From the FDA Drug Label
Warnings and Precautions 5. 1 Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Multiorgan Hypersensitivity Gabapentin should be discontinued if an alternative etiology for the signs or symptoms cannot be established. 5. 2 Anaphylaxis and Angioedema Patients should be instructed to discontinue gabapentin and seek immediate medical care should they experience signs or symptoms of anaphylaxis or angioedema.
The FDA drug label does not provide information on whether gabapentin is okay to resume in a patient with a history of adverse reactions, such as Anaphylaxis or DRESS.
- Key considerations:
- The label advises discontinuing gabapentin if an alternative etiology for signs or symptoms cannot be established.
- Patients should seek immediate medical care if they experience signs or symptoms of anaphylaxis or angioedema. However, it does not provide guidance on when or if it is safe to resume gabapentin in patients who have experienced these reactions 1.
From the Research
Gabapentin should not be resumed in a patient with acute mountain sickness (AMS) without careful evaluation, as it may worsen cognitive impairment and confusion, particularly in patients with renal dysfunction or those taking other medications that may exacerbate AMS symptoms. The provided evidence does not directly address the use of gabapentin in patients with AMS, but it highlights the importance of careful evaluation and consideration of the underlying pathophysiological mechanisms of AMS 2. When considering resumption of gabapentin, it is essential to assess the patient's current mental status, kidney function, and the original indication for gabapentin. If the decision is made to resume therapy, consider starting at a lower dose (such as 100mg once or twice daily) and gradually titrating while monitoring for worsening confusion, sedation, or ataxia 3, 4, 5, 6. Alternative medications for pain or seizure control might be more appropriate depending on the clinical situation and the cause of the patient's altered mental status.
Some key points to consider when evaluating the patient include:
- The patient's symptoms and severity of AMS
- The patient's renal function and potential need for dose adjustment
- The potential for drug interactions with other medications being used to treat AMS
- The need for careful monitoring of the patient's mental status and adjustment of the treatment plan as needed
It is also important to note that the evidence suggests that different time courses of AMS may be related to different pathophysiological mechanisms, which could impact treatment decisions 2. Therefore, a thorough evaluation of the patient's condition and careful consideration of the potential risks and benefits of resuming gabapentin are necessary before making a decision.