Gabapentin: Difference between revisions
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===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: | *Initial: 300mg PO q8hr | ||
*May increase up to | *May increase up to 600mg PO q8hr<br /> | ||
===Post herpetic neuralgia=== | ===Post herpetic neuralgia=== | ||
*Day 1: | *Day 1: 300mg PO qDay | ||
*Day 2: | *Day 2: 300mg PO q12hr | ||
*Day 3: | *Day 3: 300mg PO q8hr<br /> | ||
===Muscle Cramps (Off-label)=== | ===Muscle Cramps (Off-label)=== | ||
*100- | *100-300mg PO qHS; may titrate to 300-400mg q8hr PRN | ||
===Anxiety (Off-label)=== | ===Anxiety (Off-label)=== | ||
*300mg PO qHS initially, THEN | *300mg PO qHS initially, THEN 300mg PO q8h; may further increase as tolerated<br /> | ||
===Diabetic Neuropthy (Off-label)=== | ===Diabetic Neuropthy (Off-label)=== | ||
* | *900mg/day PO initially; may increase gradually q3Days to 1800-3600mg/day | ||
===Neuropathic Pain=== | ===Neuropathic Pain=== | ||
* | *600mg PO load in ED | ||
*Discharge with | *Discharge with 300mg --> 900mg per day divided tid (as in post-herpetic neuralgia regimen) | ||
*Discharge with pain specialist follow-up | *Discharge with pain specialist follow-up | ||
*Max dosage | *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> | ||
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*<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): | *3-4 years (maintenance): 40mg/kg/day PO divided q8hr | ||
*5-12 years (maintenance): 25-35mg/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 | *>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- | : CrCl>60 mL/min: 300-1200mg PO TID | ||
: CrCl 30-60 mL/min: 200- | : CrCl 30-60 mL/min: 200-700mg q12hr | ||
: CrCl 15-29 mL/min: 200- | : CrCl 15-29 mL/min: 200-700mg qDay | ||
: CrCl<15 mL/min: 100- | : CrCl<15 mL/min: 100-300mg qDay | ||
: HD: 125- | : HD: 125-350mg posthemodialysis after each 4h dialysis interval | ||
*Hepatic Dosing | *Hepatic Dosing | ||
Revision as of 21:46, 18 July 2016
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
- none
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
- ↑ Epocrates. Gabapentin Monograph. https://online.epocrates.com/u/10a1022