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ClassificationTherapeutic: analgesic adjuncts
Time/action profile (blood levels)
|PO-IR||rapid||2–4 hr||8 hr|
|PO-SR||unknown||5–8 hr||24 hr|
Adverse Reactions/Side Effects
Central nervous system
- suicidal thoughts (life-threatening)
- confusion (most frequent)
- depression (most frequent)
- dizziness (most frequent)
- drowsiness (most frequent)
- concentration difficulties (children)
- emotional lability (children)
- hyperkinesia (children)
Ear, Eye, Nose, Throat
- abnormal vision
- weight gain
- rhabdomyolysis (life-threatening)
- ↑ creatine kinase
- ataxia (most frequent)
- altered reflexes
- multiorgan hypersensitivity reactions (life-threatening)
- facial edema
Drug-Drug interactionAntacids 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/DosageThe sustained/extended-release formulations should not be interchanged with the immediate-release products
Renal ImpairmentOral (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.
Renal ImpairmentOral (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
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)
Availability (generic available)
- 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 DiagnosesRisk for injury (Side Effects)
Chronic pain (Indications)
Ineffective coping (Indications)
- 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.
- 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.
- 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®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.
NeurontinA 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
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?