Gabapentin

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Generic Name: Gabapentin Brand Name(s): Generics only. No brands available. Avability: Rx Pregnancy Category: C

Uses

What is Gabapentin used for?

Gabapentin is used with other medications to prevent and control seizures. It is also used to relieve nerve pain following shingles (a painful rash due to herpes zoster infection) in adults. Gabapentin is known as an anticonvulsant or antiepileptic drug.

How should I take Gabapentin?

Take this medication by mouth with or without food as directed by your doctor. Dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight.

If you are taking the tablets and your doctor directs you to split the tablet in half, take the other half-tablet at your next scheduled dose. Discard half tablets if not used within several days of splitting them. If you are taking the capsules, swallow them whole with plenty of water.

It is very important to follow your doctor’s dosing instructions exactly. During the first few days of treatment, your doctor may gradually increase your dose so your body can adjust to the medication. To minimize side effects, take the very first dose at bedtime.

Take this medication regularly to get the most benefit from it. This drug works best when the amount of medicine in your body is kept at a constant level. Therefore, take gabapentin at evenly spaced intervals at the same time(s) each day. If you are taking this medication 3 times a day to control seizures, do not let more than 12 hours pass between doses because your seizures may increase.

Do not take this medication more often or increase your dose without consulting your doctor. Your condition will not improve any faster and the risk of serious side effects may increase.

Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.

Antacids containing aluminum or magnesium may interfere with the absorption of this medication. Therefore, if you are also taking an antacid, it is best to take gabapentin at least 2 hours after taking the antacid.

Different forms of gabapentin (such as immediate-release, sustained-release, enacarbil sustained-release) are absorbed in the body differently. Do not switch from one form to the other without consulting your doctor.

Tell your doctor if your condition does not improve or if it worsens.

How do I store Gabapentin?

Store both tablets and capsules at room temperature away from light and moisture. Store the liquid medicine in the refrigerator. Do not freeze.

There may be different brands of Gabapentin that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Gabapentin down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Gabapentin?

Before taking gabapentin, tell your doctor or pharmacist if you are allergic to it; or to gabapentin enacarbil; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, mental/mood problems (such as depression, thoughts of suicide), use/abuse of drugs/alcohol, breathing problems.

This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially swelling of the hands/ankles/feet, slow/shallow breathing, dizziness, or loss of coordination. Dizziness and loss of coordination can increase the risk of falling.

Children may be more sensitive to the side effects of this drug, especially mental/mood/behavior changes (such as hostility, problems concentrating, restlessness).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

Gabapentin passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Gabapentin during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Gabapentin. Gabapentin is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Gabapentin?

Drowsiness, dizziness, loss of coordination, tiredness, blurred/double vision, unusual eye movements, or shaking (tremor) may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these unlikely but serious side effects occur: swelling of the hands/ankles/feet.

A small number of people who take anticonvulsants for any condition (such as seizures, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.

Get medical help right away if you have any very serious side effects, including: slow/shallow breathing.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Gabapentin?

A product that may interact with this drug is: orlistat.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine, morphine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Do not use this medication with other medications that contain gabapentin (including gabapentin enacarbil).

This medication may interfere with certain laboratory tests for urine protein. Make sure laboratory personnel and all your doctors know you use this drug.

Gabapentin may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Gabapentin?

Gabapentin may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Gabapentin?

Gabapentin may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Gabapentin.

What is the dose of Gabapentin for an adult?

Usual Adult Dose for Epilepsy

Initial dose: 300 mg orally on day one, 300 mg orally 2 times day on day two, then 300 mg orally 3 times a day on day three

Maintenance dose: 300 to 600 mg orally 3 times a day

Maximum dose: 3600 mg orally daily (in 3 divided doses)

-Maximum time between doses in the 3 times a day schedule should not exceed 12 hours

-The safety and effectiveness of gabapentin available under the trade name Gralise (R) or Horizant (R) in patients with epilepsy has not been studied.

Comment:

-May be taken with or without food.

-Half-tablets not used within 28 days of breaking the scored tablet should be discarded.

Use: Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization

Usual Adult Dose for Postherpetic Neuralgia

-Initial dose: 300 mg orally on day one, 300 mg orally 2 times day on day two, then 300 mg orally 3 times a day on day three

-Titrate up as needed for pain relief

-Maximum dose: 1800 mg per day (600 mg orally 3 times a day)

COMMENT:

-May be taken with or without food.

-Half-tablets not used within 28 days of breaking the scored tablet should be discarded.

Gabapentin available under the trade name GRALISE (R):

-Maintenance dose: Gralise (R) should be titrated to 1800 mg orally once daily with the evening meal.

-Recommended titration schedule:

Day 1: 300 mg orally with the evening meal

Day 2: 600 mg orally with the evening meal

Days 3 through 6: 900 mg orally with the evening meal

Days 7 through 10: 1200 mg orally with the evening meal

Days 11 through 14: 1500 mg orally with the evening meal

Day 15: 1800 mg orally with the evening meal

COMMENT:

-Gralise (R) is not interchangeable with other gabapentin products because of differing pharmacokinetic profiles that affect the frequency of administration.

Gabapentin enacarbil extended release tablets are available under the trade name HORIZANT (R):

-The recommended dosage is 600 mg orally 2 times a day. Therapy should be initiated at a dose of 600 mg orally in the morning for 3 days of therapy, then increased to 600 mg 2 times a day (1200 mg/day) on day four.

COMMENT:

Gabapentin enacarbil extended release tablets available under the trade name Horizant (R) and gabapentin are not interchangeable.

Use: Postherpetic neuralgia

Usual Adult Dose for Restless Legs Syndrome

Gabapentin enacarbil available under the trade name Horizant (R):

600 mg orally once daily with food at about 5 PM

Comment:

-May be taken with or without food.

Use: For the treatment of moderate-to-severe primary Restless Legs Syndrome (RLS) in adults

Dose Adjustments

Because elderly patients are more likely to have decreased renal function, the dose of this drug should be adjusted based on CrCl values.

GRALISE (R):

-If the dose of this drug under the trade name Gralise (R) is reduced, discontinued, or substituted with an alternative medication, this should be done gradually over a minimum of 1 week or longer or as directed by the physician.

HORIZANT (R):

-If the dose of this drug available under the trade name Horizant (R) is discontinued, patients with RLS receiving 600 mg or less once daily can discontinue the drug without tapering. If the recommended dose is exceeded, the dose should be reduced to 600 mg daily for 1 week prior to discontinuation to minimize the potential of withdrawal seizure.

-Patients with PHN receiving Horizant (R) twice daily should reduce the dose to once daily for 1 week prior to discontinuation to minimize the potential for withdrawal seizure.

Other Comments

Administration advice:

-This drug may be given with or without food.

-Tablets should be swallowed whole and should not be cut, crushed, or chewed.

-Gabapentin enacarbil available under the trade name Horizant (R) should be taken with food.

-Gabapentin available under the trade name Gralise (R) should be taken with food with the evening meal.

-Gabapentin available under the trade names Gralise (R) and Horizant (R) should be swallowed whole, not crushed, split, or chewed.

General:

Horizant (R) and Gralise (R) are not interchangeable with other gabapentin products because of differing pharmacokinetic profiles.

-If gabapentin is discontinued and/or an alternate anticonvulsant medication is added to the therapy, this should be done gradually over a minimum of 1 week.

-Gabapentin available under the trade names Gralise (R) or Horizant (R) are not interchangeable with each other or with other gabapentin products.

What is the dose of Gabapentin for a child?

Usual Pediatric Dose for Epilepsy

Less than 3 years: Not recommended

Greater than or equal to 3 and less than 12 years:

Starting Dose: Ranges from 10 to 15 mg/kg/day in 3 divided doses

Effective Dose: Reached by upward titration over a period of approximately 3 days; the effective dose in patients 5 years of age and older is 25 to 35 mg/kg/day in divided doses (3 times a day). The effective dose in pediatric patients ages 3 and 4 years is 40 mg/kg/day and given in divided doses (3 times a day). Gabapentin may be administered as the oral solution, capsule, or tablet, or using combinations of these formulations. Dosages up to 50 mg/kg/day have been well tolerated in a long term clinical study. The maximum time interval between doses should not exceed 12 hours.

Greater than 12 years:

-Initial dose: 300 mg orally on day one, 300 mg orally 2 times a day on day two, then 300 mg orally 3 times a day on day three

-Maintenance dose: 900 to 1800 mg orally in 3 divided doses; the dose may be increased up to 1800 mg/day. Dosages up to 2400 mg/day have been well tolerated in long term clinical studies. Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated. The maximum time between doses in the three times a day schedule should not exceed 12 hours.

Use: Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization in patients 3 years of age and older

Renal Dose Adjustments

For patients greater than or equal to 12 years:

-CrCl greater than 60 mL/min: 300 to 1200 mg orally 3 times a day

-CrCl 30 to 59 mL/min: 200 to 700 mg orally daily; increase to 600 mg as needed

-CrCl 15 to less than 29 mL/min: 200 to 700 mg orally once a day

-CrCl 15 mL/min: 100 to 300 mg orally every other day

-CrCl less than 15 mL/minute: Reduce daily dose in proportion to CrCl based on dose for CrCl 15 mL/minute (e.g., for a CrCl of 7.5 mL/min, reduce the daily dose by one-half to 50 to 150 mg/day)

-Hemodialysis: Dose based on CrCl plus a single supplemental dose of 125 to 350 mg given after each 4 hours of hemodialysis

-Use of this drug in patients less than 12 years of age with compromised renal function has not been studied.

The dose of gabapentin available under the trade name GRALISE (R) should be adjusted in patients with reduced renal function. Patients with reduced renal function should initiate GRALISE (R) at a daily dose of 300 mg. Daily dosing in patients with reduced renal function should be individualized based on tolerability and desired clinical benefit. GRALISE (R) should be titrated following the schedule outlined below:

Hemodialysis: Not recommended

CrCl less than 30 mL/min: Not recommended

CrCl 30 to 60 mL/min: 600 to 1800 mg orally with the evening meal

CrCl greater than or equal to 60 mL/min: 1800 mg orally with the evening meal

The dose of gabapentin enacarbil available under the trade name HORIZANT (R) should be adjusted in patients with reduced renal function as follows:

RESTLESS LEGS SYNDROME:

-CrCl less than 15 mL/min on hemodialysis: Not recommended

-CrCl less than 15 mL/min: 300 mg orally every other day

-CrCl 15 to 29 mL/min: 300 mg orally once a day

-CrCl 30 to 59 mL/min: Start at 300 mg orally daily and increase to 600 mg as needed

-CrCl greater than or equal to 60 mL/min: 600 mg orally once a day

POSTHERPETIC NEURALGIA:

-CrCl less than 15 mL/min on hemodialysis: 300 mg orally following every dialysis; increase to 600 mg orally following every dialysis if needed

-CrCl less than 15 mL/min: 300 mg orally every other day in the AM; increase to 300 mg orally once daily in the AM if needed

-CrCl 15 to 29 mL/min: 300 mg orally in the morning on day 1 and day 3 of therapy, then 300 mg once a day in the morning; may increase to 300 mg orally 2 times a day if needed; when tapering: if taking 300 mg orally 2 times a day, reduce to 300 mg orally once a day in the AM for 1 week; if taking 300 mg orally once a day no taper is needed

-CrCl 30 to 59 mL/min: 300 mg orally in the AM for 3 days, then 300 mg orally 2 times a day; increase to 600 mg orally 2 times a day as needed; when tapering: reduce current maintenance dose to once daily in the AM for 1 week

-CrCl greater than or equal to 60 mL/min: 600 mg orally in the morning for 3 days, then 600 mg orally 2 times a day thereafter; when tapering: 600 mg orally in the AM for 1 week

Precautions

-Safety and efficacy have not been established in patients younger than 18 years in the management of postherpetic neuralgia.

-Safety and efficacy have not been established in patients younger than 3 years in the adjunctive treatment of partial seizures.

-Safety and efficacy have not been established in patients younger than 18 years for gabapentin available under the trade names Gralise (R) or Horizant (R).

Dialysis

For patients greater than or equal to 12 years:

-Hemodialysis: Dose based on CrCl plus a single supplemental dose of 125 to 350 mg given after each 4 hours of hemodialysis

GRALISE (R): Hemodialysis: Not recommended

HORIZANT (R):

RESTLESS LEGS SYNDROME:

-CrCl less than 15 mL/min on hemodialysis: Not recommended

POSTHERPETIC NEURALGIA:

-CrCl less than 15 mL/min on hemodialysis: 300 mg orally following every dialysis; increase to 600 mg orally following every dialysis if needed

How is Gabapentin available?

Gabapentin is available in the following dosage forms and strengths:

  • Oral tablet,
  • Oral capsule,
  • Oral solution,
  • Oral tablet, extended release,
  • Compounding powder.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Gabapentin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: August 9, 2018 | Last Modified: August 9, 2018

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