From the FDA Drug Label
Adult Patients with Renal Impairment Subjects (N=60) with renal impairment (mean creatinine clearance ranging from 13 to 114 mL/min) were administered single 400 mg oral doses of gabapentin. Hemodialysis In a study in anuric adult subjects (N=11), the apparent elimination half-life of gabapentin on nondialysis days was about 132 hours; during dialysis the apparent half-life of gabapentin was reduced to 3.8 hours. [see Dosage and Administration (2.3) and Use in Specific Populations (8. 6)]
Gabapentin use in patients with kidney failure requires careful consideration of the patient's renal function. The drug label provides information on the pharmacokinetics of gabapentin in adult patients with renal impairment, indicating that the mean gabapentin half-life ranged from about 6.5 hours (patients with creatinine clearance >60 mL/min) to 52 hours (creatinine clearance <30 mL/min).
- Key points:
- Gabapentin is primarily renally excreted.
- Renal clearance of gabapentin decreases with age and renal impairment.
- Hemodialysis has a significant effect on gabapentin elimination in anuric subjects. Given the information provided, gabapentin can be used in patients with kidney failure, but the dosage may need to be adjusted based on the patient's renal function, as indicated in the Dosage and Administration section of the label 1.
From the Research
Gabapentin should be used with caution in patients with kidney failure, and dose adjustments are necessary to minimize the risk of adverse events. For patients with kidney failure, gabapentin doses must be significantly reduced based on creatinine clearance levels. According to the most recent study 2, patients with a creatinine clearance less than 60 mL/min are frequently prescribed inappropriately high doses of gabapentinoids, which can lead to increased side effects. The medication is primarily eliminated unchanged through the kidneys, which means it can accumulate to toxic levels in patients with impaired kidney function if not properly adjusted. This accumulation can lead to increased side effects such as dizziness, drowsiness, and confusion, which may be particularly problematic in patients with kidney failure who often have multiple comorbidities.
Some key points to consider when using gabapentin in patients with kidney failure include:
- Dose adjustments: Patients with a creatinine clearance less than 15 mL/min typically require doses of 100-300 mg daily, compared to normal doses of 900-3600 mg daily in those with normal kidney function 3.
- Monitoring: Regular monitoring of kidney function and careful assessment of side effects is essential when using gabapentin in these patients.
- Hemodialysis: Hemodialysis removes gabapentin from the blood, so supplemental doses may be needed after dialysis sessions.
- Concomitant medications: Concomitant opioid and psychiatric medications can contribute to a higher prevalence of adverse events regardless of creatinine clearance level 2.
Overall, the use of gabapentin in patients with kidney failure requires careful consideration of the potential risks and benefits, as well as close monitoring of kidney function and side effects. The most recent study 4 suggests that starting a gabapentinoid at a higher dose is associated with a slightly higher risk of adverse events, which should be balanced against the benefits of using a higher-dose gabapentinoid.