What is the recommended dose and frequency of Gabapentin (Gabapentin)

From the Guidelines

Gabapentin should be started at a low dose of 100-300 mg nightly and increased to 900-3600 mg daily in divided doses 2 to 3 times a day, with dose increments of 50%-100% every few days, as this approach has been shown to be effective in managing neuropathic pain while minimizing side effects 1. The dosing regimen for gabapentin can vary depending on the condition being treated, but for most conditions, the maintenance dose ranges from 900-3600 mg daily, divided into three doses.

• For neuropathic pain, a common regimen is to start with a low dose and gradually increase as needed up to 1800-3600 mg daily in divided doses.
• Elderly patients and those with renal impairment require lower doses, with adjustments based on creatinine clearance, as noted in studies such as 1 and 1. Some key points to consider when prescribing gabapentin include:
• The medication should be taken with food to improve absorption.
• Patients should not stop it abruptly as this can trigger withdrawal symptoms or seizures.
• Common side effects include dizziness, drowsiness, and peripheral edema, which often improve with continued use. It's also important to note that gabapentin works by binding to calcium channels in the nervous system, reducing the release of excitatory neurotransmitters, and its efficacy and tolerability have been compared to other medications such as pregabalin in studies like 1. Overall, the goal of gabapentin treatment is to find a balance between effective pain management and minimizing side effects, and this can be achieved by starting with a low dose and gradually increasing as needed, while also taking into account individual patient factors such as age and renal function 1.

From the FDA Drug Label

Dosage and Administration 2. 1 Dosage for Postherpetic Neuralgia In adults with postherpetic neuralgia, gabapentin may be initiated on Day 1 as a single 300 mg dose, on Day 2 as 600 mg/day (300 mg two times a day), and on Day 3 as 900 mg/day (300 mg three times a day). The dose can subsequently be titrated up as needed for pain relief to a dose of 1800 mg/day (600 mg three times a day) 2. 2 Dosage for Epilepsy with Partial Onset Seizures Patients 12 years of age and above The starting dose is 300 mg three times a day. The recommended maintenance dose of gabapentin tablets is 300 mg to 600 mg three times a day.

The recommended gabapentin dose and frequency are as follows:

• For postherpetic neuralgia: 300 mg on Day 1,600 mg/day (300 mg two times a day) on Day 2, and 900 mg/day (300 mg three times a day) on Day 3, titrated up to 1800 mg/day (600 mg three times a day) as needed.
• For epilepsy with partial onset seizures in patients 12 years and above: 300 mg three times a day, with a recommended maintenance dose of 300 mg to 600 mg three times a day 2.

From the Research

Gabapentin Dose and Frequency

• The recommended gabapentin dosing schedule is t.i.d. (three times a day) 3
• Studies have shown that higher doses and faster titration schedules may be effective in achieving improved seizure control without compromising tolerability 4
• In adult patients, gabapentin may be initiated at a dosage of 900 mg/d and titrated to maintenance dosages ≥ 3600 mg/d 4
• Children may be treated with gabapentin 23 to 78 mg/kg per day 4
• At large daily doses, oral bioavailability may be improved by giving the daily dose more frequently, such as q.i.d. (four times a day) instead of t.i.d. 3
• However, improved gabapentin bioavailability at doses of 3600 mg/day was not achieved with more frequent drug administration, and thus is not warranted 3
• At 4800 mg/day, a 22% increase in bioavailability was observed with more frequent drug dosing 3

Titration and Maintenance

• Titration to effect can be accomplished rapidly, if necessary, but optimal seizure control may take months to achieve 4
• Most patients who received high dosages (e.g., 3600 mg/d) or experienced fast titration rates tolerated gabapentin well 4
• Side effects occurred around the onset of dosing and were reported in some studies to be transient 4

Clinical Practice

• In clinical practice, treatment initiation of currently available drugs indicated for neuropathic pain less frequently leads to long-term treatment compared to clinical trials, and few patients try more than one drug 5
• Gabapentin is a commonly prescribed medication for neuropathic pain, with a recommended dosage and titration schedule similar to that for epilepsy 6