From the Guidelines
Yes, Neurontin (gabapentin) can be taken by patients on hemodialysis, but the dosage needs to be adjusted. For patients on hemodialysis, a typical starting dose is 100-300 mg after each dialysis session, with a maintenance dose of 200-300 mg following each 4-hour dialysis treatment, as shown in a study published in the British Journal of Dermatology 1. Gabapentin is primarily eliminated by the kidneys, and hemodialysis removes significant amounts of the drug from the bloodstream. Without proper dose adjustment, patients on dialysis could experience excessive side effects including dizziness, drowsiness, and confusion due to drug accumulation. Some key points to consider when prescribing gabapentin to patients on hemodialysis include:
- Starting with a low dose and titrating up as needed and tolerated
- Coordinating medication timing with dialysis sessions, with doses typically given after dialysis is completed
- Monitoring patients closely for signs of toxicity or adverse effects
- Adjusting the dose based on individual patient factors, such as renal function and response to treatment It's essential that medication timing be coordinated with dialysis sessions, with doses typically given after dialysis is completed, and always consult with your nephrologist and healthcare team before making any changes to your medication regimen, as individual factors may require personalized dosing adjustments. In terms of specific dosing guidelines, a study published in the Mayo Clinic Proceedings 1 provides recommendations for the pharmacological management of neuropathic pain, including gabapentin, but the most relevant and recent evidence for patients on hemodialysis is found in the British Journal of Dermatology study 1.
From the FDA Drug Label
Gabapentin can be removed by hemodialysis Although hemodialysis has not been performed in the few overdose cases reported, it may be indicated by the patient’s clinical state or in patients with significant renal impairment. Coma, resolving with dialysis, has been reported in patients with chronic renal failure who were treated with 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.
Yes, patients on hemodialysis can have Neurontin (gabapentin). The drug can be removed by hemodialysis, and it may be indicated in patients with significant renal impairment 2. Additionally, studies have shown that hemodialysis can reduce the elimination half-life of gabapentin in anuric adult subjects 2.
From the Research
Gabapentin Use in Hemodialysis Patients
- Gabapentin is an anticonvulsant drug that is cleared solely by renal excretion and is not bound to plasma proteins 3.
- The elimination half-life of gabapentin on non-hemodialysis days averaged 132 hours, and approximately 35% of the gabapentin dose was recovered in dialysate 3.
- It is recommended that patients with end-stage renal disease maintained on hemodialysis receive an initial 300-mg to 400-mg gabapentin loading dose, and plasma gabapentin concentrations can be maintained by giving 200 to 300 mg of gabapentin after every 4 hours of hemodialysis 3.
Efficacy of Gabapentin in Hemodialysis Patients
- Gabapentin is an effective treatment for restless legs syndrome (RLS) in hemodialysis patients, with 11 out of 13 patients responding to gabapentin but not placebo 4.
- Gabapentin has also been shown to reduce the frequency and intensity of muscle cramps during hemodialysis sessions 5.
Safety of Gabapentin in Hemodialysis Patients
- Gabapentin has been associated with a higher hazard of altered mental status, fall, and fracture in hemodialysis patients, particularly at higher doses 6.
- Gabapentin-induced myopathy has been reported in 2 patients on short daily hemodialysis, with an elevation in creatine kinase levels 7.
- Common adverse effects of gabapentin include somnolence, dizziness, ataxia, fatigue, nystagmus, and tremor, with myalgia reported in 2% of gabapentin users 7.