What is the initial dosing regimen for gabapentin (Neurontin) when treating neuropathic pain?

From the Guidelines

Gabapentin for nerve pain should be started at a low dose of 100-300 mg nightly and gradually increased to minimize side effects, with dose increments of 50%-100% every few days, as recommended by the study 1. When initiating gabapentin therapy, it is essential to begin with a low dose and titrate upwards to minimize adverse effects. The starting dose can be 100-300 mg nightly, with gradual increases of 50%-100% every few days, as needed, and as tolerated by the patient. Some key points to consider when dosing gabapentin include:

• Starting with a low dose and gradually increasing it to minimize side effects
• Typical dose increments of 50%-100% every few days
• Slower titration for elderly or medically frail patients
• Dose adjustment required for patients with renal insufficiency
• Most patients require 1800-3600 mg daily, divided into 2-3 doses, for effective pain control, as seen in the study 1. It is crucial to take gabapentin with food to improve absorption and reduce stomach upset. Common side effects, such as dizziness, drowsiness, and fatigue, often improve with time. Elderly patients or those with kidney impairment require lower doses, and the medication should be taken consistently at scheduled times to avoid withdrawal symptoms. Gabapentin works by binding to calcium channels in the nervous system, reducing the release of excitatory neurotransmitters involved in pain signaling, as explained in the study 1.

From the FDA Drug Label

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 of gabapentin for nerve pain should be initiated as a single 300 mg dose on Day 1, then increased to 600 mg/day on Day 2, and 900 mg/day on Day 3, with subsequent titration as needed for pain relief, up to a maximum dose of 1800 mg/day 2.

• Initial dose: 300 mg on Day 1
• Dose on Day 2: 600 mg/day (300 mg two times a day)
• Dose on Day 3: 900 mg/day (300 mg three times a day)
• Maximum dose: 1800 mg/day (600 mg three times a day)

From the Research

Gabapentin Dosing for Nerve Pain

• The initial dose of gabapentin for neuropathic pain can be started at 900 mg/d, with a gradual increase to 1800 mg/d for greater efficacy 3.
• Doses up to 3600 mg/d may be needed in some patients, and the effective dose should be individualized according to patient response and tolerability 3.
• A study found that gabapentin at doses of 1200 mg or more daily can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy 4.
• The dosing schedule may vary depending on the specific condition being treated, with some studies suggesting a starting dose of 300 mg/d on day 1,600 mg/d on day 2, and 900 mg/d on day 3 3.

Efficacy and Tolerability

• Gabapentin has been shown to be effective in the treatment of painful diabetic neuropathy, postherpetic neuralgia, and other neuropathic pain syndromes 4, 3.
• Adverse effects of gabapentin are typically mild to moderate and usually subside within approximately 10 days from the initiation of treatment 3.
• Common adverse events associated with gabapentin include dizziness, somnolence, peripheral oedema, and gait disturbance 4.
• Gabapentin has been compared to other medications, such as duloxetine and pregabalin, in the treatment of diabetic peripheral neuropathic pain, with varying results 5, 6.