What is the recommended dose and frequency for gabapentin (Neurontin)?

From the Guidelines

Gabapentin dosing typically starts at 100-300 mg nightly and can be 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 recommended by the study published in the Journal of the National Comprehensive Cancer Network 1. The dosing regimen for gabapentin can vary depending on the patient's response and tolerability.

• Starting dose: 100-300 mg nightly
• Titration: increase by 50%-100% every few days
• Maximum dose: 3600 mg daily in divided doses 2 to 3 times a day
• Considerations: slower titration for elderly or medically frail patients, dose adjustment required for patients with renal insufficiency It's also important to note that gabapentin should be taken with food to improve absorption and reduce gastrointestinal side effects, and it's crucial to maintain consistent blood levels by taking the medication at evenly spaced intervals throughout the day, as supported by the study published in Diabetes/Metabolism Research and Reviews 1 and Mayo Clinic Proceedings 1. When discontinuing gabapentin, the dose should be gradually tapered over at least one week to prevent withdrawal symptoms, as recommended by the study published in Clinical Infectious Diseases 1 and 1. Common side effects of gabapentin include dizziness, drowsiness, and peripheral edema, as reported in the study published in Diabetes/Metabolism Research and Reviews 1. Gabapentin works by binding to calcium channels in the nervous system, reducing the release of excitatory neurotransmitters and thereby decreasing nerve pain and seizure activity. The most recent and highest quality study, published in Clinical Infectious Diseases in 2017 1 and 1, recommends a typical adult regimen of 2400 mg per day in divided doses for the management of chronic HIV-associated neuropathic pain.

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. 2. 3 Dosage Adjustment in Patients with Renal Impairment Dosage adjustment in patients 12 years of age and older with compromised renal function or undergoing hemodialysis is recommended, as follows (see dosing recommendations above for effective doses in each indication):

The recommended dose and frequency for gabapentin (Neurontin) are as follows:

• For postherpetic neuralgia:
  • Day 1: 300 mg single dose
  • Day 2: 600 mg/day (300 mg two times a day)
  • Day 3: 900 mg/day (300 mg three times a day)
  • Titrate up to 1800 mg/day (600 mg three times a day) as needed
• For epilepsy with partial onset seizures (patients 12 years and above):
  • Starting dose: 300 mg three times a day
  • Maintenance dose: 300 mg to 600 mg three times a day
• For patients with renal impairment:
  • Dosage adjustment is recommended based on creatinine clearance (see TABLE 1)
  • Administer doses at the following frequencies:
    • Three times a day (TID) for creatinine clearance ≥60 mL/min
    • Two times a day (BID) for creatinine clearance >30-59 mL/min
    • Single daily dose (QD) for creatinine clearance >15-29 mL/min
    • Reduce daily dose in proportion to creatinine clearance for patients with creatinine clearance <15 mL/min 2

From the Research

Gabapentin Dosing

The recommended dose and frequency for gabapentin vary depending on the condition being treated.

• For neuropathic pain, the dose can be started at 900 mg/d (300 mg/d on day 1,600 mg/d on day 2, and 900 mg/d on day 3) and titrated up to 1800 mg/d for greater efficacy 3.
• Doses up to 3600 mg/d may be needed in some patients 3, 4.
• For patients with sciatica, gabapentin can be started at a dose of 300 mg once/day and titrated gradually up to 900 mg 3 times/day 5.

Administration

Gabapentin can be administered in divided doses, typically 3 times a day 3, 5.

• The effective dose should be individualized according to patient response and tolerability 3.
• Gabapentin has been shown to be effective in relieving symptoms of neuropathic pain, including allodynia, burning pain, shooting pain, and hyperesthesia 3, 5.

Comparison to Pregabalin

Pregabalin, a structural congener of gabapentin, has a more "pharmaceutically elegant" profile, with linear and dose-independent absorption and a narrow therapeutic dosing range 6.

• However, pregabalin still requires multiple administrations per day, and daily doses > 150 mg/d require dose titration 6.