Gabapentin Dosing for Sciatica
For sciatica, gabapentin should be started at 100-300 mg at bedtime and gradually titrated to 900-3600 mg daily in divided doses (2-3 times per day), with dose adjustments required for renal insufficiency. 1
Initial Dosing and Titration
- Starting dose: 100-300 mg at bedtime or 100-300 mg three times daily
- Titration: Increase by 100-300 mg every 3-7 days as tolerated
- Target dose: 900-3600 mg daily in divided doses (2-3 times per day)
- Duration for adequate trial: 3-8 weeks for titration plus 2 weeks at maximum dose 1
Dosing Considerations
- Slower titration is recommended for elderly patients or those who are medically frail
- Dose adjustment required for patients with renal insufficiency
- Nonlinear pharmacokinetics (due to saturable absorption) necessitate careful titration
- Morning sedation can be minimized by starting with a nighttime dose
Efficacy for Sciatica
While gabapentin is frequently used for neuropathic pain components, evidence specifically for sciatica is mixed:
- Case reports suggest efficacy in some patients with sciatica 2
- In a head-to-head comparison, gabapentin showed superior pain reduction compared to pregabalin for chronic sciatica (mean pain reduction 1.72 vs 0.94 on a 10-point scale) 3
- Gabapentin may be more effective when added to existing pain regimens 4
Adverse Effects Management
Common adverse effects include:
- Sedation and dizziness
- Confusion
- Peripheral edema
- Weight gain
To minimize adverse effects:
- Start with lower dosages
- Titrate slowly (every 3-7 days)
- Take with food to reduce gastrointestinal effects
- Monitor for increased suicidal thoughts, especially during initial titration
Monitoring
- Assess pain reduction and functional improvement at each dose increase
- Monitor renal function, especially in elderly patients or those with known renal impairment
- Evaluate for adverse effects at each follow-up
- Gabapentin is not effective as a PRN medication; consistent dosing is required
Alternative Options
If gabapentin is ineffective or poorly tolerated:
- Pregabalin (50 mg 3 times daily or 75 mg twice daily, increased to 300 mg/day after 3-7 days) 1
- Duloxetine (30 mg daily, increased to 60-120 mg daily) 1, 5
- Tricyclic antidepressants (10-25 mg at bedtime, increased to 50-150 mg) 1
- Topical lidocaine 5% patch applied daily to the painful site 1
Important Considerations
- Abrupt discontinuation can lead to withdrawal symptoms; taper over at least 1 week when discontinuing
- Gabapentin requires consistent dosing and is not effective as a PRN medication
- Patients should be advised about potential sedation and not to drive until effects are known
- Avoid alcohol and other CNS depressants which may potentiate sedative effects
Gabapentin's efficacy for neuropathic pain makes it a reasonable option for sciatica with a neuropathic component, though individual response varies and careful titration is necessary to balance efficacy with tolerability.