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When in the judgment of the clinician there is a need for dose reduction, discontinuation, or substitution with an alternative medication, this should be done gradually over a minimum of 1 week.
Epilepsy: Adults and Pediatric Patients Older Than 12 Years of Age: In clinical trials, the effective dosing range was 900 mg/day to 1800 mg/day. Therapy may be initiated by administering 300 mg three times a day on Day 1, or by titrating the dose (Table 2). Thereafter, the dose can be increased in three equally divided doses up to a maximum dose of 2400 mg/day. The maximum time between doses in the three times a day schedule should not exceed 12 hours to prevent breakthrough convulsions. (See Table 2.)
Click on icon to see table/diagram/imagePediatric Patients Aged 3-12 Years: The starting dose should range from 10 to 15 mg/kg/day given in equally divided doses (three times a day), and the effective dose reached by upward titration over a period of approximately 3 days. The effective dose of gabapentin in pediatric patients age 5 years and older is 25 to 35 mg/kg/day given in equally divided doses (three times a day). The effective dose in pediatric patients aged 3 to less than 5 years is 40 mg/kg/day given in equally divided doses (three times a day). Doses 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.
It is not necessary to monitor gabapentin plasma concentrations to optimize gabapentin therapy. Further, gabapentin may be used in combination with other antiepileptic drugs without concern for alteration of the plasma concentrations of gabapentin or serum concentrations of other antiepileptic drugs.
Neuropathic Pain in Adults: Neurontin should be titrated to a maximum dose of 1800 mg/day. Titration to an effective dose can be progress rapidly and can be accomplished over a few days by administering 300 mg once a day on Day 1, 300 mg twice a day on Day 2 and 300 mg three times a day on Day 3, (see Table 2).
Thereafter, the dose can be increased using increments of 300 mg/day given in three divided doses to a maximum of 1800 mg/day.
Dose Adjustment in Impaired Renal function in Patients with Neuropathic Pain or Epilepsy: Dose adjustment is recommended in patients with compromised renal function (Table 3) and/or in those undergoing hemodialysis. (See Table 3.)
Click on icon to see table/diagram/imageDose Adjustment in Patients Undergoing Hemodialysis: For patients undergoing hemodialysis who have never received gabapentin, a loading dose of 300 mg to 400 mg is recommended, and then 200 mg to 300 mg of gabapentin following each 4 hours of hemodialysis.
On dialysis-free days there should be no treatment with Neurontin.
If Neurontin discontinued and/or an alternate anticonvulsant medication is added to the therapy, this should be done gradually over a minimum of 1 week.
Method and Duration of Administration: Neurontin capsules should be swallowed whole with sufficient fluid intake. Administration may be made during or between meals. In three-times daily administration, care should be taken that the interval between two single doses does not exceed 12 hours.
Whether a missed dose of Neurontin (this means more than 12 hours passed since the last administration) should be made up for by taking an additional dose of Neurontin later or not is at the physician's discretion.
In concurrent treatment with magnesium or aluminium containing antacids, Neurontin should be taken at least 2 hours after administration of the antacid. This largely avoids a reduction in gabapentin bioavailability.
The duration of administration depends on the clinical requirements. In the treatment of epilepsy, usually, long-term therapy is required.
If therapy with Neurontin capsules should be discontinued, the dose reduced, or switched to another drug, this should be done gradually over a minimum of one week, although there is no evidence of a rebound phenomenon (increased occurrence of epileptic seizures following abrupt withdrawal of therapy).
In the treatment of neuropathic pain, efficacy and safety has not been examined in clinical studies for treatment periods longer than 5 months.
