Gabapentin (Oral)

Gabapentin is an anticonvulsant indicated for partial seizures in adults and children older than 3 years old.

Overview

Gabapentin is indicated for epileptic patients who experience partial seizures.

Gabapentin has many other applications, including for the treatment of hot flashes, restless leg syndrome, neuropathic pain, and postherpetic neuralgia – a common side effect of shingles characterized by pain.

Though Gabapentin alleviates pain, it is not prescribed for generalized pain due to sprains, strains, or arthritis.

Gabapentin is a prescription only medicine which is sold and marketed under many brand names, including:

  • Gralise
  • Neurontin
  • FusePaq Fanatrex
  • Gabarone
  • Horizant
  • SmartRx Gaba-V Kit
  • Neuraptine

What is a partial seizure?

This is defined as a seizure that transpires in only one portion of the brain. One of the main hallmarks of this condition are subsets of symptoms that affect only one side of the body, depending on how minor or severe the partial seizure is. Patients may experience:

  • Involuntary and uncontrollable twitching
  • A tingling or crawling sensation
  • Muscle spasms
  • Eye rolling
  • Increased sensory perception

Partial seizures are otherwise known as focal or local seizures. Gabapentin is used to lower the incidences of these epileptic episodes and is often used in conjunction with other antiepileptic drugs.

Conditions Treated?

  • Partial-Onset Seizures, Restless Leg Syndrome, Postherpetic Neuralgia, Fibromyalgia, Hot Flashes, Local Seizures

Type Of Medicine?

  • Anticonvulsant, GABA Analogue

Side Effects

As with most prescription medicines, Gabapentin may cause a number of unwanted side effects.

General side effects of gabapentin

Some of the most common side effects of Gabapentin include:

  • Clumsiness
  • Involuntary eye movements

Less common adverse reactions of gabapentin are:

  • Pain in the chest
  • Changes in stool color
  • Feeling depressed
  • Hostility toward others
  • Mood swings
  • Memory loss
  • Fevers and chills
  • Aches and pains
  • Difficulty urinating
  • Feeling out of breath
  • Cold or flu like symptoms
  • Mouth ulcers
  • Swollen lymph nodes or glands
  • Easy bruising
  • Lethargy
  • Inexplicable bleeding

Common side effects in children

Children who are taking this medicine may experience:

  • Behavioral issues
  • Aggression
  • Feeling anxious
  • Difficulty concentrating
  • Excessive crying
  • Feeling depressed
  • A distorted sense of wellbeing
  • Hyperactivity
  • Frequent and sudden mood swings
  • Dramatized emotions
  • Feeling restless
  • Being overly suspicious

Other side effects – frequency unestablished

Some of the other side effects reported for Gabapentin include:

  • Pain in the stomach
  • Skin irritations
  • Loss of consciousness
  • Seizures
  • Feeling confused
  • Decreased urinary output
  • Abnormal heartbeat
  • Diarrhea
  • Feeling dizzy
  • A headache
  • Dehydration
  • Pain in the joints
  • An allergic reaction
  • Appetite loss
  • Feeling nauseous
  • Lesions on the skin
  • Regurgitating blood
  • Jaundice
  • Bad breath

Dosage

The doses outlined below portray averages. Doctors generally write prescriptions based on a number of factors, including:

  • Underlying diseases
  • Patients' age and weight
  • The brand and strength of the medicine
  • The time intervals between doses
  • The timeline for treatment

These factors all play a significant role in the safety of using this medicine. As a result, it is important to never start, stop, or alter the dose before first speaking with your healthcare provider.

Oral gabapentin doses for epilepsy:

  • Children Under 3 Years of Age: Safety and Dose Amounts Must be Established by a Medical Provider
  • Children 3-11 Years of Age: 10-15 mg/kg of Body Weight | Split 3X Daily
  • Children Over 12 Years of Age: 300 mg | 3X Daily (Max Daily Dose: 2,400 mg)
  • Adults: 300 mg | 3X Daily (Max Dose: 2,400 mg)

Note: These are preliminary or starting doses. The prescription may be altered over time based on patient responses and tolerance to the drug.

Oral gabapentin doses for postherpetic neuralgia:

  • Children: Varies Based on a Doctor's Assessment
  • Adults: Single Dose of 300 mg in the Evening (Max Daily Dose: 1,800 mg)

Missed doses

If you miss a dose, take it as soon as you remember. If the time is close for the next dose, skip the missed dose altogether. Gabapentin doses should never be doubled.

Overdose

In the event of an overdose, call 911 immediately. The American Association of Poison Control Centers can also be reached by calling 1 (800) 222-1222.

Best practices for use

Gabapentin should be taken exactly as prescribed in order to reduce the chances of adverse side effects. These general guidelines should be followed at all times:

  • Do not exceed the prescribed dose amounts
  • Do not take this drug more than the scheduled times per day selected by your healthcare provider or pharmacist
  • Do not alter the dosage before first consulting with your primary healthcare provider
  • Do not continue using the drug if your doctor has ordered you to discontinue use

Patients are also advised to read through the insert label dispensed with the medication to learn detailed warnings, side effects, interactions and more. If you have any questions or concerns while using this medication, consult your healthcare provider.

Brand differentiation

Gabapentin is available in different brands. Double check that the drug name your doctor prescribed was dispensed by the pharmacy, as each brand name works differently.

Gabapentin is dispensed in several brands and formats, including as a tablet, suspension liquid, capsule, or solution.

The most popular brands and strengths of Gabapentin are:

  • Generic Oral Tablets: 100 mg, 300 mg, 400 mg, 600 mg, 800 mg
  • Generic Oral Capsules: 100 mg, 300 mg, 400 mg
  • General Oral Solutions: 250 mg
  • Neurontin Brand Oral Tablets: 600 mg, 800 mg
  • Neurontin Brand Oral Capsules: 100 mg, 300 mg, 400 mg
  • Neurontin Brand Oral Solution: 250 mg
  • Horizant Brand Oral Extended-Release Tablets: 300 mg, 600 mg
  • Gralise Brand Oral Tablets: 300 mg, 600 mg

Proper use

The best practices for using Gabapentin vary slightly based on the brand name prescribed. For example:

Gralise:

If your pharmacist has prescribed Gralise, the best practices for use include:

1. Take Gralise with a full meal in the evening

2. Do not break or crush the tablet. Gralise should be swallowed whole to ensure its extended-release effects.

3. The intermission time between scheduled doses should not exceed 12 hours in most cases, as Gabapentin works best when it's continuously flowing through the bloodstream.

Neurontin tablets or capsules:

If your pharmacist has prescribed Neurontin tablets or capsules, the best practices for use include:

1. Take with or without meals.

2. Neurontin tablets can sometimes be divided in two.

3. To retain the effectiveness of this medicine, divided tablets should be taken as soon as the next scheduled dose. If more than four weeks have passed since splitting the tablet in two, discard right away.

4. Even though the capsule can be cut in two, do not crush, break, or chew the half of the whole tablet. For best results, swallow whole with a full glass of water to take advantage of the extended release features.

Neurontin syrups:

If your pharmacist has prescribed the Neurontin syrup, the best practices for use include:

  • Use the measuring syringe, cup, or spoon dispensed with your medication. Check the box or the bottle cap for this measuring tool. If you're unable to locate it, check with your pharmacist.

Teaspoons found in most households do not provide accurate measurements for taking prescriptions.

Antacid use with Neurontin

Generally taken for indigestion, upset stomach, or heartburn, antacids that are made of aluminium or magnesium should not be taken at the same time as Neurontin.

Healthcare specialists suggest taking the antacid at least 2 hours in advance of a scheduled dose of Neurontin to reduce the chances of adverse side effects – which include lower concentrations of Gabapentin in the blood – and subsequently a higher risk of seizures.

Here are a few specimens of antacids containing aluminum or magnesium:

  • Maalox
  • Gelusil
  • Di-Gel
  • Mylanta
  • Gaviscon

Interactions

Certain drugs and other substances may influence the performance of this medicine. In general, doctors avoid prescribing Gabapentin with the following medicines unless it is necessary:

  • Dihydroxyaluminum Sodium Carbonate
  • Morphine Sulfate Liposome
  • Magnesium Oxide
  • Dihydroxyaluminum Aminoacetate
  • Calcifediol
  • Magnesium Trisilicate
  • Aluminum Hydroxide
  • Magnesium Hydroxide
  • Aluminum Phosphate
  • Morphine
  • Orlistat
  • Aluminum Carbonate, Basic
  • Magnesium Carbonate
  • Magaldrate
  • Ginkgo

Note: If concurrent use of two or more drugs is needed, your medical provider typically assesses the benefits and risks and makes adjusted doses where necessary.

CNS depressants

Avoid taking CNS depressants with Gabapentin as doing so could induce extreme sleepiness. Examples include antihistamines, allergy medications, and more. Ask a doctor for more details on concurrent use with this class of drugs.

Alcohol interactions

Similarly, patients should not consume alcohol while undergoing treatment with Gabapentin. Some side effects of doing so include loss of alertness, sleepiness, confusion, dizziness, and more.

Pre-existing conditions

Using Gabapentin may cause certain underlying conditions to become worse. Contraindications have been found when this drug is used concomitantly with patients diagnosed with:

  • A mental illness
  • Depression
  • Mood swings
  • Kidney disease

Warnings

To improve patient safety, healthcare providers generally dispense the following warnings for patients taking Gabapentin:

Gabapentin use

This medicine does not treat the underlying disease of epilepsy. In epileptic cases, it is intended only as a partial seizure control medicine. Once the drug is discontinued, the chances of getting a seizure increases. As a result, ensure that all scheduled doses are adhered to.

Follow-up visits

Patients are counseled to make every effort to keep follow-up appointments during the first few months of treatment for partial seizures. During these check-ups, your doctor assesses if the medication is working or if altered doses are needed.

Hypersensitivity

Tell your doctor if you have a history of allergies to medicines, foods, dyes, preservatives, or animal substances.

Gabapentin may cause a severe allergic reaction to occur in some patients, which affects the kidney or livers. This is otherwise known as a multiorgan hypersensitivity vs. anaphylaxis shock. Another term used to describe this condition is DRESS, which is short for drug reaction with eosinophilia and systemic symptoms.

Patients are advised to watch for the telltale signs of DRESS and to seek medical help right away if the following symptoms occur:

  • A fever
  • Swollen lymph nodes that are tender to the touch
  • Easy bruising
  • Jaundice

Safety while driving or operating machinery

While taking Gabapentin, you may experience the following side effects:

  • Feeling faint or dizzy
  • Lethargy
  • Slowed reactions to stimuli
  • Clumsiness
  • Changes in vision
  • Extreme drowsiness
  • Difficulty concentrating
  • Confusion

Due to these risks, it is essential that patients create a backup plan for how to react if the above symptoms develop while driving or operating machinery.

For example, if you have difficulty seeing or concentrating while driving, it's best to pull over to a safe location and call for help. If your symptoms persist, do not hesitate to call your medical provider.

Mood swings

In some patients, Gabapentin could cause:

  • Agitation
  • Irritability
  • Feelings of hopelessness
  • Sadness
  • Depression
  • Nervousness
  • Restlessness
  • Hostility

In extreme cases, it may cause suicidal feelings. If these symptoms surface, contact your healthcare provider immediately. This is considered to be a medical emergency and supplementary treatments or adjusted doses may be required.

Drowsiness

Taking Gabapentin with certain types of medications or substances could increase feelings of drowsiness. To name a few examples, avoid concurrent use with:

  • Antihistamines
  • Alcohol
  • Cold or flu medicines
  • Hay fever OTCs
  • Medicines for allergies
  • Sleep aids
  • Paid medicines or NSAIDs
  • Muscle relaxants
  • Anesthetics, including dental anesthetics
  • Other seizure drugs

This list includes both prescription and over-the-counter medications. To improve safety when taking Gabapentin, be sure to create a full list of all medications being used and hand this list to your doctor.

Stomach acid drugs

Do not take antacids with Gabapentin at the same time. If you frequently experience an upset stomach or indigestion, an antacid may be used at least two hours prior to the scheduled dose time for Gabapentin.

Discontinuing gabapentin

If you or your child's partial seizures are under control, do not stop taking using Gabapentin without first consulting with your doctor. Here are the main explanations:

1. The medicine should never be stopped abruptly. Gabapentin should be discontinued on a gradual basis to reduce the risks of side effects.

2. Seizures can be controlled or regulated only when you have a continuous supply of the drug in the bloodstream. If you stop taking this prescription suddenly, this potentially increases the risk of developing a serious and potentially fatal condition known as static epilepticus – characterized by a seizure lasting for more than half an hour.

Upcoming medical procedures

When visiting dental care providers or other medical specialists, ensure that acting specialists are aware of Gabapentin use. This drug could cause negative interactions to occur with other medicines. Moreover, Gabapentin may distort the results of certain medical exams.

Medical history

To ensure this medicine does not exacerbate certain conditions, including kidney disease, notate your full medical history with your primary care provider. Tell your doctor about any pre-existing conditions, history of allergies, or current medications in use.

By doing so, your doctor is better able to assess benefits vs. risks, and ultimately, whether it is safe to prescribe Gabapentin.

Use in pediatric populations

Gabapentin should not be administered to epileptic children younger than 3 years of age. Additionally, in epileptic children between the age ranges of 3 and 12 years of age, this medicine may cause a number of troubling side effects, including:

  • Behavioral Issues
  • Hypersensitivity
  • Restlessness
  • Aggression
  • Difficulty Concentrating in School

Ask your doctor for more information on how this medicine affects children.

Use in nursing mothers

Data is lacking on how Gabapentin affects infants of nursing mothers using this drug. As a result, care should be taken to weigh the risks and benefits before prescribing this medicine to women who are breastfeeding.

Use in the Geriatric Population

Senior patients may need adjusted doses of this medication due to the high probability of underlying conditions such as edema or kidney issues. To better gauge effectiveness and the potential risks, senior patients should be closely monitored during the course of treatment.

Storage

Gabapentin oral tablets and capsules should be stored at a room temperature of 20°C and 25°C (68°F and 77°F). Some other general guidelines for storing include avoiding:

  • Heat
  • Direct Light
  • Moisture
  • Freezing Temperatures

The oral solution or syrup should be refrigerated at temperatures ranging from 2°C and 8°C (36°F to 46°F). Confirm the storage instructions on the insert label or with your pharmacist as different brands and strengths may feature varying storage labels.

Keep the medicine in the original container and retighten the cap. Additionally, ensure the medicine is placed out of the reach of children. In the event of an overdose, call 911 immediately.

If you no longer use this medicine, healthcare specialists suggest taking advantage of return programs available at many local pharmacies.

Summary

Gabapentin is available under a number of trade names in capsule, tablet, and solution forms. This medicine is only available with a doctor's prescription. It is primarily indicated for partial seizures in children and adults, except for pediatric patients younger than three years old.

Gabapentin is prescribed for other medical conditions, including restless leg syndrome, hot flashes, nerve pain, and postherpetic neuralgia – a painful side effect of shingles.

For safety reasons, patients should be counseled about the side effects, drug interactions and warnings before use.

For example, serious side effects including a coma, allergic reaction, or extreme drowsiness have been known to occur. Some drug interactions can exacerbate adverse reactions like sleepiness, including NSAIDs, CNS depressants, and over the counter muscle relaxants or flu and allergy medicines. As a result, care should be taken to avoid using Gabapentin concurrently with these sleep-inducing medications.

Moreover, extra precautions should be taken while driving or operating heavy machinery. If extreme drowsiness, slowed thinking, or loss of alertness become persistent issues, consult your healthcare provider.

Gabapentin is also known to cause sudden mood swings, hostility, behavioral problems, depression, and in extreme cases, feelings of suicide, particularly in children and patients who have a history of depression. If these symptoms occur, contact your healthcare provider immediately.

Other warnings while using Gabapentin include paying attention to all instructions provided by your healthcare provider. Do not take more of this medicine than prescribed or stop taking the medicine suddenly. The medicine only works for regulating partial seizures and is not a cure for epilepsy. If you stop or alter the dosage, your partial seizures may return or increase. Additionally, abrupt discontinuation may lead to static epilepticus, a serious seizure lasting more than 30 minutes.

Clinical monitory should be expected intermittently to determine if the drug is working properly and whether a modified dose is needed.

Generally speaking, Gabapentin helps epileptic patients enjoy a life with fewer incidences of partial seizures. It moreover improves the quality of life for patients who regularly suffer from neuropathic pain, hot flashes, or restless leg syndrome.