Gabapentin Dosage Guide

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

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

Liver Dose Adjustments
Data not available

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.

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).

Consult WARNINGS section for additional precautions.

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

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.

Gabapentin is an Addiction Treatment Medication

abapentin is used to treat cases of addiction in an off-label manner. Different companies, including Parke-Davis, Greenstone, and Teva, manufacture several varieties of the generic drug. Other drugs that have been used to treat the symptoms of addiction withdrawal, for specific substances, include:

  • Clondine
  • Other anticonvulsants, such as Tegretol and Depakote
  • Methadone and buprenorphine
  • Naltrexone

Typical Application

Available in capsules, tablets, and as an oral liquid, dosages range from 100 mg to 800 mg. The frequency with which a dose is repeated depends on the specific dose, which is usually based on the severity of withdrawal and the client’s weight. The drug’s half-life is around 5-7 hours.

Generally, it is used during medical detox and throughout subsequent treatment modalities to support relapse prevention while clients adjust to their new sober lifestyles.

Treating Substance Abuse

According to Medscape, gabapentin can inflict users with suicidal thoughts and abrupt changes in behavior. For this reason, it should only be used under medical supervision. It can also cause elevated blood pressure, fever, sleep problems, appetite changes, and chest pain.

While it has been used to treat addictions to other substances, gabapentin is most often used to treat alcoholism — an addiction some 16.6 million adults suffered from in 2013, per the National Institute on Alcohol Abuse and Alcoholism.

During withdrawal from alcohol abuse or dependency, clients may experience anxiety, tremors, agitation, and irritability. In order to understand how gabapentin works, there must be a basic understanding of how the brain works first. Nervous system activity is partially controlled by GABA neurotransmitters. Gabapentin works by reducing activity among GABA. As a result, signals for pain, agitation, and anxiety are reduced, too.

An American Journal of Psychiatry study showed impressive results during the 16-week treatment of 150 people who were dependent on alcohol, noting better results among those who were treated with both gabapentin and naltrexone than the latter alone. TheJournal of Clinical Psychiatry reported on another study in which individuals treated for alcoholism with gabapentin showed a significant reduction in how much they drank and a greater rate of abstinence than those in the placebo group.

Gabapentin has the same calming effect on individuals who are detoxing from marijuana and benzodiazepines. Despite claims from fans of the plant-based drug, marijuana is indeed addictive. In 2012, 305,560 people checked into rehab citing cannabis as their primary drug of abuse, per the Substance Abuse and Mental Health Services Administration. One Neuropsychopharmacology study that analyzed the use of gabapentin in the treatment of marijuana addiction and withdrawal noted individuals in the gabapentin treatment group used less marijuana, had fewer withdrawal symptoms, and experienced improvements in cognitive functioning, compared to the placebo group.

What is the sidd effects of Gabapentin ?

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, depression, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  1. increased seizures;
  2. severe weakness or tiredness;
  3. upper stomach pain;
  4. chest pain, new or worsening cough with fever, trouble breathing;
  5. severe tingling or numbness;
  6. rapid back and forth movement of your eyes;
  7. kidney problems–little or no urination, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath; or
  8. severe skin reaction–fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Who is not suitable for Ordering Gabapentin Online ?

Normally Gabapentin is suitable for all adult and children bigger than six years old. But you are not allowed to order Gabapentin online if you have any of following health conditions (But you are OK to order in your local street pharmacies):

  1. You are younger than 18 years old;
  2. You have kidney disease;
  3. diabetes;
  4. liver disease and heart diseases;
  5. a history of depression, mood disorder, drug abuse, or suicidal thoughts or actions;
  6. (for patients with RLS) if you are a day sleeper or work a night shift;
  7. You are breastfeeding mother or you are pregnant;
  8. have thoughts about suicide.

Stop immediately if you have any thoughts about suicide. Donot order Gabapentin online if you have suicide thoughts. Please go to your doctor to have your completely checked.

Gabapentin Action of Mechanism

The chemical structure of gabapentin (Neurontin) is derived by addition of a cyclohexyl group to the backbone of gamma-aminobutyric acid (GABA).

Gabapentin prevents seizures in a wide variety of models in animals, including generalized tonic-clonic and partial seizures. Gabapentin has no activity at GABAA or GABAB receptors of GABA uptake carriers of brain. Gabapentin interacts with a high-affinity binding site in brain membranes, which has recently been identified as an auxiliary subunit of voltage-sensitive Ca2+ channels.

gabapentinaction

However, the functional correlate of gabapentin binding is unclear and remains under study. Gabapentin crosses several lipid membrane barriers via system L amino acid transporters. In vitro, gabapentin modulates the action of the GABA synthetic enzyme, glutamic acid decarboxylase (GAD) and the glutamate synthesizing enzyme, branched-chain amino acid transaminase.

Results with human and rat brain NMR spectroscopy indicate that gabapentin increases GABA synthesis. Gabapentin increases non-synaptic GABA responses from neuronal tissues in vitro. In vitro, gabapentin reduces the release of several mono-amine neurotransmitters.

Gabapentin is used primarily to treat seizures and neuropathic pain. It is also commonly prescribed for many off-label uses, such as treatment of anxiety disorders, insomnia, and bipolar disorder. There are, however, concerns regarding the quality of the trials conducted and evidence for some such uses, especially in the case of its use as a mood stabilizer in bipolar disorder.

Gabapentin prevents pain responses in several animal models of hyperalgesia and prevents neuronal death in vitro and in vivo with models of the neurodegenerative disease amyotrophic lateral sclerosis (ALS). Gabapentin is also active in models that detect anxiolytic activity.

Although gabapentin may have several different pharmacological actions, it appears that modulation of GABA synthesis and glutamate synthesis may be important.

Gabapentin Side Effects

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

gabapentin-memory-loss

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, signs of infection (such as fever, cough, persistentsore throat).

A small number of people who take anticonvulsants for any condition (such as seizures, bipolar disorder, pain) may experience depression, suicidalthoughts/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 serious side effects, including: unusual fever, swollen glands, yellowing skin/eyes, unusual tiredness, dark urine, signs ofkidney problems (such as change in the amount of urine), chest pain.

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: rash,itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US –

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Gabapentin can be used to treat more than 30 diseases

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 zosterinfection) in adults. Gabapentin is known as an anticonvulsant or antiepileptic drug.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by yourhealth care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

Gabapentin may also be used to treat other nerve pain conditions (such as diabetic neuropathy, peripheral neuropathy, trigeminal neuralgia) and restless legs syndrome.

Gabapentin can also be used to treat following health conditions:

  • Alcohol Withdrawal
  • Anxiety
  • Benign Essential Tremor
  • Bipolar Disorder
  • Burning Mouth Syndrome
  • Cluster-Tic Syndrome
  • Cough
  • Diabetic Peripheral Neuropathy
  • Epilepsy
  • Erythromelalgia
  • Fibromyalgia
  • Hiccups
  • Hot Flashes
  • Hyperhidrosis
  • Insomnia
  • Lhermitte’s Sign
  • Migraine
  • Nausea/Vomiting, Chemotherapy Induced
  • Neuropathic Pain
  • Occipital Neuralgia
  • Pain
  • Periodic Limb Movement Disorder
  • Peripheral Neuropathy
  • Postherpetic Neuralgia
  • Postmenopausal Symptoms
  • Pruritus
  • Pudendal Neuralgia
  • Reflex Sympathetic Dystrophy Syndrome
  • Restless Legs Syndrome
  • Small Fiber Neuropathy
  • Spondylolisthesis
  • Syringomyelia
  • Transverse Myelitis
  • Trigeminal Neuralgia
  • Vulvodynia

Gabapentin enhances slow-wave sleep in patients with primary insomnia

Polysomnographic study revealed increased sleep efficiency and slow-wave sleep, decreased wake after sleep onset, and spontaneous arousal index after gabapentin treatment. The biochemical blood test revealed decreased prolactin levels in the morning after treatment. Electroencephalographic power spectral analysis showed increased delta-2 and theta power in sleep stage 1 and decreased sigma activity power in sleep stages N2 and N3 after gabapentin treatment. Heart rate variability analyses also showed a significant increase in normalized high frequency percentage in sleep stages N2 and N3 and low frequency-high frequency ratio in sleep stage N2 after treatment. In addition, neuropsychological tests revealed the elevation of visual motor processing speed after gabapentin treatment.

CONCLUSIONS:

Gabapentin enhances slow-wave sleep in patients with primary insomnia. It also improves sleep quality by elevating sleep efficiency and decreasing spontaneous arousal. The results suggest that gabapentin may be beneficial in the treatment of primary insomnia.

What is Migraine ?

Migraine is a very common, but very particular, type of headache. Most people who have migraine experience repeated attacks of headaches that occur over many years. The typical migraine headache is throbbing or pulsating, and often is associated with nausea and changes in vision. While many migraine headaches are severe, not all severe headaches are migraines, and some episodes can be quite mild.

Up to 20% of people in the United States will experience migraine headaches at some point in life. In about half of those, migraine headaches first appear during childhood or adolescence. Two-thirds of people who get migraines are women, probably because of the influence of hormones. Migraines also tend to run in families.

Despite years of research, scientists do not know exactly why migraines occur. The pain of migraines is associated with swelling in blood vessels and irritation of nerves that surround the brain. But most experts don’t think that this is the direct cause of migraines.

The brain doesn’t have pain receptors. But it processes pain signals from other parts of the body. It’s the pain processing networks, or centers, in the brain that are overly reactive or dysfunctional in migraine.

The brain chemical serotonin may play an important role in this process as it does in other conditions, including depression and eating disorders.

migraine5Some people with migraine have very frequent headaches, sometimes every day. This form of migraine, called chronic migraine, is difficult to treat. The newest treatment is Botox (onabotulinumtoxinA). The doctor gives multiple injections around the head and neck once every 12 weeks. It is approved for people that experience migraine headaches more than 14 days per month.

Some people can prevent migraines by avoiding triggers. Others have prevented migraines successfully through relaxation techniques, acupuncture, or exercise. However, these therapies alone don’t work for everyone. Some people also need treatment with medication to reduce the number of migraines they have. The drugs used to prevent migraines are different from drugs that to treat migraines once a migraine starts. Drugs that prevent migraines, such as gabapentin, must be taken daily.

Results from some clinical trials have shown a modest benefit from the use of gabapentin for migraine prevention. However, the American Academy of Neurology (AAN), the organization that provides guidance for the use of drugs to prevent migraines, has stated that there is not enough evidence at this time to support the use of gabapentin for migraine prevention. Healthcare professionals can choose to prescribe gabapentin when other prevention therapies have not worked, however.