Gabapentin
NEURONTIN
What it isAlpha-2-delta calcium-channel subunit ligand for seizures and postherpetic neuralgia; also used off label for other neuralgia.
Why it mattersSaturable absorption produces diminishing exposure gains as the dose rises, unlike pregabalin.
What it changesReduce in renal impairment; accumulation sedates. Opioids add respiratory depression, and misuse is increasingly recognized.
FDA-approved for
- seizures (1993)
- postherpetic neuralgia (2002)
- restless legs (enacarbil) (2011)
Off-label
- anxiety
- neuropathic pain
- alcohol use disorder
- hot flashes
- restless legs
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Postherpetic neuralgia | Adults | 300 mg QD (day 1) → 300 mg BID (day 2) → 300 mg TID (day 3) | 600 mg TID (1800 mg/day) | 1800 mg/day |
| Partial onset seizures | ≥12 yr | 300 mg TID | 300–600 mg TID | 3600 mg/day |
| Partial onset seizures | Peds 3–11 yr | 10–15 mg/kg/day TID | 3–4 yr: 40 mg/kg/day; 5–11 yr: 25–35 mg/kg/day |
Renal Adjust by creatinine clearance in patients ≥12 yr; reduce dose for renal impairment and supplement after hemodialysis
Hepatic Undefined
Max interval between doses ≤12 h
Instructions
- Do not discontinue abruptly — taper over ≥1 week to reduce seizure/withdrawal risk
- Maximum time between doses should not exceed 12 h
Cautions
- DRESS/multiorgan hypersensitivity
- Anaphylaxis and angioedema
- Somnolence/sedation, dizziness, driving impairment
- Suicidal behavior and ideation
- Increased seizure risk with abrupt discontinuation
- Respiratory depression with CNS depressants/opioids or respiratory impairment
- Neuropsychiatric reactions in children 3–12 yr
Adverse reactions
- Dizziness
- Somnolence
- Peripheral edema
- Ataxia
- Fatigue
- Nystagmus
- (peds) viral infection, fever, nausea/vomiting, hostility
Pregnancy Available data do not indicate increased risk of major birth defects/miscarriage; developmental toxicity in animals; neonatal withdrawal reported with concomitant opioids near delivery
Lactation Secreted in human milk; effects on infant unknown
NO BOXED WARNINGS
Principal riskSedation and dizziness, additive with opioids
Cost, est. cash$4–$80/month
Generic entry2003
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, dizziness and misuse potential; respiratory depression increases with opioids.
Mechanism of action: Gabapentin ballicule
Open Gabapentin in the interactive console ↗
Memory aids: mascots and interaction avatars
Pens shaped like neurons with heads of Yo Gabba Gabba characters
