What is the typical dosing frequency of Gabapentin (Neurontin) for neuropathic pain and epilepsy?

Gabapentin Dosing Frequency for Neuropathic Pain and Epilepsy

Gabapentin should be administered 2-3 times daily for both neuropathic pain and epilepsy, with the maximum time between doses not exceeding 12 hours. 1

Dosing for Neuropathic Pain

Initial Dosing and Titration

• Start gabapentin at 100-300 mg at bedtime or 100-300 mg three times daily 2
• Titrate gradually: Day 1: 300 mg once daily; Day 2: 300 mg twice daily; Day 3: 300 mg three times daily 1
• Continue titration as needed for pain relief, with dose increments of 50-100% every few days 3
• Slower titration is recommended for elderly patients or those who are medically frail 3

Maintenance Dosing

• Effective dose range: 900-3600 mg/day in divided doses (2-3 times daily) 1
• For postherpetic neuralgia, efficacy has been demonstrated at doses from 1800-3600 mg/day, though additional benefit beyond 1800 mg/day was not clearly demonstrated in clinical studies 1, 4
• Most patients achieve adequate pain relief at doses between 1800-2400 mg/day 5
• Typical maintenance dose: 300-600 mg three times daily 1

Dosing for Epilepsy

Adults and Children 12 Years and Older

• Starting dose: 300 mg three times daily 1
• Recommended maintenance dose: 300-600 mg three times daily 1
• Maximum dose: up to 3600 mg/day divided into three doses 1

Children 3-11 Years

• Starting dose: 10-15 mg/kg/day in three divided doses 1
• Maintenance dose:
  • Ages 3-4 years: 40 mg/kg/day in three divided doses 1
  • Ages 5-11 years: 25-35 mg/kg/day in three divided doses 1
• Maximum dose: up to 50 mg/kg/day in three divided doses 1

Special Considerations

Renal Impairment

• Dosage adjustment is required for patients with compromised renal function 1
• For creatinine clearance 30-59 mL/min: 400-1400 mg/day in two divided doses 1
• For creatinine clearance 15-29 mL/min: 200-700 mg/day as a single daily dose 1
• For creatinine clearance <15 mL/min: 100-300 mg/day as a single daily dose 1
• Hemodialysis patients require supplemental doses after each 4-hour hemodialysis session 1

Elderly Patients

• Start with lower doses and implement slower titration due to higher likelihood of decreased renal function 1
• Adjust dose based on creatinine clearance values 1

Administration Guidelines

• Gabapentin can be taken with or without food 1
• The maximum time between doses should not exceed 12 hours 1
• If treatment is to be discontinued, taper gradually over a minimum of 1 week to avoid withdrawal symptoms 1

Common Side Effects

• Dizziness (19%), somnolence (14%), peripheral edema (7%), and gait disturbance (14%) 4
• Side effects are typically mild to moderate and usually subside within approximately 10 days from treatment initiation 5
• Adverse effects can be minimized by starting with lower doses and titrating slowly 2

Efficacy

• In postherpetic neuralgia, approximately 32% of patients achieve substantial pain relief (≥50% reduction) with gabapentin compared to 17% with placebo 4
• In painful diabetic neuropathy, about 38% of patients achieve substantial pain relief with gabapentin compared to 21% with placebo 4
• Gabapentin is effective for alleviating steady burning pain, lancinating pain, and allodynia 6