Does gabapentin affect kidney function?

From the Guidelines

Gabapentin can affect kidney function, particularly in patients with pre-existing kidney problems, and requires dosage adjustments to prevent toxicity and potential kidney damage. According to the most recent study 1, gabapentinoids, such as gabapentin, can cause life-threatening drug accumulation and toxicity in patients with renal impairments. The study highlights the importance of careful dosing and monitoring in patients with kidney disease.

Key points to consider:

• Gabapentin is primarily eliminated through the kidneys, and patients with reduced kidney function may experience higher blood levels of the medication, increasing the risk of side effects 1.
• Dosage adjustments are typically necessary for patients with kidney impairment, including reducing the dose or extending the time between doses 1.
• Patients taking gabapentin should have their kidney function monitored periodically, especially those with pre-existing kidney disease, the elderly, or those taking other medications that affect the kidneys 1.
• In patients with normal kidney function, gabapentin generally doesn't cause kidney damage, but it can occasionally lead to acute kidney injury in rare cases 1.

It is essential to discuss kidney function and potential dosing adjustments with a healthcare provider, especially for patients with kidney disease, to ensure safe and effective use of gabapentin.

From the FDA Drug Label

Gabapentin is eliminated from the systemic circulation by renal excretion as unchanged drug. Gabapentin elimination half-life is 5 to 7 hours and is unaltered by dose or following multiple dosing. Gabapentin elimination rate constant, plasma clearance, and renal clearance are directly proportional to creatinine clearance In elderly patients, and in patients with impaired renal function, gabapentin plasma clearance is reduced. Gabapentin can be removed from plasma by hemodialysis.

Gabapentin affects kidney function as it is primarily eliminated by the kidneys and its clearance is directly proportional to creatinine clearance. This means that patients with impaired renal function may have reduced gabapentin clearance, leading to increased drug levels and potential toxicity.

• Key points:
  • Gabapentin is eliminated by renal excretion
  • Clearance is proportional to creatinine clearance
  • Impaired renal function can reduce gabapentin clearance
  • Dosage adjustment is necessary in patients with compromised renal function 2 2

From the Research

Gabapentin and Kidney Function

• Gabapentin is cleared via renal excretion, and its elimination is proportional to creatinine clearance (CrCL) 3, 4, 5.
• Impaired renal function results in higher plasma gabapentin concentrations, longer elimination half-lives, and reduced clearance values 4, 5.
• The pharmacokinetics of gabapentin are affected by renal function, and dosage adjustments are necessary in patients with impaired renal function 3, 4, 5.

Renal Clearance and Gabapentin

• Gabapentin clearance is directly proportional to creatinine clearance, and renal impairment reduces gabapentin excretion and increases plasma gabapentin concentrations in a linear fashion 5.
• The elimination half-life of gabapentin increases to 132 hours in patients on dialysis, compared to 5-9 hours in patients with normal renal function 5.

Clinical Implications

• Indication and drug dose of gabapentin in dialysis patients should be tightly controlled, and drug monitoring used to avoid unintended overdose 5.
• Dosage adjustment for gabapentin is necessary in patients with impaired renal function, and the dose should be reduced in patients with even moderate renal failure (creatinine clearance below 60 ml/min) 3, 4, 5.