Can extended-release (ER) tablets of Gabapentin (gabapentin) be cut?

Gabapentin Extended-Release Tablets Should Not Be Cut

Extended-release (ER) formulations of gabapentin should not be cut, crushed, or chewed as this would compromise their controlled-release mechanism and potentially lead to dose dumping, increasing the risk of adverse effects. 1

Understanding Extended-Release Gabapentin Formulations

Extended-release formulations of gabapentin are specifically designed to:

• Release medication gradually over a prolonged period
• Maintain more consistent blood levels
• Allow for less frequent dosing (typically once or twice daily instead of three times daily)
• Potentially reduce side effects associated with peak concentrations

Pharmacokinetic Considerations

The FDA-approved gabapentin label clearly indicates that extended-release formulations have specific properties that would be compromised if the tablet is altered:

• For scored tablets (600 mg or 800 mg), the immediate-release formulation can be divided, but unused half-tablets should be taken as the next dose and not stored beyond 28 days 1
• Extended-release formulations rely on polymer technology that controls drug release through gradual swelling and retention in the gastrointestinal tract 2
• Altering the tablet would disrupt this mechanism, potentially causing dose dumping and increasing the risk of adverse effects

Clinical Implications of Cutting ER Tablets

Cutting extended-release gabapentin tablets would:

1. Destroy the controlled-release mechanism
2. Potentially release a higher dose than intended in a shorter timeframe
3. Increase risk of adverse effects such as:
   • Dizziness
   • Somnolence
   • Ataxia
   • Peripheral edema

Alternative Options for Dosing

For patients who need dose adjustments or have difficulty swallowing whole tablets:

• Use immediate-release gabapentin formulations which are available in multiple strengths (100 mg, 300 mg, 400 mg, 600 mg, 800 mg) for more flexible dosing 1
• For immediate-release formulations, scored tablets can be divided as needed 1
• Consider gabapentin oral solution for patients with swallowing difficulties 3

Special Considerations for Elderly Patients

The elderly population requires particular attention when using extended-release formulations:

• Elderly patients are more sensitive to both pharmacological and toxicological effects of medications 3
• Extended-release formulations of antiepileptic drugs may be better tolerated than immediate-release equivalents, but cannot be altered 3
• For elderly patients with swallowing difficulties, immediate-release formulations or oral solutions are preferred over cutting extended-release tablets 3

Conclusion

Extended-release gabapentin tablets must be taken whole to maintain their intended pharmacokinetic profile and therapeutic effect. Cutting these tablets would compromise their controlled-release properties and potentially lead to adverse effects. For patients requiring dose adjustments or who have difficulty swallowing, immediate-release formulations offer more flexibility in dosing and administration.