Neurontin


Also found in: Dictionary, Thesaurus, Wikipedia.

gabapentin

(ga-ba-pen-tin) ,

Gralise

(trade name),

Horizant

(trade name),

Neurontin

(trade name)

Classification

Therapeutic: analgesic adjuncts
Pregnancy Category: C

Indications

Partial seizures (adjunct treatment) (immediate-release only).Postherpetic neuralgia.Restless legs syndrome (Horizant only).Neuropathic pain.Prevention of migraine headache.Bipolar disorder.Anxiety.Diabetic peripheral neuropathy.

Action

Mechanism of action is not known. May affect transport of amino acids across and stabilize neuronal membranes.

Therapeutic effects

Decreased incidence of seizures.
Decreased postherpetic pain.
Decreased leg restlessness.

Pharmacokinetics

Absorption: Well absorbed after oral administration by active transport. At larger doses, transport becomes saturated and absorption ↓ (bioavailability ranges from 60% for a 300-mg dose to 35% for a 1600-mg dose).
Distribution: Crosses blood-brain barrier; enters breast milk.
Metabolism and Excretion: Eliminated mostly by renal excretion of unchanged drug.
Half-life: Adults—5–7 hr (normal renal function); up to 132 hr in anuria; Children—4.7 hr.

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
PO-IRrapid2–4 hr8 hr
PO-SRunknown5–8 hr24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: All patients (may ↑ risk of suicidal thoughts/behaviors);Renal insufficiency (↓ dose and/or ↑ dosing interval if CCr ≤60 mL/min); Obstetric: Pregnancy; Pediatric: Children <18 yr (sustained-/extended-release) or <3 yr (immediate-release) (safety not established); Lactation: Discontinue drug or bottle-feed; Geriatric: May be more susceptible to toxicity due to age-related ↓ in renal function.

Adverse Reactions/Side Effects

Central nervous system

  • suicidal thoughts (life-threatening)
  • confusion (most frequent)
  • depression (most frequent)
  • dizziness (most frequent)
  • drowsiness (most frequent)
  • sedation
  • anxiety
  • concentration difficulties (children)
  • emotional lability (children)
  • hostility
  • hyperkinesia (children)
  • malaise
  • vertigo
  • weakness

Ear, Eye, Nose, Throat

  • abnormal vision
  • nystagmus

Cardiovascular

  • hypertension

Gastrointestinal

  • weight gain
  • anorexia
  • flatulence
  • gingivitis

Musculoskeletal

  • rhabdomyolysis (life-threatening)
  • arthralgia
  • ↑ creatine kinase

Neurologic

  • ataxia (most frequent)
  • altered reflexes
  • hyperkinesia
  • paresthesia

Miscellaneous

  • multiorgan hypersensitivity reactions (life-threatening)
  • facial edema

Interactions

Drug-Drug interaction

Antacids may ↓ absorption of gabapentin.↑ risk of CNS depression with other CNS depressants, including alcohol, antihistamines, opioids, and sedative/hypnotics.Morphine ↑ gabapentin levels and may ↑ risk of toxicity, dosage adjustments may be required.Kava-kava, valerian, or chamomile can ↑ CNS depression.

Route/Dosage

The sustained/extended-release formulations should not be interchanged with the immediate-release products

Epilepsy

Oral (Adults and Children >12 yr) 300 mg 3 times daily initially. Titration may be continued until desired (range is 900–1800 mg/day in 3 divided doses; doses should not be more than 12 hr apart). Doses up to 2400–3600 mg/day have been well tolerated.
Oral (Children ≥5–12 yr) 10–15 mg/kg/day in 3 divided doses initially titrated upward over 3 days to 25–35 mg/kg/day in 3 divided doses; dosage interval should not exceed 12 hr (doses up to 50 mg/kg/day have been used).
Oral (Children 3–4 yrs) 10–15 mg/kg/day in 3 divided doses initially titrated upward over 3 days to 40 mg/kg/day in 3 divided doses; dosage interval should not exceed 12 hr (doses up to 50 mg/kg/day have been used).

Renal Impairment

Oral (Adults and Children >12 yr) CCr 30–59 mL/min—200–700 mg twice daily; CCr 15–29 mL/min—200–700 mg once daily; CCr 15 mL/min—100–300 mg once daily; CCr <15 mL/min—Reduce daily dose in proportion to CCr.

Postherpetic Neuralgia

Oral (Adults) Immediate-release—300 mg once daily on first day, then 300 mg 2 times daily on second day, then 300 mg 3 times/day on day 3, may then be titrated upward as needed up to 600 mg 3 times/day; Sustained-release (Gralise)—300 mg once daily on first day, then 600 mg once daily on second day, then 900 mg once daily on days 3–6, then 1200 mg once daily on days 7–10, then 1500 mg once daily on days 11–14, then 1800 mg once daily thereafter; Extended-release (Horizant)—600 mg once daily in the morning on days 1–3, then 600 mg twice daily thereafter.

Renal Impairment

Oral (Adults) CCr 30–59 mL/min—200–700 mg twice daily (immediate-release); 600–1800 mg once daily (sustained-release [Gralise]); 300 mg once daily in the morning on days 1–3, then 300 mg twice daily thereafter (may ↑ to 600 mg twice daily, as needed) (extended-release [Horizant]); CCr 15–29 mL/min—200–700 mg once daily (immediate-release); sustained release [Gralise] not recommended; 300 mg in the morning on days 1 and 3, then 300 mg once daily in the morning thereafter (may ↑ to 300 mg twice daily, as needed) (extended-release [Horizant]); CCr 15 mL/min—100–300 mg once daily (immediate-release); sustained release [Gralise] not recommended; CCr <15 mL/min—↓ daily dose in proportion to CCr (immediate release); sustained release [Gralise] not recommended; 300 mg every other day in the morning (may ↑ to 300 mg once daily in the morning, as needed) (extended-release [Horizant]); CCr <15 mL/min (on hemodialysis)—300 mg after each dialysis session (may ↑ to 600 mg after each dialysis sessions, as needed)(extended-release [Horizant]).

Restless Legs Syndrome

Oral (Adults) Extended-release (Horizant)—600 mg once daily at 5 pm.

Renal Impairment

(Adults) CCr 30–59 mL/min—300 mg once daily at 5 pm; may ↑ to 600 mg once daily at 5 pm as needed ; CCr 15–29 mL/min—300 mg once daily at 5 pm; CCr <15 mL/min—300 mg every other day; CCr <15 mL/min (on hemodialysis)—Not recommended.

Neuropathic Pain (unlabeled use)

Oral (Adults) 100 mg 3 times daily initially. Titrate weekly by 300 mg/day up to 900–2400 mg/day (maximum: 3600 mg/day).
Oral (Children) 5 mg/kg/dose at bedtime initially then ↑ to 5 mg/kg BID on day 2 and 5 mg/kg TID on day 3. Titrate to effect up to 8–35 mg/kg/day in 3 divided doses.

Availability (generic available)

Capsules: 100 mg, 300 mg, 400 mg Cost: Generic — 100 mg $11.45 / 100, 300 mg $15.18 / 100, 400 mg $12.36 / 100
Tablets: 600 mg, 800 mg Cost: Generic — 600 mg $33.96 / 100, 800 mg $49.20 / 100
Extended-release tablets (Horizant): 600 mg
Sustained-release tablets (Gralise): 300 mg, 600 mg Cost: 300 mg $99.00 / 30, 600 mg $329.40 / 90
Oral solutioncool strawberry anise flavor: 250 mg/5 mL Cost: Generic — $148.91 / 470 mL

Nursing implications

Nursing assessment

  • Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.
  • Seizures: Assess location, duration, and characteristics of seizure activity.
  • Postherpetic Neuralgia & Neuropathic Pain: Assess location, characteristics, and intensity of pain periodically during therapy.
  • Migraine Prophylaxis: Monitor frequency and intensity of pain on pain scale.
  • Restless Leg Syndrome: Assess frequency and intensity of restless leg syndrome prior to and periodically during therapy.
  • Lab Test Considerations: May cause false-positive readings when testing for urinary protein with Ames N-Multistix SG dipstick test; use sulfosalicylic acid precipitation procedure.
    • May cause leukopenia.

Potential Nursing Diagnoses

Risk for injury (Side Effects)
Chronic pain (Indications)
Ineffective coping (Indications)

Implementation

  • Do not confuse Neurontin with Noroxin (norfloxacin).
  • Doses of Gralise and Horizant are not interchangeable with other dose forms of gabapentin.
  • Oral: May be administered without regard to meals.
    • 600-mg and 800-mg tablets are scored and can be broken to administer a half-tablet. If half-tablet is used, administer other half at the next dose. Discard half-tablets not used within several days.
    • Administer Gralise with evening meal. Swallow tablet whole; do not crush, break, or chew.
    • Administer Horizant for Restless Leg Syndrome with evening meal at 5 pm. Horizant for Postherpetic Neuralgia is administered twice daily. Swallow tablet whole; do not crush, break, or chew.
    • Gabapentin should be discontinued gradually over at least 1 wk. If dose is 600 mg/day, may discontinue without tapering. If >600 mg/day, titrate daily to 600 mg for 1 week, then discontinue. If patient is taking 600 mg twice daily, taper to once daily before discontinuing. Abrupt discontinuation may cause increase in seizure frequency.

Patient/Family Teaching

  • Instruct patient to take medication exactly as directed. Patients on tid dosing should not exceed 12 hr between doses. Take missed doses as soon as possible; if less than 2 hr until next dose, take dose immediately and take next dose 1–2 hr later, then resume regular dosing schedule. Do not double dose. Do not discontinue abruptly; may cause increase in frequency of seizures. Instruct patient to read the Medication Guide before starting and with each Rx refill, as changes may occur.
  • Advise patient not to take gabapentin within 2 hr of an antacid.
  • Gabapentin may cause dizziness and drowsiness. Caution patient to avoid driving or activities requiring alertness until response to medication is known. Seizure patients should not resume driving until physician gives clearance based on control of seizure disorder.
  • Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking; or other unusual changes in behavior or mood occur.
  • Instruct patient to notify health care professional of medication regimen before treatment or surgery.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.
  • Advise patient to carry identification describing disease process and medication regimen at all times.

Evaluation/Desired Outcomes

  • Decreased frequency of or cessation of seizures.
  • Decreased postherpetic neuralgia pain.
  • Decreased intensity of neuropathic pain.
  • Decreased frequency of migraine headaches.
  • Increased mood stability.
  • Decrease effects of restless leg syndrome.

Neurontin

(no͝o-rŏn′tn)
A trademark for the drug gabapentin.

Neurontin®

Gabapentin Neurology An agent used to manage postherpetic neuralgia and an adjunct for managing partial seizures in Pts > age 12 Adverse events Vertigo, somnolence, peripheral edema, asthenia, diarrhea, ataxia, fatigue, nystagmus. See Herpetic neuralgia, Seizures.

Neurontin

A brand name for GABAPENTIN.

Patient discussion about Neurontin

Q. is neurontin a safe drug for a 75 year old person?i have leg and foot pain and swelling.are there bad effects

A. Neruontin active substance is Gabapentin, an anti-epileptic medication. it is also given in some other conditions such as diabetic neuropathy. i guess that's the reason you got it. one of it's side effects is swelling of the hands, feet, ankles, or lower legs. i know i got that myself...and the advise to every side effect you encounter is the same- tell your Dr. about it. he might be able to change medication or reduce it in some level.

Q. Polio Syndrome pain One of my aunt is taking Neurontin for Post Polio Syndrome pain in her left leg and arm. she did not realize that she had so much pain and that it was keeping her from doing so many things. Is Neurontin recomended for this treatment and how does it help? Will she have problems with Neurontin if she take it long term? Neurontin is greatly helping the pain but not the fatique in these limbs. Should it help the fatigue?

A. Neurontin is being given as medication for nerve pain now also...I take 800 mg a day and it was started for back pain and it is also being used in some fibro patients I am learning( i also have fibromyalgia) It didn't cause me a lot of drowsness but amount of medication and medications affect people differently so each person can be different. But with the fatigue fibromyalgia causes maybe I just can't tell the difference b/c before I started it I was tried all the time and that is not any worse. But if your Aunt and yourself feel uncomfortable with this treatment I would suggest a second opinion. Good Luck to your Aunt

More discussions about Neurontin
References in periodicals archive ?
The large capsules of Seroquel XL 50mg tablets have gold and black packaging while Neurontin, which comes in a two-piece, white capsule, is stored in white and silver blister packs.
Pfizer agreed in 2004 to pay $430 million to federal and state governments and pleaded guilty to criminal charges of illegally marketing Neurontin for migraine headaches, pain and bipolar disorder.
The company said it is possible that patients taking Neurontin to control
Harris Pogust, cochair of ATLA's new Neurontin Litigation Group, said his firm in Pennsauken, New Jersey, has filed two such cases and sees potential clients daily.
Kaiser, the first insurer to try a Neurontin case against the world's biggest drugmaker, claimed it was forced to pay $90 million more than it should have for Neurontin.
Neurontin is widely used to treat epilepsy and post-shingles pain in adults.
Seventy-one percent of surveyed PCPs and 61 percent of pain specialists prescribe Neurontin more frequently than Lyrica," said Decision Resources Analyst Sami Fam, Ph.
Of 21 primary study objectives of off-label uses of Neurontin described in original documents, six weren't included in published reports and four were reported as secondary goals, according to the study in the journal.
The jury found that Pfizer fraudulently marketed Neurontin for unapproved uses -- including bipolar disorder, neuropathic pain, and migraine -- for which Pfizer misrepresented the drug's efficacy.
New York) won't face a jury verdict over claims that its epilepsy medicine Neurontin helped cause a Massachusetts woman's suicide after her family dropped its lawsuit in the midst of trial.
New York) won't face class-action lawsuits by health-insurance companies and patients on claims it improperly marketed the epilepsy drug Neurontin for unapproved uses, a judge ruled.
session of the American Pain Society provides an analysis of a Phase 2a randomized, double-blind, placebo-controlled study in which 101 PHN patients were first treated with 600 mg Neurontin three times daily, followed by treatment with 1200 mg XP13512 or placebo twice daily for 14 days.