What is the type of medication of Gabapentin (Anticonvulsant)?

From the Guidelines

Gabapentin is a recommended medication for the treatment of neuropathic pain, with a typical starting dose of 300mg once daily, gradually increasing to 300mg three times daily (900mg total) as needed and tolerated, as supported by the most recent evidence 1.

Key Points to Consider

• Gabapentin works by binding to calcium channels in the nervous system, reducing the release of excitatory neurotransmitters that cause pain and seizure activity 1.
• Common side effects include dizziness, drowsiness, and fatigue, which often improve with continued use 1.
• The medication should be taken consistently, and never stopped abruptly as this can cause withdrawal symptoms or seizures in epilepsy patients 1.
• Similar medications in this class include pregabalin (Lyrica) and gabapentin enacarbil (Horizant), which have similar mechanisms but different dosing schedules 1.
• Gabapentin should be used cautiously in elderly patients and those with kidney problems, often requiring dose adjustments 1.
• It's essential to avoid alcohol while taking gabapentin as it can increase drowsiness and dizziness 1.

Dosage and Administration

• The typical starting dose is 300mg once daily, gradually increasing to 300mg three times daily (900mg total) as needed and tolerated 1.
• For nerve pain, doses may range from 900-3600mg daily divided into three doses 1.
• Dose increments of 50%-100% every few days, with slower titration for the elderly or medically frail 1.
• Dose adjustment required for those with renal insufficiency 1.

Important Considerations

• Gabapentin is considered a first-line anticonvulsant for the treatment of neuropathic pain other than trigeminal neuralgia 1.
• The medication is also approved for fibromyalgia, with most bothersome side effects being somnolence, dizziness, and weight gain 1.
• Complementary and alternative medical treatments, including physical therapy, exercise, stress management, and cognitive behavioral therapy, have also been proposed for the management of chronic pain 1.

From the FDA Drug Label

Gabapentin Tablets, USP are indicated for: Management of postherpetic neuralgia in adults Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization, in adults and pediatric patients 3 years and older with epilepsy

The type of medication gabapentin is, can be classified as:

• Antiepileptic
• Analgesic for the management of postherpetic neuralgia and adjunctive therapy in the treatment of partial onset seizures. 2

From the Research

Gabapentin Type Medication

• Gabapentin is commonly used to treat neuropathic pain (pain due to nerve damage) 3
• Studies have shown that gabapentin can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy 3, 4
• The outcome of at least 50% pain intensity reduction is regarded as a useful outcome of treatment by patients, and the achievement of this degree of pain relief is associated with important beneficial effects on sleep interference, fatigue, and depression, as well as quality of life, function, and work 3

Comparison with Pregabalin

• Pregabalin and gabapentin are often considered first line treatment options for various neuropathic pain conditions 5
• A retrospective cohort study found that there was no significant difference in meaningful pain reduction with gabapentin versus pregabalin, but pregabalin may afford better tolerability and lower pill burden compared to gabapentin 5
• A meta-analysis found that pregabalin showed superior results compared to gabapentin in the Visual Analog Scale (VAS) at various time intervals up to 12-14 weeks, and also had significant improvements in SF-12/SF-36/EQ-5D scores and experienced more days with no/mild pain and fewer days with severe pain 6
• Pregabalin resulted in lower opioid consumption and had a lower incidence of nausea and vomiting compared to gabapentin 6

Pharmacoeconomic Outcomes

• A systematic review found that the majority of published evidence supports the possibility that pregabalin could be a cost-effective and/or cost-saving alternative for the treatment of refractory epilepsy, generalized anxiety disorder, and neuropathic pain, in both treatment-naïve patients and in those who have demonstrated inadequate response or intolerance to previous therapy 7