From the Guidelines
Gabapentin is primarily indicated for the treatment of partial seizures, postherpetic neuralgia, and neuropathic pain conditions, including diabetic peripheral neuropathy, with a recommended starting dose of 300 mg once daily, gradually increasing to 300-600 mg three times daily, with maximum doses ranging from 1800-3600 mg daily divided into three doses, as supported by the most recent and highest quality study 1.
Indications for Gabapentin
- Partial seizures in adults and children over 3 years old, either as monotherapy or adjunctive therapy
- Postherpetic neuralgia in adults
- Neuropathic pain conditions, including:
- Diabetic peripheral neuropathy
- Fibromyalgia
- Other types of nerve pain
- Restless leg syndrome
- Alcohol withdrawal
- Hot flashes
- Adjunct treatment for anxiety disorders
Dosage and Administration
- Starting dose: 300 mg once daily
- Gradually increase to 300-600 mg three times daily
- Maximum doses: 1800-3600 mg daily divided into three doses
- Dosage adjustments necessary in patients with renal impairment
- Taper gradually when discontinuing to avoid withdrawal symptoms
Mechanism of Action
- Binds to the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system
- Reduces the release of excitatory neurotransmitters
- Effective in treating both seizures and neuropathic pain
Clinical Evidence
- Supported by multiple studies, including 1, 1, 1, 1, 1, and 1
- Recommended as an initial pharmacologic treatment for neuropathic pain in diabetes, along with pregabalin and duloxetine 1
From the FDA Drug Label
Gabapentin Tablets, USP are indicated for: Management of postherpetic neuralgia in adults Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization, in adults and pediatric patients 3 years and older with epilepsy
The indications for gabapentin (Neurontin) are:
- Management of postherpetic neuralgia in adults
- Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization, in adults and pediatric patients 3 years and older with epilepsy 2
From the Research
Indications for Gabapentin
Gabapentin is indicated for various conditions, including:
- Adjunctive treatment of complex partial seizures with and without generalization 3
- Treatment of neuropathic pain, including painful diabetic neuropathy and postherpetic neuralgia 4, 5
- Treatment of epilepsy, including partial seizures with or without secondary generalization 6, 7
Dosage and Administration
The dosage of gabapentin varies depending on the condition being treated and the patient's renal function.
- For adjunctive treatment of complex partial seizures, the recommended dosage is 900-1800 mg/day 3
- For treatment of neuropathic pain, the recommended dosage is 1800-3600 mg/day, with a starting dose of 900 mg/day 4, 5
- For treatment of epilepsy, the recommended dosage is 900-3600 mg/day, with a starting dose of 900 mg/day 6, 7
Efficacy and Safety
Gabapentin has been shown to be effective in reducing pain and seizure frequency in various studies.
- In patients with postherpetic neuralgia, gabapentin at doses of 1200 mg/day or greater was associated with substantial pain relief (at least 50% pain relief) in 32% of patients, compared to 17% with placebo 5
- In patients with painful diabetic neuropathy, gabapentin at doses of 1200 mg/day or greater was associated with substantial pain relief in 38% of patients, compared to 21% with placebo 5
- Gabapentin is generally well-tolerated, with common side effects including dizziness, somnolence, and peripheral edema 4, 5, 6, 7