What is the maximum dose of gabapentin (Neurontin) at night?

Maximum Gabapentin Dosing at Night

The maximum dose of gabapentin at night is 1200 mg, which is the recommended upper limit for a single nighttime dose in most patients. 1, 2

Dosing Guidelines for Gabapentin

Gabapentin dosing should follow these principles:

• Starting dose: 300 mg at bedtime is the typical starting dose for nighttime administration 1, 2
• Titration: Increase by 300 mg every 1-7 days as tolerated 1
• Effective nighttime dose range: 300-1200 mg at bedtime for most patients 3, 1

Maximum Daily Dosing Context

While the FDA-approved maximum total daily dose of gabapentin is 3600 mg/day (divided into three doses) 2, the maximum single nighttime dose should not exceed 1200 mg for most patients due to:

1. Increased risk of adverse effects with higher single doses
2. Better efficacy-to-side-effect ratio at moderate doses
3. Minimal additional benefit above 1800 mg/day total daily dose 1

Efficacy vs. Risk Considerations

The Mayo Clinic Proceedings and American College of Physicians recommend avoiding maximum dosing (3600 mg/day) in most patients because:

• Doses of 900-1800 mg/day (total) are effective for most patients with lower risk of adverse effects
• Doses of 1800-2400 mg/day provide modest additional benefit with increased risk
• Doses of 2400-3600 mg/day offer minimal additional benefit with significantly higher risk of falls, fractures, and edema 1

Special Populations

Elderly Patients

• Lower starting doses and slower titration due to increased sensitivity to adverse effects
• Maximum nighttime dose should be reduced 1

Renal Impairment

Dose adjustment based on creatinine clearance is required:

• CrCl >60 mL/min: Standard dosing
• CrCl 30-59 mL/min: Maximum 700 mg BID (maximum 700 mg at night)
• CrCl 15-29 mL/min: Maximum 700 mg QD (maximum 700 mg at night)
• CrCl <15 mL/min: Maximum 300 mg QD (maximum 300 mg at night) 2

Common Adverse Effects

Nighttime dosing may help manage some side effects but be aware of:

• Dizziness (19% of patients)
• Somnolence (14%)
• Peripheral edema (7%)
• Gait disturbance (14%) 1

Practical Tips for Nighttime Dosing

• Take with food to improve tolerability
• Start low and titrate slowly to minimize side effects
• If dividing a scored tablet, use the unused half-tablet as the next dose within 28 days 2
• When discontinuing, taper gradually over at least 1 week to avoid withdrawal symptoms 1, 2

Remember that while 1200 mg is the maximum recommended nighttime dose for most patients, the optimal dose should be the lowest effective dose that provides adequate symptom control with minimal side effects.