From the Research
For patients with acute kidney injury (AKI), the maximum dose of gabapentin should be adjusted based on the estimated glomerular filtration rate (eGFR) or creatinine clearance to prevent toxicity and adverse effects. The most recent and highest quality study on this topic is not directly provided, but based on general medical knowledge and the principles of drug dosing in renal impairment, the following guidelines can be applied:
- For mild AKI (eGFR 60-89 mL/min), the maximum daily dose is typically 1,800-2,400 mg divided into three doses.
- For moderate AKI (eGFR 30-59 mL/min), the maximum is 600-1,400 mg daily in divided doses.
- For severe AKI (eGFR 15-29 mL/min), limit to 300-700 mg daily in divided doses.
- For patients with eGFR <15 mL/min or on hemodialysis, the maximum dose should be 100-300 mg daily, with a supplemental dose after each hemodialysis session 1, 2, 3, 4, 5. Key considerations in managing gabapentin dosing in AKI include:
- Gabapentin is primarily eliminated unchanged through the kidneys.
- Accumulation in renal impairment can lead to increased side effects including dizziness, somnolence, and confusion.
- Start with lower doses and titrate slowly while monitoring for adverse effects.
- Serum drug level monitoring is not routinely available or necessary for gabapentin, so clinical assessment of efficacy and toxicity should guide dosing decisions. It's crucial to prioritize the patient's morbidity, mortality, and quality of life when making dosing decisions, especially in the context of acute kidney injury where the risk of drug accumulation and toxicity is heightened 1.