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

Gabapentin 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 side 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.

 

Why is Gabapentin prescribed?

Gabapentin capsules, tablets, and oral solution are used along with other medications to help control certain types of seizures in people who have epilepsy. Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down). Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.

How should this medicine be used?

Gabapentin comes as a capsule, a tablet, an extended-release (long-acting) tablet, and an oral solution (liquid) to take by mouth. Gabapentin capsules, tablets, and oral solution are usually taken with a full glass of water (8 ounces [240 milliliters]), with or without food, three times a day.

These medications should be taken at evenly spaced times throughout the day and night; no more than 12 hours should pass between doses. The extended-release tablet (Horizant) is taken with food once daily at about 5 PM. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take gabapentin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Gabapentin extended-release tablets cannot be substituted for another type of gabapentin product. Be sure that you receive only the type of gabapentin that was prescribed by your doctor. Ask your pharmacist if you have any questions about the type of gabapentin you were given.

Swallow the extended-release tablets whole; do not cut, chew, or crush them.

If your doctor tells you to take one-half of a regular tablet as part of your dose, carefully split the tablet along the score mark. Use the other half-tablet as part of your next dose. Properly dispose of any half-tablets that you have not used within several days of breaking them.

If you are taking gabapentin to control seizures or PHN, your doctor will probably start you on a low dose of gabapentin and gradually increase your dose as needed to treat your condition. If you are taking gabapentin to treat PHN, tell your doctor if your symptoms do not improve during your treatment.

Gabapentin may help to control your condition but will not cure it. Continue to take gabapentin even if you feel well. Do not stop taking gabapentin without talking to your doctor, even if you experience side effects such as unusual changes in behavior or mood. If you suddenly stop taking gabapentin tablets, capsules, or oral solution, you may experience withdrawal symptoms such as anxiety, difficulty falling asleep or staying asleep, nausea, pain, and sweating. If you are taking gabapentin to treat seizures and you suddenly stop taking the medication, you may experience seizures more often. Your doctor may decrease your dose gradually over at least a week.

Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with gabapentin and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs) or the manufacturer’s website to obtain the Medication Guide.

Other uses for this medicine

Gabapentin is also sometimes used to relieve the pain of diabetic neuropathy (numbness or tingling due to nerve damage in people who have diabetes), and to treat and prevent hot flashes (sudden strong feelings of heat and sweating) in women who are being treated for breast cancer or who have experienced menopause (”change of life”, the end of monthly menstrual periods). Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking gabapentin,

  • tell your doctor and pharmacist if you are allergic to gabapentin, any other medications, or any of the inactive ingredients in the type of gabapentin you plan to take. Ask your pharmacist for a list of the inactive ingredients.
  • you should know that gabapentin is available in different forms that may be prescribed for different uses. Ask your doctor to be sure that you are not taking more than one product that contains gabapentin.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antidepressants; antihistamines; medications for anxiety; medications that make you feel dizzy or drowsy; medications for mental illness; naproxen (Aleve, Anaprox, Naprosyn, others); opioid (narcotic) medications for pain such as hydrocodone (in Hydrocet, in Vicodin, others), morphine (Avinza, Kadian, MSIR, others), or oxycodone OxyContin, in Percocet, in Roxicet, others); sedatives; medications for seizures; sleeping pills, and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • if you are taking antacids such as Maalox or Mylanta, take them at least 2 hours before you take gabapentin tablets, capsules, or solution.
  • tell your doctor if you have or have ever had lung or kidney disease. If you will be taking the extended-release tablets, also tell your doctor if you need to sleep during the day and stay awake at night.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking gabapentin, call your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking gabapentin.
  • you should know that this medication may make you drowsy or dizzy, may slow your thinking, and may cause loss of coordination. Do not drive a car or operate machinery until you know how this medication affects you, and your doctor agrees that it is safe for you to begin these activities.
  • if you are giving gabapentin to your child, you should know that your child’s behavior and mental abilities may change while he or she is taking gabapentin. Your child may have sudden changes in mood, become hostile or hyperactive, have difficulty concentrating or paying attention, or be drowsy or clumsy. Have your child avoid activities that could be dangerous, such as riding a bicycle, until you know how gabapentin affects him or her.
  • remember that alcohol can add to the drowsiness caused by this medication.
  • you should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking gabapentin for the treatment of epilepsy, mental illness, or other conditions. A small number of adults and children 5 years of age and older (about 1 in 500 people) who took anticonvulsants such as gabapentin to treat various conditions during clinical studies became suicidal during their treatment. Some of these people developed suicidal thoughts and behavior as early as one week after they started taking the medication. There is a risk that you may experience changes in your mental health if you take an anticonvulsant medication such as gabapentin, but there may also be a risk that you will experience changes in your mental health if your condition is not treated. You and your doctor will decide whether the risks of taking an anticonvulsant medication are greater than the risks of not taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood); talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; giving away prized possessions; or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If you forget to take gabapentin capsules, tablets, or oral solution, take the missed dose as soon as you remember it. However, if it is almost time for the next dose or if you forget to take gabapentin extended-release tablets, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Gabapentin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • drowsiness
  • tiredness or weakness
  • dizziness
  • headache
  • uncontrollable shaking of a part of your body
  • double or blurred vision
  • unsteadiness
  • anxiety
  • memory problems
  • strange or unusual thoughts
  • unwanted eye movements
  • nausea
  • vomiting
  • heartburn
  • diarrhea
  • dry mouth
  • constipation
  • increased appetite
  • weight gain
  • swelling of the hands, feet, ankles, or lower legs
  • back or joint pain
  • fever
  • runny nose, sneezing, cough, sore throat, or flu-like symptoms
  • ear pain
  • red, itchy eyes (sometimes with swelling or discharge)

Some side effects may be serious. If you experience any of the following symptoms, call your doctor immediately:

  • rash
  • itching
  • swelling of the face, throat, tongue, lips, or eyes
  • hoarseness
  • difficulty swallowing or breathing
  • seizures
  • difficulty breathing; bluish-tinged skin, lips, or fingernails; confusion; or extreme sleepiness

Gabapentin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets, extended-release tablets, and capsules at room temperature, away from excess heat and moisture (not in the bathroom). Store the oral solution in the refrigerator.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of emergency/overdose

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

  • double vision
  • slurred speech
  • drowsiness
  • diarrhea

What other information should I know?

Keep all appointments with your doctor.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking gabapentin.

If you use a dipstick to test your urine for protein, ask your doctor which product you should use while taking this medication.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names

  • Gralise®
  • Horizant®
  • Neurontin®

Last Revised – 05/15/2020

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.

Side Effects

Drug information provided by: IBM Micromedex

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

  1. Clumsiness or unsteadiness
  2. continuous, uncontrolled, back-and-forth, or rolling eye movements

More common in children

  1. Aggressive behavior or other behavior problems
  2. anxiety
  3. concentration problems and change in school performance
  4. crying
  5. depression
  6. false sense of well-being
  7. hyperactivity or increase in body movements
  8. rapidly changing moods
  9. reacting too quickly, too emotional, or overreacting
  10. restlessness
  11. suspiciousness or distrust

Less common

  1. Black, tarry stools
  2. chest pain
  3. chills
  4. cough
  5. depression, irritability, or other mood or mental changes
  6. fever
  7. loss of memory
  8. pain or swelling in the arms or legs
  9. painful or difficult urination
  10. sore throat
  11. sores, ulcers, or white spots on the lips or in the mouth
  12. swollen glands
  13. unusual bleeding or bruising
  14. unusual tiredness or weakness

Incidence not known

  1. Abdominal or stomach pain
  2. blistering, peeling, or loosening of the skin
  3. clay-colored stools
  4. coma
  5. confusion
  6. convulsions
  7. dark urine
  8. decreased urine output
  9. diarrhea
  10. difficult or troubled breathing
  11. dizziness
  12. fast or irregular heartbeat
  13. headache
  14. increased thirst
  15. irregular, fast or slow, or shallow breathing
  16. itching or skin rash
  17. joint pain
  18. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  19. loss of appetite
  20. muscle ache or pain
  21. nausea
  22. pale or blue lips, fingernails, or skin
  23. red skin lesions, often with a purple center
  24. red, irritated eyes
  25. unpleasant breath odor
  26. vomiting of blood
  27. yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  1. Blurred vision
  2. cold or flu-like symptoms
  3. delusions
  4. dementia
  5. hoarseness
  6. lack or loss of strength
  7. lower back or side pain
  8. swelling of the hands, feet, or lower legs
  9. trembling or shaking

Less common or rare

  1. Accidental injury
  2. appetite increased
  3. back pain
  4. bloated or full feeling
  5. body aches or pain
  6. burning, dry, or itching eyes
  7. change in vision
  8. change in walking and balance
  9. clumsiness or unsteadiness
  10. congestion
  11. constipation
  12. cough producing mucus
  13. decrease in sexual desire or ability
  14. dryness of the mouth or throat
  15. earache
  16. excess air or gas in the stomach or intestines
  17. excessive tearing
  18. eye discharge
  19. feeling faint, dizzy, or lightheadedness
  20. feeling of warmth or heat
  21. flushed, dry skin
  22. flushing or redness of the skin, especially on the face and neck
  23. frequent urination
  24. fruit-like breath odor
  25. impaired vision
  26. incoordination
  27. increased hunger
  28. increased sensitivity to pain
  29. increased sensitivity to touch
  30. increased thirst
  31. indigestion
  32. noise in the ears
  33. pain, redness, rash, swelling, or bleeding where the skin is rubbed off
  34. passing gas
  35. redness or swelling in the ear
  36. redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
  37. runny nose
  38. sneezing
  39. sweating
  40. tender, swollen glands in the neck
  41. tightness in the chest
  42. tingling in the hands and feet
  43. trouble sleeping
  44. trouble swallowing
  45. trouble thinking
  46. twitching
  47. unexplained weight loss
  48. voice changes
  49. vomiting
  50. weakness or loss of strength
  51. weight gain

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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 zoster infection) 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.