What is the recommended dose of gabapentin (Neurontin)?

From the Guidelines

Gabapentin is typically started at a low dose of 100-300 mg nightly and gradually increased to minimize side effects, with effective doses ranging from 900-3600 mg daily, divided into three doses, as recommended by the most recent and highest quality study 1. The recommended dosing regimen for gabapentin is as follows:

• Starting dose: 100-300 mg nightly
• Increase to 900-3600 mg daily in divided doses 2 to 3 times a day
• Dose increments of 50%-100% every few days
• Slower titration for the elderly or medically frail
• Dose adjustment required for those with renal insufficiency This dosing regimen is supported by studies such as 1 and 1, which provide guidelines for the pharmacological management of neuropathic pain. It's worth noting that the efficacy and tolerability of gabapentin have been established in several randomized controlled trials, including those for the treatment of painful diabetic peripheral neuropathy 1. Some key points to consider when prescribing gabapentin include:
• Gradual dose escalation to minimize side effects
• Individualized dosing based on patient response and tolerability
• Regular monitoring for adverse effects, such as dizziness, drowsiness, and fatigue
• Adjustment of dose or discontinuation if adverse effects occur
• Consideration of renal function and adjustment of dose as needed.

From the FDA Drug Label

Dosage and Administration 2. 1 Dosage for Postherpetic Neuralgia In adults with postherpetic neuralgia, gabapentin may be initiated on Day 1 as a single 300 mg dose, on Day 2 as 600 mg/day (300 mg two times a day), and on Day 3 as 900 mg/day (300 mg three times a day). The dose can subsequently be titrated up as needed for pain relief to a dose of 1800 mg/day (600 mg three times a day) 2. 2 Dosage for Epilepsy with Partial Onset Seizures Patients 12 years of age and above The starting dose is 300 mg three times a day. The recommended maintenance dose of gabapentin tablets is 300 mg to 600 mg three times a day. 2. 3 Dosage Adjustment in Patients with Renal Impairment Dosage adjustment in patients 12 years of age and older with compromised renal function or undergoing hemodialysis is recommended, as follows (see dosing recommendations above for effective doses in each indication): TABLE 1 Gabapentin Tablets Dosage Based on Renal Function Renal Function Creatinine Clearance (mL/min) Total Daily Dose Range (mg/day) Dose Regimen (mg) ≥60 900-3600 300 TID 400 TID 600 TID 800 TID 1200 TID

The recommended dose of gabapentin (Neurontin) varies based on the indication and patient population.

• For postherpetic neuralgia, the dose can be titrated up to 1800 mg/day (600 mg three times a day).
• For epilepsy with partial onset seizures in patients 12 years of age and above, the recommended maintenance dose is 300 mg to 600 mg three times a day.
• For patients with renal impairment, dosage adjustments are recommended based on creatinine clearance, with total daily dose ranges from 100-3600 mg/day. 2

From the Research

Recommended Dose of Gabapentin

The recommended dose of gabapentin (Neurontin) can vary depending on the individual and the condition being treated.

• According to the study 3, treatment should be started at a dose of 900 mg/d, with additional titration to 1800 mg/d recommended for greater efficacy.
• Doses up to 3600 mg/d may be needed in some patients, and the effective dose should be individualized according to patient response and tolerability.
• The study 4 also suggests that gabapentin at doses of 1800 mg to 3600 mg daily can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy.
• Other studies, such as 5 and 6, have used doses ranging from 900 mg/day to 2400 mg/day, with some patients requiring higher doses for pain relief.

Titration and Dosage

• The study 3 recommends a titration schedule of 300 mg/d on day 1,600 mg/d on day 2, and 900 mg/d on day 3.
• The study 6 used a titration schedule of 900 mg/day over 3 days, followed by two further increases to a maximum of 2400 mg/day if required by the end of week 5.
• The study 7 started patients on 300 mg gabapentin three times per day, with daily doses of up to 2400 mg required for pain relief.

Efficacy and Safety

• The studies 3, 4, 5, and 6 have shown that gabapentin is effective in reducing pain and improving quality of life in patients with neuropathic pain syndromes.
• The most common adverse events associated with gabapentin are mild to moderate dizziness and somnolence, which are usually transient and occur during the titration phase 4, 6.