What is the next dose increase for Gabapentin (Gabapentin) 100 mg three times a day (TID)?

Gabapentin Dose Escalation from 100 mg TID

For a patient currently on gabapentin 100 mg three times daily (300 mg/day total), increase to 200 mg three times daily (600 mg/day total) or 300 mg three times daily (900 mg/day total), with dose increases of 100-300 mg every 1-7 days as tolerated. 1

Recommended Titration Strategy

The FDA-approved dosing schedule for gabapentin allows for flexible titration by 100-300 mg increments every 1-7 days, targeting maintenance doses of 1800-3600 mg/day in three divided doses. 1, 2

Standard Dose Escalation Options

From your current dose of 100 mg TID (300 mg/day):

• Conservative approach: Increase to 200 mg TID (600 mg/day), then 300 mg TID (900 mg/day) 1, 2
• Moderate approach: Increase directly to 300 mg TID (900 mg/day) if tolerability allows 1, 3
• Subsequent increases: Continue escalating by 300 mg/day increments (adding 100 mg to each of the three daily doses) every 1-7 days until reaching therapeutic effect or maximum dose of 3600 mg/day 1, 2

Target Therapeutic Doses

• Minimum effective dose: 900 mg/day (300 mg TID) for initial therapeutic assessment 3
• Standard therapeutic range: 1800-3600 mg/day in three divided doses 1, 2
• Optimal dosing: Evidence suggests 1800 mg/day provides good efficacy, with doses up to 3600 mg/day offering additional benefit in some patients 2, 3

Critical Timing Considerations

An adequate therapeutic trial requires 3-8 weeks for titration plus 2 weeks at maximum tolerated dose before determining efficacy. 1, 4

• Do not prematurely discontinue therapy before completing this adequate trial period 4
• Most patients will reach therapeutic doses within 2-4 weeks of initiation 3

Special Population Adjustments

Elderly Patients

Use 100 mg increments rather than 300 mg increments, with slower titration intervals. 1, 4

• Lower maintenance doses may be effective due to increased sensitivity to side effects 5
• Dose selection must account for decreased renal function common in elderly patients 2

Renal Impairment

Mandatory dose reduction based on creatinine clearance is required. 1, 2

For your patient on 100 mg TID with renal impairment:

• CrCl >30-59 mL/min: Maximum 200-300 mg twice daily 2
• CrCl >15-29 mL/min: Maximum 200-300 mg once daily 2
• CrCl <15 mL/min: Maximum 100-150 mg once daily 2

Common Pitfalls to Avoid

Starting at high doses or escalating too rapidly dramatically increases adverse effects, particularly dizziness and sedation. 1, 4

• Gabapentin has nonlinear pharmacokinetics due to saturable absorption, requiring careful titration 1
• Side effects typically occur at treatment onset but are usually transient, subsiding within approximately 10 days 3
• The maximum time between doses should not exceed 12 hours to maintain therapeutic levels 2

Monitoring Strategy

Watch for dose-dependent dizziness and sedation, which can be minimized by gradual titration. 1, 4

• Lower extremity edema may develop, particularly at higher doses 1
• These adverse effects are typically mild to moderate and resolve with continued treatment 3