From the FDA Drug Label
TABLE 1 Gabapentin Tablets Dosage Based on Renal Function Renal Function Creatinine Clearance (mL/min) Total Daily Dose Range (mg/day) Dose Regimen (mg) ...
30-59 400-1400 200 BID 300 BID 400 BID 500 BID 700 BID
The maximum daily dose of gabapentin for a patient with a GFR of 43 is 1400 mg/day.
- The dose regimen can be 200 BID, 300 BID, 400 BID, 500 BID, or 700 BID. 1
From the Research
For a patient with a GFR of 43 mL/min, the maximum daily gabapentin dose should be reduced to 1400 mg per day, divided into multiple doses, as supported by the most recent study 2. This is approximately 700 mg twice daily or 400-500 mg three times daily. Gabapentin is primarily eliminated unchanged through the kidneys, so dosing must be adjusted when renal function is impaired. With a GFR of 43, which indicates moderate renal impairment, the drug's clearance is reduced, leading to higher blood levels and increased risk of side effects if standard doses are used. Some key points to consider when prescribing gabapentin to patients with renal impairment include:
- Patients should be monitored for signs of gabapentin toxicity such as dizziness, somnolence, confusion, and ataxia 3.
- Starting at a lower dose (such as 300 mg daily) and gradually titrating up to the maximum based on response and tolerability is recommended 4.
- If renal function worsens, further dose reductions may be necessary.
- Gabapentin should be taken with food to reduce gastrointestinal side effects, and doses should not be abruptly discontinued to avoid withdrawal symptoms. It's also important to note that the relationship between gabapentinoid dosing, kidney function, and the incidence of gabapentinoid-related adverse events requires larger, multicentre studies 2. However, based on the available evidence, reducing the maximum daily gabapentin dose for patients with a GFR of 43 mL/min is a necessary precaution to minimize the risk of adverse events. The study by 4 highlights the importance of careful dosing in patients with chronic kidney disease, and the need to balance the benefits of gabapentin use against the potential risks. Overall, the recommendation to reduce the maximum daily gabapentin dose for patients with a GFR of 43 mL/min is supported by the most recent and highest quality evidence 2.