Gabapentin is an anticonvulsant that is also widely used for nerve pain. It is FDA-approved, as Neurontin and as generic gabapentin, for nerve pain that lingers after shingles (postherpetic neuralgia) in adults and as an add-on treatment for partial-onset seizures. The approved products are 100, 300, and 400 mg capsules, 600 and 800 mg tablets, and an oral solution of 50 mg per mL (prescribing information).
Bayview Pharmacy compounds gabapentin in forms those products do not cover: a gel, cream, or ointment applied to the skin, combination topicals, oral suspensions in other concentrations, and capsules smaller than 100 mg. Your provider decides whether gabapentin fits your situation, and a valid prescription is required.
How does gabapentin work?
Gabapentin is structurally related to GABA, a chemical messenger that calms nerve activity, but it does not change how the body binds, takes up, or breaks down GABA. It binds tightly to a part of the calcium channels on nerve cells called the alpha-2-delta subunit. Exactly how that relieves pain or prevents seizures is not known (prescribing information).
Topical gabapentin: what the evidence shows
A gel or cream puts gabapentin directly on the painful area of skin. The research behind it is limited and mostly uncontrolled:
- Nerve pain. In a review of 23 patients with hard-to-treat nerve pain in one area who used a 6% gabapentin gel, average pain scores fell from 8.2 to 5.6 out of 10 after a month, and no side effects were reported. The study looked back at patient records and had no comparison group (Hiom et al., 2015).
- Vulvodynia. A 2023 review found four observational studies of topical gabapentin, most using 6%. All reported lower pain, but none was a randomized trial, and the authors concluded that the effect could not yet be judged (Ergisi et al., 2023). See vulvodynia vaginal creams.
- Combination pain creams. In a randomized trial of 399 people with localized chronic pain, compounded creams, including two that contained gabapentin, relieved pain no better than a placebo cream (Ann Intern Med trial).
Some providers still prescribe topical gabapentin when other treatments have not helped or when oral gabapentin causes side effects such as drowsiness. Results vary from person to person, and your provider decides whether it is worth trying.
| Topical gabapentin (compounded) | Oral gabapentin | |
|---|---|---|
| Where it is used | Applied to the painful area of skin | Swallowed; acts throughout the body |
| FDA status | No FDA-approved product; compounded, not FDA-approved | FDA-approved capsules, tablets, and oral solution |
| Evidence | Small observational studies; a trial of combination creams found no benefit over placebo | Randomized trials for postherpetic neuralgia and seizures |
| What Bayview prepares | Gel, cream, or ointment 2% to 10%; combination topicals | Oral suspensions in other concentrations; 25 and 50 mg capsules |
This comparison is for education only and is not a statement that either form is better, safer, or more effective. Your provider decides which form, if any, is appropriate for you.
Gabapentin liquid and small-strength capsules
The manufactured gabapentin oral solution is 50 mg per mL, contains xylitol and glycerin with strawberry-anise flavoring, and is stored in the refrigerator (prescribing information). The smallest manufactured capsule is 100 mg. Federal rules limit compounding a copy of a drug that is commercially available, unless the prescriber documents a change that makes a real difference for the patient (FDA guidance).
So Bayview compounds water-free (anhydrous) oral suspensions in concentrations such as 200 mg per mL, capsules of 25 or 50 mg for small doses or slow increases, and, when the prescription states the reason, a liquid or capsule at a strength that is also manufactured. Veterinarians also order gabapentin liquids and capsules for dogs and cats; see anxiety and behavior medications for pets.
Is gabapentin a controlled substance?
Not under federal law (prescribing information). Some states classify it as a Schedule V controlled substance, including Alabama, Kentucky, Tennessee, Virginia, and West Virginia (Drugs.com). None of the states where Bayview is licensed schedules gabapentin, but Massachusetts (Mass.gov), Connecticut (CT DCP), and New Jersey (NJ PMP) require pharmacies to report gabapentin prescriptions to the state prescription monitoring program. Misuse and abuse of gabapentin have been reported (prescribing information).
Side effects & safety
With oral gabapentin, the most common side effects in nerve pain studies were dizziness, sleepiness, and swelling of the hands, feet, or legs (prescribing information). Others include tiredness, unsteadiness, blurred or double vision, and weight gain (MedlinePlus). Gabapentin can slow breathing, especially when taken with opioids or other sedating medications or by people with lung problems, and like other anticonvulsants it carries a small risk of suicidal thoughts (prescribing information).
Topical gabapentin is applied only where it is needed. In the small topical gabapentin studies above, the side effects reported were mostly irritation where it was applied (Ergisi et al., 2023). Apply it to intact skin, wash your hands afterward, and keep it away from your eyes unless your provider directs otherwise.
Who should not use it?
Do not use gabapentin if you are allergic to it or to an ingredient in your prescription. Before starting, tell your provider if you have kidney disease (oral doses are lowered when the kidneys clear medicine more slowly), lung disease, depression, or a history of substance misuse; if you take opioids, sleep medicines, or other sedatives; or if you are pregnant or breastfeeding (prescribing information). Do not drive or use machinery until you know how gabapentin affects you.
How do I get started?
Gabapentin is a prescription medication, so a licensed provider decides whether treatment is appropriate and chooses the form, strength, and directions. Bayview Pharmacy does not provide consultations or determine appropriateness. Already have a prescription at another pharmacy? You can transfer it to Bayview. Once you have a prescription, your provider can order through Bayview, and a pharmacist is available if you have questions. Bayview compounds gabapentin as part of our compounded medications catalog, alongside lidocaine cream and ointment and diclofenac gel.
Clinical details for prescribers
Regulatory. FDA-approved gabapentin is oral only: capsules 100, 300, 400 mg; tablets 600, 800 mg; oral solution 250 mg/5 mL (50 mg/mL; xylitol, glycerin, strawberry-anise flavor; refrigerate). Indications: postherpetic neuralgia in adults; adjunctive therapy for partial-onset seizures. Not federally controlled; misuse and abuse have been reported postmarketing (labeling). Schedule V in AL, KY, MT, ND, TN, VA, and WV (Drugs.com, March 2026); PMP reporting required in MA, CT (since January 1, 2021), and NJ. Compounded topical gabapentin is not FDA-approved. For a 100, 300, or 400 mg capsule or a 50 mg/mL liquid, note on the prescription the patient-specific change and the significant difference it produces, as section 503A requires (FDA 503A guidance).
Oral dosing (labeling):
- Postherpetic neuralgia: 300 mg on day 1, 300 mg twice daily on day 2, 300 mg three times daily on day 3, then titrate as needed to 1800 mg/day in three divided doses; doses up to 3600 mg/day were studied without added benefit above 1800 mg/day.
- Epilepsy, 12 years and older: start 300 mg three times daily; maintenance 300 to 600 mg three times daily. No more than 12 hours between doses.
- Reduce the dose for creatinine clearance below 60 mL/min and in hemodialysis. Taper over at least one week when stopping.
- Respiratory depression: risk is higher with CNS depressants, including opioids, and with underlying respiratory impairment; consider a low starting dose and monitor.
Topical evidence:
- Retrospective observational series, 6% w/w gabapentin gel, refractory focal peripheral neuropathic pain (n = 23): BPI NRS 8.2 to 5.6 at one month (p < 0.001), responses maintained at six months in responders, no adverse effects reported; no control arm (Hiom et al. 2015).
- Vulvodynia: four observational studies (2% to 6%, mostly 6%), fair to poor quality, no RCTs; efficacy cannot be determined (Ergisi et al. 2023).
- RCT, n = 399, localized neuropathic, nociceptive, or mixed pain: compounded creams (neuropathic: ketamine, gabapentin, clonidine, lidocaine; mixed: ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, lidocaine) applied three times daily were not significantly better than placebo (Ann Intern Med 2019).
What Bayview compounds:
- Topical gel in an anhydrous base, 2%, 4%, 6%, and 10% (tube or metered pump); cream 10% (VersaBase, pump); ointment 6%.
- Combination topicals, for example amitriptyline 2% / diclofenac 5% / gabapentin 5% gel, gabapentin 6% / lidocaine 5% / bupivacaine 2% gel, and gabapentin 6% / amitriptyline 2% / lidocaine 1% scalp solution. Vaginal and vulvar gabapentin creams are on the vulvodynia page.
- Anhydrous oral suspensions (for example 200 mg/mL); capsules 25 and 50 mg; 100 and 300 mg capsules or a 50 mg/mL liquid with a documented change.
- Baclofen / gabapentin suppositories, rectal or vaginal, as prescribed.
Licensed to dispense in RI, MA, CT, NJ, NH, FL, ME, and PA. Ordering and account setup are covered on our for providers page.
This information is about a prescription medication and is not medical advice. Compounded medications are prescription-only and are not FDA-approved. Your provider determines whether treatment is appropriate and sets the form, strength, and dose.
References
- Gabapentin (Neurontin) prescribing information, FDA label revised April 2025
- MedlinePlus: gabapentin
- Hiom et al. 2015: topical gabapentin gel for neuropathic pain, a proof of concept study (Int J Pharm Pract)
- Ergisi et al. 2023: topical gabapentin in vulvodynia, a narrative synthesis (Front Pain Res)
- Johns Hopkins Medicine: randomized trial of compounded topical pain creams (Ann Intern Med, 2019)
- FDA guidance: compounded drugs that are essentially copies (503A)
- Drugs.com: is gabapentin a controlled substance? (reviewed March 2026)
- Massachusetts PMP: pharmacy reporting and data submission
- Connecticut DCP: gabapentin and naloxone added to CPMRS
- New Jersey PMP: reporting requirements
