From the Guidelines
The maximum recommended dose of gabapentin (Neurontin) for adults is typically 3,600 mg per day, divided into three equal doses. This dosing regimen is supported by various studies, including one published in the Journal of the National Comprehensive Cancer Network, which recommends gabapentin doses of 900-3600 mg daily in divided doses 2 to 3 times a day 1. Another study published in Diabetes/Metabolism Research and Reviews also supports this dosing range, listing gabapentin 900-3600 mg/day as a treatment option for painful diabetic peripheral neuropathy 1. However, more recent guidelines, such as the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV, suggest a typical adult regimen of 2400 mg per day in divided doses 1. It's essential to note that patients with renal impairment require dose adjustments, and careful monitoring is necessary when approaching maximum dosages due to potential side effects like dizziness, somnolence, and peripheral edema.
Some key points to consider when prescribing gabapentin include:
- Starting with a lower dose and gradually increasing as needed to minimize side effects
- Adjusting doses for patients with renal impairment based on creatinine clearance
- Monitoring for common side effects, especially at higher doses
- Considering alternative treatment options if patients have an inadequate response to gabapentin, such as serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, or pregabalin.
Overall, the maximum recommended dose of gabapentin should be individualized based on patient response and tolerability, with careful consideration of potential side effects and interactions.
From the FDA Drug Label
In clinical studies, efficacy was demonstrated over a range of doses from 1800 mg/day to 3600 mg/day with comparable effects across the dose range; however, in these clinical studies, the additional benefit of using doses greater than 1800 mg/day was not demonstrated. Dosages up to 2400 mg/day have been well tolerated in long-term clinical studies Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated. TABLE 1 Gabapentin Tablets Dosage Based on Renal Function ... Total Daily Dose Range (mg/day) ... 900-3600
The maximum recommended dose of gabapentin per day is 3600 mg/day 2.
From the Research
Maximum Recommended Dose of Gabapentin
The maximum recommended dose of gabapentin varies depending on the condition being treated and the individual patient's response to the medication.
- For neuropathic pain, the maximum dose is typically 3600 mg per day, with some studies suggesting that doses up to 3600 mg per day can provide good levels of pain relief for some patients with postherpetic neuralgia and peripheral diabetic neuropathy 3, 4.
- A systematic review and meta-analysis of randomized controlled trials found that gabapentin at doses of 1800 to 3600 mg per day could significantly improve sleep interference, at least 50% reduction in pain intensity, and Patient/Clinician Global Impression of Change (PGIC/CGIC), but also increased the incidence of adverse events 5.
- For epilepsy, gabapentin may be initiated at a dosage of 900 mg per day and titrated to maintenance dosages of 3600 mg per day or more, with most patients tolerating the medication well 6.
Important Considerations
- The effective dose of gabapentin should be individualized according to patient response and tolerability 4.
- Higher doses of gabapentin may increase the risk of adverse events, such as dizziness, somnolence, and peripheral edema 3, 5.
- Gabapentin enacarbil (GEn) at doses of 1200 mg per day and 2400 mg per day may be effective and safe for treating postherpetic neuralgia, while GEn 3600 mg per day may increase the risk of adverse events 5.