Gabapentin Dosing for Sciatica
For sciatica, gabapentin should be initiated at 100-300 mg at bedtime or 100-300 mg three times daily, with gradual titration by 100-300 mg every 1-7 days as tolerated, up to a maximum of 3600 mg/day in three divided doses. 1, 2
Initial Dosing and Titration
- Start with 100-300 mg at bedtime or 100-300 mg three times daily 1, 2
- Increase dose by 100-300 mg every 1-7 days as tolerated 1
- Titrate until achieving pain relief, experiencing dose-limiting adverse effects, or reaching the maximum dose of 3600 mg/day 1
- Maximum single dose is generally 1200 mg, as part of the maximum daily dose of 3600 mg divided into three doses 2
Duration of Treatment
- An adequate trial of gabapentin for neuropathic pain requires 2 months or more to determine full efficacy 1, 2
- The typical effective dose range for neuropathic pain is between 1800-3600 mg/day 2
Clinical Evidence in Sciatica
- In case reports, gabapentin has shown efficacy for sciatica at doses ranging from 300 mg/day up to 2700 mg/day (900 mg three times daily) 3
- In a head-to-head comparison with pregabalin, gabapentin (400-800 mg three times daily) demonstrated superior pain reduction with fewer and less severe adverse events in patients with chronic sciatica 4
Special Considerations
- Reduce dosage in patients with renal insufficiency 1
- Consider lower starting dosages and slower titration in geriatric patients to minimize side effects 1, 2
- Common adverse effects include dizziness and sedation, which can be reduced by starting with lower dosages and titrating cautiously 1
Monitoring and Dose Adjustments
- Continue titration until benefit occurs or side effects begin to appear 2
- If side effects develop, consider temporarily reducing the dose and then resuming slower titration 1
- Evaluate response to therapy regularly during the titration period 2