Medications
Gabapentin & Pregabalin Before Surgery
Gabapentin (Neurontin) and pregabalin (Lyrica) are nerve-pain and seizure medicines that are usually continued around surgery, and are sometimes even given on purpose to help with pain. The key is that your anesthesia team knows you take one.
Quick answer
The one firm rule: do not stop it on your own, and tell your anesthesia team you take it so they can plan your sedation and pain relief safely. Always follow the specific dose-timing instruction your team gives you for the morning of surgery.
Why it matters
Gabapentin and pregabalin (together called gabapentinoids) calm overactive nerve signals. People take them for nerve pain, fibromyalgia, epilepsy, and anxiety. Around surgery they are generally helpful rather than harmful, which is why they are usually continued and are part of many multimodal pain plans that reduce reliance on opioids.
The reason your team needs to know is interaction, not danger from the drug itself. Gabapentinoids add to the sedating and breathing-slowing effects of anesthesia, opioid pain medicines, and other sedatives. When these are layered together, breathing can slow more than expected. This matters most for older adults, people with sleep apnea, and anyone with reduced kidney function, since the drug clears through the kidneys and can build up.
Because of this additive effect, your anesthesiologist may simply adjust your other medicines, lower the opioid dose, and watch your breathing a little more closely after surgery. That is routine, safe management. What they want to avoid is being surprised by a medicine they did not know about, which is exactly why naming it on your pre-op medication list is the important step.
Do not stop without instruction
The risk is far more serious if you take it for epilepsy or seizures: abruptly stopping can trigger a seizure or a run of seizures. If you take it for nerve pain, stopping early usually means your pain flares back hard right before surgery, which is miserable and avoidable. If your medicine ever does need to come down, it should be tapered slowly under medical guidance — not cut off in one step. Let your surgical and anesthesia team make that call together.
What to ask your doctor
- Should I take my normal gabapentin or pregabalin dose on the morning of surgery, and with how much water?
- I take this for epilepsy / seizures — what is the plan to make sure I never miss a dose around my operation?
- Will you be giving me other sedatives or opioids that add to its effect, and do you need to adjust anything?
- I have reduced kidney function (or sleep apnea) — does that change my dose or how I'll be monitored afterward?
Red flags — call your team
Red flags — call your team
- Severe drowsiness, confusion, or being hard to wake after surgery — especially if you've also had opioid pain medicine.
- Slow, shallow, or pauses in breathing, or lips/fingertips looking blue or grey — call for help immediately.
- Withdrawal-type symptoms if a dose was missed — a seizure, severe anxiety, shaking, sweating, or a racing heartbeat.
References
- General anesthesia and pain guidance (for example, ASA and ASRA-type perioperative recommendations) supports continuing gabapentinoids around surgery while watching for added sedation and breathing slowing when combined with opioids, particularly in older or kidney-impaired patients. Drug labels (FDA) warn against abrupt discontinuation because of withdrawal and seizure risk.
- These are general guidelines only. Your own surgical and anesthesia team's instructions always take precedence over anything written here — follow the specific plan they give you.
Frequently asked questions
Do I take gabapentin or pregabalin the morning of my surgery?
Usually yes. Most teams want you to continue right through, including the morning of surgery, taken with a small sip of water. Some anesthesiologists even give a dose on purpose as a pre-med to reduce pain afterward. But timing can vary with your dose and procedure, so confirm the exact morning-of plan with your anesthesia team rather than guessing.
Why does my anesthesiologist care that I take it?
Because it adds to the sedating and breathing-slowing effects of anesthesia and opioid pain medicines. On its own it's well tolerated, but stacked with other sedatives it can slow breathing more than expected, especially in older adults, people with sleep apnea, or reduced kidney function. Knowing about it lets your team adjust doses and monitor you safely. It is not a reason to stop the medicine.
Can I just stop it for a few days to be safe?
No — please don't stop it on your own. Stopping suddenly can cause withdrawal symptoms, and if you take it for epilepsy it can trigger seizures. If you take it for nerve pain, your pain usually flares badly right before surgery. If it ever needs to be reduced, that's done slowly with a taper under your team's guidance, never in one abrupt step.
Is gabapentin handled the same way as my diabetes tablets?
No. Many diabetes tablets are paused on the day of surgery because of fasting and blood-sugar concerns. Gabapentin and pregabalin are different — they're usually continued, not held. The rules really do depend on the specific medicine, which is why a personalized check with your team beats applying one blanket rule to everything you take.