What Can Cause A Gabapentin False-Positive On A Drug Test?

In our latest question and answer, the pharmacist discusses drug testing for gabapentin and what could cause a false-positive.

Question

I tested positive for gabapentin but I haven't taken it in 10 years or more. I am however taking Trileptal. Is it possible this drug along with others I am on (Celexa, Prilosec, Flonase, Celebrex, and albuterol) could have caused this reading?

Asked by Skya On Oct 04, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Oct 04, 2022
Last updated Apr 16, 2024

Key points

  • There is no definitive research suggesting that other drugs can cause a false positive for gabapentin, aside from Lyrica (pregabalin), a drug closely related to it.
  • Similarly, gabapentin is very unlikely to cause a false positive for other drugs.
  • Based on how urine drug tests work, it makes sense that anticonvulsant drugs have a higher risk of causing a false-positive than other drugs, but how common this is isn't known.
  • Urine-based drug screenings can produce false-positive results. If you believe an error has occurred, you should request another test, or a more accurate, confirmatory test using a different method of testing.

Answer

Thanks for reaching out to us! Gabapentin (brand name Neurontin) is an antiepileptic drug but is most commonly used to treat neuropathic pain. When gabapentin first came to the market, it was not a controlled substance, but since that time, several states have reclassified it as a control (e.g. Kentucky, Alabama, Michigan, North Dakota, and West Virginia).

Even though it is not a controlled substance in most states, it generally isn't included in most standard urine drug screenings but it can be screened for and tests for it do exist.

However, since it isn't commonly tested for, there is a notable lack of information regarding whether it can cause false-positive for other drugs or whether other drugs can cause a false-positive result for gabapentin.

Studies do show that Lyrica (pregabalin) could potentially cause a false positive for gabapentin, but past that, there isn't much documentation for other drugs.

Drug Testing For Gabapentin

As mentioned, gabapentin is typically not tested for on most common urine drug screening tests for a number of reasons:

  • It is not a federally controlled substance and is only a control in a small number of states.
  • It does not belong to a class of medication known for well-known for abuse, such as amphetamines, opioids, and benzodiazepines (although it certainly can be abused or misused).

Most common urine drug screenings are '5-panel' and are designed to detect the following:

  • Marijuana
  • Cocaine
  • Amphetamines (e.g. amphetamine, methamphetamine, etc...)
  • Opioids (e.g. codeine, morphine, heroin, hydrocodone, oxycodone, etc...)
  • Phencyclidine (PCP)

There are newer drug tests that have a better ability to detect synthetic opioids, but gabapentin is still not routinely tested for.

Gabapentin False-Positives

Most studies suggest that gabapentin is highly unlikely to cause a 'false-positive' for any of the drugs being looked for on a standard 5-panel test due to its difference in structure and molecular composition.

Nevertheless, there are some studies that report that it may interfere with certain tests for amphetamines.

While gabapentin isn't commonly a drug that is tested for on drug screenings currently, this may change.

A number of studies are coming out reporting that it can be abused since it can cause euphoria at high doses and can increase the duration of a 'high' caused by opioids. This is why some states have already made it a control.

Since we may drug tests for gabapentin ordered more frequently, it would be prudent to have additional information on whether or not it can cause false-positive for other drugs or if other drugs can cause positive results for it.

Why Do False Positives Happen?

Most urine drug tests are known as 'immunoassay' screenings since they utilize antibodies to bind to a particular drug substance in a sample. When an antibody binds to a compound (like gabapentin), it produces a reaction, which is then reported as a 'positive' result.

Immunoassay urine drug screenings have a well-known problem with 'cross-reactivity', which can cause erroneous results.

Sometimes, an antibody will bind to the wrong drug substance, and produce a reaction. While this would get recorded as a 'positive' result, it, in fact, is a 'false-positive'. Cross-reactivity most often occurs when drug compounds are similar in structure to the compound being tested for, but this isn't always the case.

What Can Cause A Gabapentin False-Positive?

There is currently no definitive information on other drugs causing a false positive for gabapentin other than Lyrica (pregabalin), a drug closely related to gabapentin.

As mentioned above, most sources state that it would be unlikely for gabapentin to interfere with most drugs on the standard 5-panel drug test simply due to the differences in its molecular structure.

However, since most false positives occur as a result of an antibody binding to a drug that has a similar structure, it makes sense that the risk of a false-positive gabapentin test is highest with other anti-epileptic drugs, or those similar to it.

In terms of the drugs that you are taking, you are on the antiepileptic drug, Trileptal (oxcarbazepine). There certainly is a chance that could cause a false positive for gabapentin, but how likely this it just isn't known.

What To Do If You Get A 'False-Positive' Result

Most studies discussing urine drug testing recommend that they should only be used as an initial screening since the incidence of false-positive results is high.

There are several other laboratory methods that can be used as a confirmatory test, such as gas chromatography-mass spectrometry. Drug tests using gas chromatography-mass spectrometry don't rely on antibodies and can accurately detect actual drug compounds in a given sample.

If you have the opportunity to request a confirmatory test to rule out your previous false-positive result, you should certainly do so!

Final Words

Thanks for reaching out to us and I hope this helped!

References

  • Gabapentin for Adults with Neuropathic Pain: A Review of the Clinical Efficacy and Safety, PubMed
  • Urine Drug Screening: Minimizing False-Positives and False-Negatives to Optimize Patient Care, U.S. Pharmacist
  • Abuse of Gabapentin is Associated with Opioid Addiction, PubMed
  • Pervasive Gabapentin Interference in the LC-MS/MS Analysis of Amphetamine, Oxford Academic
  • Immunoassays for drug screening in urine: Chances, challenges, and pitfalls, PubMed
  • Urine Drug Screening: Practical Guide for Clinicians, Mayo Clinic
  • Commonly prescribed medications and potential false-positive urine drug screens, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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