Gabapentin (Neurontin)

Capsules: 100 mg, 300 mg & 400 mg

Tablets: 600 mg & 800 mg
Indications Adjunctive therapy in treatment of partial seizures with or without secondary
generalization in patients above 12 yr with epilepsy; adjunctive therapy for partial seizures in
children 3 to 12 years; management of postherpetic neuralgia in adults.
Route/Dosage
Epilepsy
Adults and children above 12 years:
PO 900 to 1800 mg/day in divided doses tid. Initial dose: 300 mg on day 1 and calculate upward
rapidly. To minimize CNS side effects, administer initial dose on day 1 at bedtime.
Children 3 to 12 years:
PO Initiate therapy at 10 to 15 mg/kg/day in divided doses (ie, 3 times/day) and calculate dose
upward over a period of about 3 dayears to the effective dose.
Then ..
Children 3 TO 4 YR: PO The effective dose is 40 mg/kg/day in divided doses (ie, 3 times/day).
Children at least 5 years: PO The effective dose is 25 to 35 mg/kg/day in divided doses (ie, 3
times/day).
Postherpetic Neuralgia
Adults: PO Start with a single 300 mg dose on day 1, 600 mg on day 2 (divided twice daily), and
900 mg on day 3 (divided 3 times daily). Subsequently, calculate the dose upward as needed for
pain relief to a daily dose of 1800 mg (divided 3 times daily).
Interactions
Antacids: May reduce bioavailability of gabapentin. Cimetidine: Reduces renal clearance of
gabapentin.
Side effects:
CV Hypertension.
CNS Somnolence, dizziness, ataxia, tremor, nervousness, dysarthria, amnesia, depression,
abnormal thinking, twitching, abnormal coordination, vertigo, hyperkinesia, parasthesia,
reflex abnormality, hostility, anxiety.
DERM Pruritus, abrasion, purpura.
EENT Diplopia, amblyopia, nystagmus, abnormal vision, gingivitis.
GI Dyspepsia, dry mouth or throat, constipation, dental abnormalities, increased appetite,
anorexia, flatulence.
RESP Rhinitis, pharyngitis, coughing, pneumonia.
OTHER Fatigue, weight increase, back pain, peripheral edema, impotence, leukopenia,
vasodilation, asthenia, malaise, facial edema, arthralgia.
Precautions
Pregnancy: Category C.
Lactation: Secreted in breast milk.
Children: Safety and efficacy in children below 3 yr not established; safety and efficacy in
management of postherpetic neuralgia in pediatric patients not established.
Elderly and debilitated patients: Because of age-related renal impairment, dosage adjustment may
be required.
Carcinogenesis: May have carcinogenic potential.
Renal impairment: Dose reduction recommended.
Serious adverse effects: During clinical trials, some patients experienced status epilepticus, and 8
sudden, unexplained deaths occurred. The association of these events with gabapentin use is
unclear.
Withdrawal: Do not discontinue antiepileptic drugs abruptly because of possible increased seizure
frequency from drug withdrawal.

PATIENT CARE CONSIDERATIONS
Administration/Storage
Administer medication with or without food and at least 2 hr after antacid administration.
Administer initial dose on day 1 at bedtime to minimize CNS side effects.
Calculate the effective dose given tid up to 1800 mg/day; maximum time between doses in
tid schedule should not exceed 12 hr.
Discontinue medication gradually over minimum of 1 wk.
Store medication in tightly sealed container.
OVERDOSAGE: SIGNS & SYMPTOMS
Ataxia, labored breathing, ptosis, sedation, hypoactivity or excitation, double vision, slurred
speech, drowsiness, lethargy, diarrhea

Patient/Family Education
Instruct patient to take medication at least 2 hr after taking antacid.
Explain that missed dose should be taken as soon as remembered but that 2 doses should not
be taken together. Instruct patient to call health care provider if at least 2 doses are missed.
Instruct patient to report the following symptoms to health care provider: excessive fatigue
or weakness, dizziness, somnolence, incoordination, tremor or other symptoms of CNS
depression, change in normal behavior, weight gain, back pain, alterations in GI syearstem,
alteration in skin or mucous membranes, fluid retention, general body discomfort, anorexia,
visual disturbances, impotence.
Advise patient that drug may cause drowsiness and to use caution while driving or
performing other tasks requiring mental alertness.