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Capsule $0.09

Gabapentin

Editor: Updated Class:

ADMINISTRATION ROUTES:

PO, NG

ALTERNATIVE NAMES:

Neurontin, Nupentin

ICU INDICATIONS:

  1. Treatment of pain (particularly neuropathic pain)

Note: Gabapentin is an anticonvulsant but is not generally used for this indication in ICU

PRESENTATION AND ADMINISTRATION:

PO:

Capsules:

Neurontin 100 mg capsules (white), Neurontin 300 mg capsules (yellow), Neurontin 400 mg capsules (orange)

Nupentin 100 mg capsules (white), Nupentin 300 mg capsules (yellow), Nupentin 400 mg capsules (orange)

Note: Neurontin capsules can be opened and contents mixed with 10 mL of water for administration via NG tube

Tablets:

Neurontin 600 mg tablets (white)

DOSAGE:

PO / NG:

Begin at 100 mg q8h

Increase as tolerated to maximum 1800 mg total per day (given in divided doses)

Total dosage up to 3600 mg total per day (given in divided doses) have occasionally been used

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose in renal impairment [GFR (mL/min)]

GFR (ml/min) DOSE
<15 300 mg alternate days
15-30 300 mg OD
31-60 300 mg BD
61-90 400 mg TDS

Dose in renal replacement therapy

MODALITY DOSE
CAPD 300 mg alternate days
HD 200 - 300 mg after each dialysis session
CVVHDF rarely indicated; increased doses may be required

DOSAGE IN PAEDIATRICS:

PO:

2 mg/kg TDS

Increase to maximum 15 mg/kg or higher if tolerated

CLINICAL PHARMACOLOGY:

Gabapentin is structurally related to the neurotransmitter GABA (gamma-aminobutyric acid). Its mechanism of action is unknown.

CONTRAINDICATIONS:

  1. Hypersensitivity to gabapentin

WARNINGS:

When gabapentin is used as an anticonvulsant, abrupt withdrawal may precipitate seizures

PRECAUTIONS:

General:

See WARNINGS

Laboratory Tests:

No tests in addition to routine ICU tests are required

Drug/Laboratory Test Interactions:

Because false positive readings were reported with the Ames N-Multistix SG dipstick test for urinary protein when gabapentin was added to other antiepileptic drugs, the more specific sulfosalicylic acid precipitation procedure is recommended to determine the presence of urine protein

IMPORTANT DRUG INTERACTIONS IN ICU:

None of note

ADVERSE REACTIONS:

Body as a Whole:

Headache, abdominal pain

Digestive System:

Diarrhoea, dry mouth, constipation, nausea, vomiting, flatulence

Metabolic and Nutritional Disorders:

Weight gain, Hyperglycaemia

Nervous System:

Dizziness, Somnolence, Ataxia, Abnormal gait, Incoordination, Amnesia, Hypesthesia

Skin and Appendages:

Rash