There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the FDA Drug Label
Apparent oral clearance (CL/F) of gabapentin decreased as age increased, from about 225 mL/min in those under 30 years of age to about 125 mL/min in those over 70 years of age. Renal clearance (CLr) and CLr adjusted for body surface area also declined with age; however, the decline in the renal clearance of gabapentin with age can largely be explained by the decline in renal function. Adult Patients with Renal Impairment Subjects (N=60) with renal impairment (mean creatinine clearance ranging from 13 to 114 mL/min) were administered single 400 mg oral doses of gabapentin.
The FDA drug label does not explicitly state that gabapentin is contraindicated in Acute Kidney Injury (AKI). However, it does mention that gabapentin is primarily renally excreted and that renal clearance declines with age and renal impairment.
- Key points:
- Gabapentin clearance is directly proportional to creatinine clearance.
- Patients with renal impairment have decreased gabapentin clearance.
- The label provides dosage adjustments for patients with renal impairment, but does not explicitly address AKI. Given the information available, a conservative clinical decision would be to use caution when administering gabapentin to patients with AKI, as the drug's clearance may be decreased in this population 1.
From the Research
Gabapentin Contraindication in Acute Kidney Injury (AKI)
- Gabapentin is not strictly contraindicated in Acute Kidney Injury (AKI), but its use requires careful consideration and dose adjustment due to its exclusive renal elimination 2, 3, 4.
- The risk of gabapentin toxicity is increased in patients with impaired renal function, which can manifest as coma, myoclonus, tremulousness, or altered mental status 3, 4.
- Studies have reported cases of gabapentin toxicity in patients with acute renal failure, which resolved with discontinuation of gabapentin and treatment with hemodialysis or peritoneal dialysis 2, 3, 4.
- Appropriate dosing of gabapentin is crucial to minimize the risk of adverse events in patients with kidney disease, particularly in those with advanced kidney disease or concomitant antipsychotic use 5.
- Gabapentin requires specific precautions, usually dose reduction, in patients with renal failure, and its use should be carefully monitored to avoid toxicity 6.
Key Considerations
- Gabapentin is entirely excreted through the renal system, making dose adjustment necessary in patients with renal impairment 2.
- The risk of gabapentin toxicity is higher in patients with acute kidney injury or end-stage renal disease 3, 4.
- Clinicians should be aware of the need to review gabapentin use during periods of acute illness, especially with regard to renal impairment 2.
- Gabapentin should be used with caution in patients with kidney disease, and its dosage should be adjusted according to the patient's renal function 5, 6.