Gabapentin-induced severe vivid nightmares may constitute an underreported psychiatric side effect that can significantly impair quality of life and treatment adherence, with resolution occurring following medication discontinuation and transition to pregabalin.
Key Findings
Results
Two patients treated with gabapentin for spinal pain syndromes developed severe vivid nightmares as an adverse effect.
Both cases involved patients being treated for spinal pain syndromes (described as neuropathic and radicular pain syndromes)
Severe vivid nightmares were identified as the primary adverse effect of concern in both cases
The authors characterize this as a 'psychiatric side effect' distinct from the more commonly recognized adverse effects of gabapentin
The case series format suggests these were clinical observations rather than a controlled experimental study
Results
Both patients experienced resolution of vivid nightmares following gabapentin discontinuation and transition to pregabalin.
Management strategy included discontinuation of gabapentin in both cases
Patients were transitioned to pregabalin as an alternative medication
Resolution of nightmares was reported in both patients following this intervention
The switch to pregabalin suggests clinicians sought to maintain pain management while eliminating the nightmare side effect
Background
Severe vivid nightmares from gabapentin are characterized by the authors as an underreported psychiatric side effect.
Somnolence and dizziness are identified as 'well-recognized adverse effects' of gabapentin, in contrast to nightmares
The authors describe vivid nightmares as 'may constitute an underreported psychiatric side effect'
The side effect was noted to 'significantly impair quality of life and treatment adherence'
A brief literature review of gabapentin's effects on sleep architecture was conducted alongside the case presentations
Discussion
The paper reviews potential mechanisms by which gabapentin may affect sleep architecture and induce vivid nightmares.
The authors discuss 'potential mechanisms, clinical implications, and management approaches' related to gabapentin-induced nightmares
Gabapentin's known effects on sleep architecture are reviewed as part of the discussion
The mechanistic discussion is framed in the context of existing literature rather than novel experimental findings
Specific mechanisms are discussed in the body of the paper though not detailed in the abstract
Background
Gabapentin is widely prescribed for neuropathic and radicular pain syndromes, making recognition of this side effect clinically relevant.
The authors note gabapentin is 'widely prescribed for neuropathic and radicular pain syndromes'
Both cases in the series involved patients being treated for spinal pain syndromes specifically
The clinical implications of nightmares as a side effect include potential impacts on treatment adherence
The report is framed as a case series with brief literature review, suggesting limited prior documentation of this specific adverse effect
What This Means
This research presents two patient cases in which gabapentin — a medication commonly prescribed for nerve pain in the spine — caused severe, vivid nightmares. While gabapentin is well-known to cause drowsiness and dizziness, the authors suggest that disturbing nightmares are a lesser-known side effect that has not been widely reported in the medical literature. Both patients had their nightmares resolve after stopping gabapentin and switching to a related medication called pregabalin.
The paper also reviews existing scientific knowledge about how gabapentin affects sleep and discusses possible reasons why the drug might trigger vivid nightmares. Sleep architecture — the pattern and stages of sleep — can be altered by medications like gabapentin, and these changes may contribute to more intense or disturbing dream experiences. The authors argue that clinicians should be aware of this potential side effect because it can meaningfully reduce a patient's quality of life and their willingness to continue treatment.
This research suggests that patients who develop vivid or disturbing nightmares while taking gabapentin should discuss this with their healthcare provider, as switching to an alternative medication like pregabalin may resolve the issue while still managing pain. Because this is a small case series of only two patients, larger studies would be needed to fully understand how common this side effect is and which patients might be most at risk.
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Hasoon J, Nguyen A, Safabakhsh N, Viswanath O, Robinson C. (2026). Gabapentin-Induced Severe Vivid Nightmares: A Case Series and Brief Review.. Psychopharmacology bulletin. https://doi.org/10.64719/pb.20779