From the Research
Gabapentin is unlikely to elevate ammonia levels in most patients, but high-risk patients, particularly those with hepatic impairment or chronic kidney disease, should be monitored for potential hyperammonemia. The mechanism behind gabapentin-induced hyperammonemia is not fully understood, but it may involve interference with renal excretion of ammonia or alterations in glutamine metabolism 1. Patients taking gabapentin who develop symptoms such as confusion, lethargy, or altered mental status should be evaluated for possible hyperammonemia, especially if they have underlying liver disease or chronic kidney disease 2, 3. Some key points to consider when prescribing gabapentin include:
- Gabapentin is primarily eliminated through the kidneys rather than metabolized by the liver, which is why this side effect is relatively uncommon 2.
- The risk of adverse events, including hyperammonemia, may be higher in patients with chronic kidney disease, particularly those with advanced disease or those taking higher doses of gabapentin 3, 4.
- Regular monitoring of ammonia levels might be warranted in high-risk patients, particularly those with hepatic impairment or chronic kidney disease who are prescribed gabapentin 4.
- Dose reduction or discontinuation may be necessary under medical supervision if elevated ammonia levels are detected and attributed to gabapentin 3. Overall, while gabapentin is generally safe and effective for treating neuropathic pain, high-risk patients should be closely monitored for potential adverse effects, including hyperammonemia.