash

• Swollen lymph nodes

• Abnormal liver or kidney lab results

If you're taking gabapentin and notice any of these signs, contact your healthcare provider immediately. While DRESS is uncommon, early treatment is key.

This rare condition may also present with bilirubin in urine, which signals potential liver involvement.

What about kidney health?

Because your kidneys filter out gabapentin, you may need a lower dose if you have reduced kidney function.

If your kidneys can’t clear the medication properly, gabapentin can build up in your system, leading to side effects like:

• Drowsiness

• Dizziness

• Poor coordination

• Confusion

In people with chronic kidney disease (CKD), your provider may:

• Order kidney function tests (like eGFR or creatinine)

• Adjust the dose or timing of your gabapentin

• Consider an alternative treatment

Gabapentin can also cause fluid retention (edema) in some people. If you already have kidney concerns, this may add stress to your heart or lead to swelling in your legs or hands.

 If you're watching for buildup or toxicity, protein in urine may be an early sign your kidneys are under stress.

Who may need extra monitoring?

Gabapentin is low-risk for most people, but your doctor may want to take extra precautions if you:

• Have liver disease and take multiple medications

• Have chronic kidney disease

• Are over age 65, since aging can affect kidney clearance

• Take sedating medications like opioids, benzodiazepines (e.g., lorazepam), or sleep aids

Combining gabapentin with these drugs can increase drowsiness or slow your breathing. Even common over-the-counter medicines like diphenhydramine (Benadryl) can enhance sedation.

Always let your provider know about everything you’re taking, including supplements and OTC medications.

Those taking gabapentin for alcohol-related conditions should learn how alcohol affects kidney health long term.

What about drinking alcohol on gabapentin?

Mixing gabapentin and alcohol isn’t recommended. Together, they can lead to:

• Increased drowsiness or sedation

• Confusion or dizziness

• Greater risk of falls

• Added strain on your liver, especially if you already drink regularly

Interestingly, gabapentin is sometimes prescribed to help reduce alcohol cravings or manage alcohol withdrawal. In these cases, your doctor will monitor you closely—especially if your liver is already under stress.

 Learn how drinking alcohol damages which organ, including cumulative effects on the liver and brain.

How does gabapentin compare to other medications?

If you’re managing liver disease or trying to protect your liver, here’s how gabapentin stacks up against other commonly used drugs:

Gabapentin’s unique metabolism makes it a safer long-term option for those concerned about liver injury.

See the long-term impact of acetaminophen and other drugs on liver enzymes.

What should you do if you're worried?

Here’s how to stay safe while using gabapentin:

• Don’t stop the medication suddenly. This can cause withdrawal symptoms.

• Watch for new symptoms like yellowing skin, fatigue, swelling, or rash.

• Talk to your doctor if you’re unsure about your dose or medication mix.

• Ask for liver or kidney tests if you have pre-existing conditions.

Being proactive can help you avoid complications and feel more confident in your care plan.

Support your liver while on medication by using the best vitamins for liver health to reduce inflammation and oxidative stress.

Final thoughts: Is gabapentin liver-safe?

For most people, yes—gabapentin is considered safe and effective when it comes to liver health.

It’s one of the few medications that doesn’t require your liver to process it, which makes it a helpful option for people living with fatty liver, hepatitis, or cirrhosis. While rare side effects like DRESS syndrome or liver enzyme changes can happen, these are the exception—not the rule.

If you’re concerned about how gabapentin fits into your liver care plan, speak with your healthcare provider. You deserve to feel supported and informed.

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References

References

Gabapentin. (2020, July 30). Retrieved June 16, 2025, from Nih.gov website: https://www.ncbi.nlm.nih.gov/books/NBK548252/ 

Gabapentin (oral route). (2025). Retrieved June 16, 2025, from Mayo Clinic website: https://www.mayoclinic.org/drugs-supplements/gabapentin-oral-route/description/drg-20064011 

Rama Yasaei, Katta, S., Patel, P., & Abdolreza Saadabadi. (2024a, February 21). Gabapentin. Retrieved June 16, 2025, from Nih.gov website: https://www.ncbi.nlm.nih.gov/books/NBK493228/ 

Rama Yasaei, Katta, S., Patel, P., & Abdolreza Saadabadi. (2024b, February 21). Gabapentin. Retrieved June 16, 2025, from Nih.gov website: https://www.ncbi.nlm.nih.gov/books/NBK493228/ 

Zand, L., McKian, K. P., & Qian, Q. (2010). Gabapentin Toxicity in Patients with Chronic Kidney Disease: A Preventable Cause of Morbidity. The American Journal of Medicine, 123(4), 367–373. https://doi.org/10.1016/j.amjmed.2009.09.030