What is the maximum dose of gabapentin (Neurontin)?

From the Guidelines

The maximum dose of gabapentin for adults is typically 3,600 mg per day, divided into three equal doses (1,200 mg three times daily) 1. This maximum dose applies to patients with normal renal function who are taking gabapentin for conditions such as epilepsy, postherpetic neuralgia, or neuropathic pain. However, dosing should be individualized based on patient response and tolerability. Patients with renal impairment require dose adjustments, with lower maximum doses based on creatinine clearance. When starting gabapentin, it's essential to begin with a lower dose and gradually titrate upward to minimize side effects such as dizziness, somnolence, and peripheral edema. Some key points to consider when prescribing gabapentin include:

• Starting with a low dose, typically 100-300 mg at bedtime or 100-300 mg three times daily, and increasing as needed and tolerated 1
• Gradually titrating the dose upward every 1-7 days to minimize side effects
• Considering dose adjustments in patients with renal impairment
• Taking the medication with food to improve absorption
• Avoiding abrupt discontinuation to prevent withdrawal symptoms It's also important to note that gabapentin works by binding to voltage-gated calcium channels in the central nervous system, reducing the release of excitatory neurotransmitters. The most recent and highest quality study, from 2011, supports the use of gabapentin at a maximum dose of 3,600 mg per day for the treatment of painful diabetic peripheral neuropathy 1.

From the FDA Drug Label

Dosages up to 2400 mg/day have been well tolerated in long-term clinical studies Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated.

• The maximum dose of gabapentin is not explicitly stated, but doses up to 3600 mg/day have been administered to a small number of patients for a relatively short duration and were well tolerated 2.
• However, in clinical studies, efficacy was demonstrated over a range of doses from 1800 mg/day to 3600 mg/day with comparable effects across the dose range.
• It is also noted that the additional benefit of using doses greater than 1800 mg/day was not demonstrated.

From the Research

Maximum Dose of Gabapentin

The maximum dose of gabapentin varies depending on the condition being treated and the individual patient's response.

• According to 3, doses of up to 4,800 mg/day have been used in clinical trials and have shown greater efficacy without a significant increase in adverse effects.
• 4 suggests that gabapentin may be initiated at a dosage of 900 mg/d and titrated to maintenance dosages of ≥ 3600 mg/d in most adult patients.
• 5 reports 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.
• 6 recommends starting treatment at a dose of 900 mg/d and titrating to 1800 mg/d for greater efficacy, with doses up to 3600 mg/d possibly needed in some patients.
• 7 found that dose escalation to 1800-2400 mg/day of generic gabapentin was effective and well-tolerated in patients with refractory partial-onset epilepsy.

Key Points

• The maximum dose of gabapentin is not strictly defined, but doses up to 4,800 mg/day have been used in clinical trials.
• The effective dose should be individualized according to patient response and tolerability.
• Gabapentin at doses of 1800 mg to 3600 mg daily can provide good levels of pain relief for some patients with neuropathic pain.
• Dose escalation should be done gradually, with close monitoring of adverse events and efficacy.