Gabapentin: Difference between revisions
 
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==Adult Dosing==
==Adult Dosing==
===Partial [[Seizures]]===
===Partial [[Seizures]]===
* Adjunctive therapy for partial seizures with or without secondary generalization
*Adjunctive therapy for partial seizures with or without secondary generalization
* Initial: 300 mg PO q8hr
*Initial: 300mg PO q8hr
* May increase up to 600 mg PO q8hr<br />
*May increase up to 600mg PO q8hr<br />
===Post herpetic neuralgia===
===Post herpetic neuralgia===
* Day 1: 300 mg PO qDay
*Day 1: 300mg PO qDay
* Day 2: 300 mg PO q12hr
*Day 2: 300mg PO q12hr
* Day 3: 300 mg PO q8hr<br />
*Day 3: 300mg PO q8hr<br />
===Muscle Cramps (Off-label)===
===Muscle Cramps (Off-label)===
* 100-300 mg PO qHS; may titrate to 300-400 mg q8hr PRN
*100-300mg PO qHS; may titrate to 300-400mg q8hr PRN
===Anxiety (Off-label)===
===Anxiety (Off-label)===
*300mg PO qHS initially, THEN 300 mg PO q8h; may further increase as tolerated<br />
*300mg PO qHS initially, THEN 300mg PO q8h; may further increase as tolerated<br />
===Diabetic Neuropthy (Off-label)===
===Diabetic Neuropthy (Off-label)===
*900 mg/day PO initially; may increase gradually q3Days to 1800-3600 mg/day
*900mg/day PO initially; may increase gradually q3Days to 1800-3600mg/day
===Neuropathic Pain===
===Neuropathic Pain===
*600 mg PO load in ED
*600mg PO load in ED
*D/c with 300 mg --> 900 mg per day divided tid (as in post-herpetic neuralgia regimen)
*Discharge with 300mg → 900mg per day divided tid (as in post-herpetic neuralgia regimen)
*D/c with pain specialist follow-up
*Discharge with pain specialist follow-up
*Max dosage 3600 mg if pt already on gabapentin
*Max dosage 3600mg if patient already on gabapentin
*Taper dose > 7 days to discontinue<ref>Epocrates. Gabapentin Monograph. https://online.epocrates.com/u/10a1022</ref>
*Taper dose > 7 days to discontinue<ref>Epocrates. Gabapentin Monograph. https://online.epocrates.com/u/10a1022</ref>


==Pediatric Dosing==
==Pediatric Dosing==
===Partial seizures===
===Partial seizures===
''Adjunct for partial seizures w/o secondary generalization in pts> 12yo w/ epilepsy; also adjunctive therapy for partial seizures in pts 3-12 years''
''Adjunct for partial seizures with out secondary generalization in patients> 12yo with epilepsy; also adjunctive therapy for partial seizures in patients 3-12 years''
*<3 years: Safety and efficacy not established
*<3 years: Safety and efficacy not established
*3-12 years (initial dose): 10-15mg/kg/day PO divided q8hr initially; titrate up in 3d to effective maintenance dose
*3-12 years (initial dose): 10-15mg/kg/day PO divided q8hr initially; titrate up in 3d to effective maintenance dose
*3-4 years (maintenance): 40 mg/kg/day PO divided q8hr
*3-4 years (maintenance): 40mg/kg/day PO divided q8hr
*5-12 years (maintenance): 25-35 mg/kg/day PO divided q8hr
*5-12 years (maintenance): 25-35mg/kg/day PO divided q8hr
*>12 years (initial dose): 300mg PO q8h; may increase up to 600 mg PO q8h
*>12 years (initial dose): 300mg PO q8h; may increase up to 600mg PO q8h


==Special Populations==
==Special Populations==
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*Lactation: Enters breast milk; use with caution
*Lactation: Enters breast milk; use with caution
*Renal Dosing
*Renal Dosing
: CrCl>60 mL/min: 300-1200 mg PO TID
: CrCl>60 mL/min: 300-1200mg PO TID
: CrCl 30-60 mL/min: 200-700 mg q12hr
: CrCl 30-60 mL/min: 200-700mg q12hr
: CrCl 15-29 mL/min: 200-700 mg qDay
: CrCl 15-29 mL/min: 200-700mg qDay
: CrCl<15 mL/min: 100-300 mg qDay
: CrCl<15 mL/min: 100-300mg qDay
: HD: 125-350 mg posthemodialysis after each 4h dialysis interval
: HD: 125-350mg posthemodialysis after each 4h dialysis interval


*Hepatic Dosing
*Hepatic Dosing
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
* none
*Depression/suicidality
* SJS
* anaphylaxis
* angioedema
 
===Common===
===Common===
*>10% ataxia, dizziness,  fatigue, somnolence
*>10% ataxia, dizziness,  fatigue, somnolence
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==See Also==
==See Also==
*[[Seizure]]
*[[Anticonvulsants]]
*[[Anticonvulsant levels and reloading]]
*[[Neuropathy]]


==Source==
==References==
Medscape
<references/>
<references/>


[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:Neurology]]

Latest revision as of 04:08, 8 March 2021

General

  • Type: Anticonvulsants; GABA analog
  • Dosage Forms: capsule, tablet, oral solution 250mg/5mL
  • Common Trade Names: Neurontin, Gralise

Adult Dosing

Partial Seizures

  • Adjunctive therapy for partial seizures with or without secondary generalization
  • Initial: 300mg PO q8hr
  • May increase up to 600mg PO q8hr

Post herpetic neuralgia

  • Day 1: 300mg PO qDay
  • Day 2: 300mg PO q12hr
  • Day 3: 300mg PO q8hr

Muscle Cramps (Off-label)

  • 100-300mg PO qHS; may titrate to 300-400mg q8hr PRN

Anxiety (Off-label)

  • 300mg PO qHS initially, THEN 300mg PO q8h; may further increase as tolerated

Diabetic Neuropthy (Off-label)

  • 900mg/day PO initially; may increase gradually q3Days to 1800-3600mg/day

Neuropathic Pain

  • 600mg PO load in ED
  • Discharge with 300mg → 900mg per day divided tid (as in post-herpetic neuralgia regimen)
  • Discharge with pain specialist follow-up
  • Max dosage 3600mg if patient already on gabapentin
  • Taper dose > 7 days to discontinue[1]

Pediatric Dosing

Partial seizures

Adjunct for partial seizures with out secondary generalization in patients> 12yo with epilepsy; also adjunctive therapy for partial seizures in patients 3-12 years

  • <3 years: Safety and efficacy not established
  • 3-12 years (initial dose): 10-15mg/kg/day PO divided q8hr initially; titrate up in 3d to effective maintenance dose
  • 3-4 years (maintenance): 40mg/kg/day PO divided q8hr
  • 5-12 years (maintenance): 25-35mg/kg/day PO divided q8hr
  • >12 years (initial dose): 300mg PO q8h; may increase up to 600mg PO q8h

Special Populations

  • Pregnancy Rating: C
  • Lactation: Enters breast milk; use with caution
  • Renal Dosing
CrCl>60 mL/min: 300-1200mg PO TID
CrCl 30-60 mL/min: 200-700mg q12hr
CrCl 15-29 mL/min: 200-700mg qDay
CrCl<15 mL/min: 100-300mg qDay
HD: 125-350mg posthemodialysis after each 4h dialysis interval
  • Hepatic Dosing
    • Adult: no modifications
    • Pediatric: no modifications

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

  • Depression/suicidality
  • SJS
  • anaphylaxis
  • angioedema

Common

  • >10% ataxia, dizziness, fatigue, somnolence
  • 1-10% diplopia, nystagmus, tremor, amblyopia, back pain, constipation, depression, dry mouth, dysarthria, dyspepsia, increased appetitie, leukopenia, myalgia, nervousness, peripheral edema, pharyngitis, puritis, rhinitis, vasodilation, weight gain

Pharmacology

  • Half-life: 5-7hr
  • Metabolism: not metabolized
  • Excretion: Renal
  • Mechanism of Action: GABA analogue, but has no effect on GABA binding, uptake or degradation; mech for analgesic and anticonvulsant activity unknown

See Also

References

  1. ↑ Epocrates. Gabapentin Monograph. https://online.epocrates.com/u/10a1022
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