Adult Dosing
Partial seizures
Neurontin
- Start 300 mg PO tid, titrate to effect
- Range 900-1800 mg/day PO divided three times a day
- Max: 3600 mg/day
- Note: Doses should not be more than 12 hrs apart. Doses up to 2400-3600 mg/day have been well tolerated
Post-herpetic neuralgia
Neurontin
- 300 mg PO qd on first day, 300 mg PO bid on second day, then 300 mg PO tid on day 3
- May then be titrated upward as needed up to 600 mg three times/day
- Max: 1800 mg/day
Gralise
- Initial dose: 300 mg PO qhs on day 1; then 600 mg PO qhs on day 2; then increase by 300 mg/day q4 days
- Max: 1800 mg/day
- Notes:
- This brand is not interchangeable with other gabapentin products due to different pharmacokinetic profiles
- Administer dose with evening meal; do not split/crush/chew the tablets
- Taper dose gradually over
1 wk to reduce, discontinue, or substitute with an alternative medication
Neuropathic pain
Neurontin [Not FDA approved]
- 300 mg PO qd on first day, 300 mg PO bid on second day, then 300 mg PO tid on day 3
- Max: 3600 mg/day
Pediatric Dosing
Partial seizures
Neurontin
3-4 yrs
- Start 10-15 mg/kg/day PO divided tid
- Titrate up over a period of 3 days
- Usual dose: 40 mg/kg/day PO divided tid
- Max: 50 mg/kg/day
5-12 yrs
- Start 10-15 mg/kg/day PO divided tid
- Titrate up over a period of 3 days
- Usual dose: 25-35 mg/kg/day PO divided tid
- Max: 50 mg/kg/day
>12 yrs
- Start 300 mg PO tid, titrate to effect
- Range 900-1800 mg/day PO divided tid
- Max: 3600 mg/day
[Outline]
Neurontin
- Partial epileptic seizures with and without secondary generalization in patients >12 yrs of age (Adjunctive therapy)
- Adjunctive therapy in the treatment of partial seizures in pediatric age 3–12 yrs
Neurontin, Gralise, Horizant
- Management of post-herpetic neuralgia
Renal Dose Adjustment (Based on CrCl)
Neurontin
Adults and children >12 yrs
- 30-59 mL/min: 200-700 mg bid
- 16-29, mL/min: 200-700 mg Daily
- 15 mL/min: 100-300 mg Daily
- <15 mL/min: Reduce dose proportionately
- Hemodialysis: 125-350 mg as supplement
Gralise
Adults
- 60 mL/min: Start 300 mg PO qhs; may increase to 1800 mg PO qhs with meals
- 30-60 mL/min: Start 300 mg PO qhs; may increase to 600-1800 mg PO qhs with meals
- <30 mL/min: Avoid administration
- Patients undergoing hemodialysis: Avoid administration
Hepatic Dose Adjustment
- Hepatic impairment: No dose adjustments
See Supplemental Patient Information
- Antiepileptic drugs, including gabapentin increase the risk of suicidal thoughts or behavior. Monitor patients for emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior
- Gralise is not interchangeable with other gabapentin products; taper over a duration of one week to reduce, discontinue, or substitute with an alternative medication
- Safety and effectiveness of Gralise in epileptic patients has not been established
- Safety and effectiveness of gralise in post-herpetic neuralgia in patients < 18 years of age has not been established
- Fatal or life-threatening multiorgan hypersensitivity reactions, also known as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), have been reported in patients taking antiepileptic drugs, including gabapentin
- Gabapentin use in pediatric patients (3-12 years) with epilepsy is associated with the occurrence of central nervous system related adverse events. Neuropsychiatric events such as emotional lability, hostility, thought disorders, and hyperkinesia have occurred
- During clinical trials, some patients have experienced status epilepticus, and 8 sudden, unexplained deaths have also occurred
- Gabapentin may cause dizziness/drowsiness. Advise patients not to engage in activities requiring mental alertness such as driving and operating machinery
- Do not discontinue abruptly. Abrupt discontinuation in patients with seizure disorder may precipitate seizures. Taper over 7 days to discontinue
- Effectiveness as adjunctive therapy in the treatment of partial seizures in children <3 yrs of age has not been established
Cautions: Use cautiously in
- Renal impairment
- Elderly patients
- History of depression
- History of drug abuse
- CNS depressant use
- Alcohol use
- Pregnancy
Supplemental Patient Information
- Advise patients caregivers, and their families for reporting emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts
Pregnancy Category:C
Breastfeeding: Limited data on breastfed infants of mothers receiving gabapentin indicate that maternal doses of 2.1 g/day produce relatively low levels in infant serum. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT Last accessed 23 July 2011). According to the manufacturer, gabapentin should be used in lactating women only if the benefits outweigh the risks.
Pricing data from www.DrugStore.com in U.S.A.
- Gabapentin 100 MG CAPS [Bottle] (AMNEAL PHARMACEUTICALS)
90 mg = $43.99
270 mg = $115.97 - Gabapentin 400 MG CAPS [Bottle] (AMNEAL PHARMACEUTICALS)
90 mg = $74.99
270 mg = $209.98 - Neurontin 100 MG CAPS [Bottle] (PFIZER U.S.)
100 mg = $93.99
300 mg = $269.97 - Neurontin 250 MG/5ML SOLN [Bottle] (PFIZER U.S.)
470 5ml = $172.99
1410 5ml = $475.97 - Neurontin 800 MG TABS [Bottle] (PFIZER U.S.)
90 mg = $481
270 mg = $1399.96 - Gabapentin 300 MG CAPS [Bottle] (AMNEAL PHARMACEUTICALS)
90 mg = $18.99
270 mg = $39.96 - Gabapentin 600 MG TABS [Bottle] (GLENMARK PHARMACEUTICALS)
90 mg = $98.99
270 mg = $251.96 - Neurontin 400 MG CAPS [Bottle] (PFIZER U.S.)
30 mg = $83.99
90 mg = $245.97 - Neurontin 600 MG TABS [Bottle] (PFIZER U.S.)
90 mg = $396.98
100 mg = $435.99 - Neurontin 300 MG CAPS [Bottle] (PFIZER U.S.)
30 mg = $72.99
90 mg = $199.96 - Gabapentin 250 MG/5ML SOLN [Bottle] (HI-TECH)
470 5ml = $139.99
1410 5ml = $399.96 - Gabapentin 800 MG TABS [Bottle] (GLENMARK PHARMACEUTICALS)
90 mg = $99.99
100 mg = $107.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
