Gabapentin Dosage Forms

Gabapentin is a structural analogue of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) that was first approved for use in the United States in 1993.

It was originally developed as a novel anti-epileptic for the treatment of certain types of seizures- today it is also widely used to treat neuropathic pain.

Gabapentin has some stark advantages as compared with other anti-epileptics, such as a relatively benign adverse effect profile, wide therapeutic index, and lack of appreciable metabolism making it unlikely to participate in pharmacokinetic drug interactions. It is structurally and functionally related to another GABA derivative, pregabalin.

Neurontin (gabapentin) capsules and tablets are supplied as follows:

100-mg capsules:

Hard gelatin CONI-SNAP^® capsules with white opaque body and cap printed with “PD” on one side and “Neurontin /100 mg” on the other. -bottles of 100 capsules

300-mg capsules:

Hard gelatin CONI-SNAP^® capsules with yellow opaque body and cap printed with “PD” on one side and “Neurontin /300 mg” on the other. -bottles of 100 capsules

400-mg capsules:

Hard gelatin CONI-SNAP^® capsules with orange opaque body and cap printed with “PD” on one side and “Neurontin /400 mg” on the other. -bottles of 100 capsules

600 mg tablets:

White, elliptical, biconvex, film-coated tablet with bisecting score on both sides and debossed with “NT” and “16” on one side. -bottles of 100 tablets

800 mg tablets:

White, elliptical biconvex, film-coated tablet with bisecting score on both sides and debossed “NT” and “26” on one side. -bottles of 100 tablets

Capsules contain : gabapentin, lactose, corn starch, and talc, Capsule shells may contain : gelatin, titanium dioxide, silicon dioxide, sodium lauryl sulfate, yellow iron oxide, red iron oxide, and FD&C Blue No. 2.

Tablets contain : gabapentin, poloxamer 407 NF, copolyvidone, corn starch, magnesium stearate, hydroxypropylcellulose, talc and candelilla wax.

Some people have become addicted to gabapentin after taking it for a long time.

If this happens, you’ll have withdrawal symptoms after you stop taking the medicine.

Talk to your doctor if you’re concerned about becoming physically dependent on gabapentin.

May 17, 2023May 18, 2023

The Role of Gabapentin in Pain Management

Gabapentin is an anticonvulsant drug prescribed for seizures and nerve pain. People who develop physical dependence to gabapentin may experience withdrawal symptoms when they try to come off it. Withdrawal symptoms can begin within 12 hours to 7 days after quitting the medication and last up to 10 days. Symptoms of gabapentin withdrawal may include nausea, dizziness, headaches, insomnia, and anxiety.

Opioids, non‐steroidal anti‐inflammatory drugs (NSAIDs), antidepressants, and anticonvulsants are used as pharmacological agents to treat pain. However, no single class of drugs has been found to be effective in all types of pain, presumably because pain syndromes involve different mechanisms.

In addition, each of the currently available drugs is associated with adverse effects, some of which are potentially serious or life‐threatening such as idiosyncratic or toxic reactions.

Traditionally, the treatment of neuropathic pain has involved anticonvulsants, such as carbemazepine, valproic acid and phenytoin, and tricyclic antidepressants, such as amitriptyline and nortriptyline and doxepin. The main disadvantages of the anticonvulsants are their potential for drug interactions via the induction of hepatic enzymes, or resulting from inhibition of hepatic enzymes by other drugs. Minor side‐effects such as sedation, ataxia, vertigo and diplopia are associated with carbemazepine and phenytoin, whereas, anorexia, nausea, vomiting and tremor are associated with valproic acid. Chronic phenytoin use may cause peripheral neuropathy (30%) and gingival hyperplasia (20%), and fetal hydantoin syndrome if administered during pregnancy. Carbemazepine can cause chronic diarrhoea or the syndrome of inappropriate ADH secretion, and rarely aplastic anaemia, thrombocytopaenia, hepatocellular jaundice and cardiac arrhythmias.

Tricyclic antidepressants also cause side‐effects that can be troublesome or potentially dangerous, such as anticholinergic effects (dry mouth, blurred vision, urinary retention, ileus), sedation, orthostatic hypotension, tachycardia and atrio‐ventricular conduction disturbances. Such adverse effects are likely to reduce the tolerance of this group of drugs in elderly or unwell patients. Some subgroups of patients with painful neuropathy such as diabetes may also have autonomic neuropathy and may not tolerate the orthostatic hypotension associated with tricyclic antidepressants.

With increasing evidence of the efficacy of gabapentin in a wide variety of pain syndromes, especially neuropathic pain, gabapentin may be potentially useful because of its relative freedom from serious adverse effects, its lack of interactions with other drugs and its lack of potential for causing drug dependence.

A comparison of the evidence available of efficacy and toxicity for anticonvulsants (gabapentin, phenytoin and carbemazepine) and antidepressants (tricyclic antidepressants and SSRIs) in patients with diabetic neuropathy and postherpetic neuralgia has recently been made by Collins et al. [129] These two neuropathic pain conditions were chosen according to strict diagnostic criteria. Although two previous systematic reviews of anticonvulsants and antidepressants in diabetic neuropathy showed no significant difference in efficacy or adverse effects between the two drug classes [130, 131], Collins et al. found that when data from randomised controlled trials for both diabetic neuropathy and postherpetic neuralgia were pooled, the NNT for at least 50% pain relief was identical for both classes of drugs. When gabapentin was compared with other anticonvulsants, there was no significant difference in efficacy.

The NNT for gabapentin was 3.4 compared with 2.2 for phenytoin/carbemazepine. The number needed to harm (NNH, defined as the number needed to harm one patient from the therapy) for minor adverse effects was 2.7 for both antidepressants and anticonvulsants. Collins et al. used two trials to provide data on minor adverse effects for gabapentin and two trials for phenytoin. The NNH (minor adverse effects) was 2.6 similar to that of gabapentin and 3.2 for phenytoin. The NNH (major adverse effects) for the tricyclic antidepressants was 17, and no significant difference in the incidence of major adverse effects was found between anticonvulsants and placebo.

Collins et al. suggested that the difference in the incidence of major adverse effects can be compared by using the ratio between treatment specific benefit and treatment specific harm (defined as the number of patients needed to experience at least 50% benefit for one to experience a major adverse effect that warranted discontinuation of treatment). The ratio for gabapentin was 6 compared with an average of 8 for all anticonvulsants, and 6 for all antidepressants. As adverse data were pooled from both diabetic and postherpetic neuralgia studies, methodological factors and heterogenicity in these data may limit the validity and robustness of these ratios. The spectrum of the pain and short study duration tend to underestimate the treatment effect, whereas the small sample size of the studies overestimate the treatment effect.

The above evidence suggests that gabapentin is as efficacious at treating neuropathic pain with no significant difference in minor adverse effects and a low propensity for serious adverse effects compared with other anticonvulsants and antidepressants. Therefore, gabapentin is a useful agent in the multimodal approach in the management of neuropathic pain.

May 17, 2023May 18, 2023

Gabapentin is Used to Treat Restless Legs Syndrome

Gabapentin (Neurontin) is FDA approved to treat epilepsy and a type of nerve pain caused by shingles (postherpetic neuralgia).

Restless legs syndrome (RLS) is a disorder of the part of the nervous system that causes an urge to move the legs. Because it usually interferes with sleep, it also is considered a sleep disorder.

Causes of Restless Legs Syndrome

In most cases, doctors do not know the cause of restless legs syndrome; however, they suspect that genes play a role. Nearly half of people with RLS also have a family member with the condition.

Other factors associated with the development or worsening of restless legs syndrome include:

Chronic diseases. Certain chronic diseases and medical conditions, including iron deficiency, Parkinson’s disease, kidney failure,diabetes, and peripheral neuropathy often include symptoms of RLS. Treating these conditions often gives some relief from RLS symptoms.
Medications. Some types of medications, including antinausea drugs, antipsychotic drugs, some antidepressants, and cold and allergymedications containing sedating antihistamines, may worsen symptoms.
Pregnancy. Some women experience RLS during pregnancy, especially in the last trimester. Symptoms usually go away within a month after delivery.

Other factors, including alcohol use and sleep deprivation, may trigger symptoms or make them worse. Improving sleep or eliminating alcohol use in these cases may relieve symptoms.

Treatment for Restless Legs Syndrome

Treatment for RLS is targeted at easing symptoms. In people with mild to moderate restless legs syndrome, lifestyle changes, such as beginning a regular exercise program, establishing regular sleep patterns, and eliminating or decreasing the use of caffeine, alcohol, and tobacco, may be helpful. Treatment of an RLS-associated condition also may provide relief of symptoms.

Other non-drug RLS treatments may include:

Leg massages
Hot baths or heating pads or ice packs applied to the legs
Good sleep habits
A vibrating pad called Relaxis
Medications may be helpful as RLS treatments, but the same drugs are not helpful for everyone. In fact, a drug that relieves symptoms in one person may worsen them in another. In other cases, a drug that works for a while may lose its effectiveness over time.

Drugs used to treat RLS include:

Dopaminergic drugs, which act on the neurotransmitter dopamine in the brain.
Mirapex, Neupro, and Requip are FDA-approved for treatment of moderate to severe RLS. Others, such as levodopa, may also be prescribed.
Benzodiazepines, a class of sedative medications, may be used to help with sleep, but they can cause daytime drowsiness.
Narcotic pain relievers may be used for severe pain.
Anticonvulsants, or antiseizure drugs, such as Tegretol, Lyrica, Gabapentin ( Neurontin ), and Horizant.

Although there is no cure for restless legs syndrome, current treatments can help control the condition, decrease symptoms, and improve sleep.

Usual Adult Dose for Restless Legs Syndrome

Gabapentin enacarbil available under the trade name Horizant (R):
600 mg orally once daily with food at about 5 PM

May 17, 2023

Gabapentin is Used to Treat Nerve Pain

Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.

Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles.

Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

- - Capsule
  - Tablet
  - Solution
  - Suspension

Nerve pain can be a symptom of many different conditions, includingcancer, HIV, diabetes, and shingles.

For some, nerve pain is frustrating; for others, nerve pain is devastating and life-changing.

Whether it feels like burning, pinpricks, or sudden shocks of electricity, nerve pain can disrupt your life at home and at work. It can limit your ability to get around. Over time, it can grind you down. Studies show that people with nerve pain have higher rates of sleep problems,anxiety, and depression.Your nervous system is involved in everything your body does, from regulating your breathing to controlling your muscles and sensing heat and cold.

There are three types of nerves in the body:

Autonomic nerves. These nerves control the involuntary or partially voluntary activities of your body, including heart rate, blood pressure, digestion, and temperature regulation.
Motor nerves. These nerves control your movements and actions by passing information from your brain and spinal cord to your muscles.
Sensory nerves. These nerves relay information from your skin and muscles back to your spinal cord and brain. The information is then processed to let you feel pain and other sensations.

Because nerves are essential to all you do, nerve pain and damage can seriously affect your quality of life.

When you have a serious medical condition such as cancer or HIV, dealing with the additional misery of nerve pain can be especially hard. But there is good news. While nerve pain can’t always be cured, it can be treated — and there are a lot of good options available.

Experts believe that 40 million Americans are living with nerve pain. The impact of nerve pain is tremendous. Both the costs to the healthcare system as well as loss of wages and productivity are staggering.

How Are Nerve Pain and Nerve Damage Treated?

In many instances, nerve damage cannot be cured entirely. But there are various treatments that can reduce your symptoms. Because nerve damage is often progressive, it is important to consult with a doctor when you first notice symptoms. That way you can reduce the likelihood of permanent damage.

Often, the first goal of treatment is to address the underlying condition that’s causing your nerve pain or nerve damage. This may mean:

Regulating blood sugar levels for people with diabetes
Correcting nutritional deficiencies
Changing medications when drugs are causing nerve damage
Physical therapy or surgery to address compression or trauma to nerves
Medications to treat autoimmune conditions

Additionally, your doctor may prescribe medications aimed at minimizing the nerve pain you are feeling. These may include:

Pain relievers
Tricyclic antidepressants
Certain anti-seizure drugs – Gabapentin

Complementary and alternative approaches may also help alleviate your nerve pain and discomfort. These include:

Acupuncture
Biofeedback
Hypnosis
Meditation

How do Gabapentin Products Work for Nerve Pain?

We don’t know exactly how gabapentin works to relieve nerve pain.

The structure of gabapentin is similar to a brain chemical called gamma-aminobutyric acid (GABA). GABA slows down nerve activity and relaxes the body. This may be how gabapentin relieves nerve pain.

What are the dosages for Horizant and Gralise?

Horizant and Gralise are dosed differently, and it’s important to know that Horizant, Gralise, and IR gabapentin aren’t interchangeable. For example, taking 600 mg of Horizant is not the same as taking 600 mg of Gralise or 600 mg of IR gabapentin.

Keep in mind: You may experience withdrawal side effects like headache, nausea, and diarrhea if you stop one of these medications abruptly. Stopping them too quickly can also lead to seizures. Your healthcare provider will instruct you on how to slowly lower your dose of these medications if necessary.

Horizant

When Horizant is taken for postherpetic neuralgia, the typical starting dose is 600 mg every morning with food for 3 days. Then, the dose is usually increased to 600 mg twice daily with food.

If Horizant is prescribed for RLS, the usual dose is 600 mg once daily at around 5PM with food.

Gralise

For postherpetic neuralgia, your healthcare provider will likely start you on a low dose of Gralise (300 mg) and slowly raise the dose over the course of 2 weeks or more (up to 1,800 mg). Gralise comes as a “starter pack” that contains a dose titration guide to help you with the initial dosage schedule.

Regardless of your dose, Gralise is taken once a day with the evening meal.

How effective are Horizant and Gralise at treating nerve pain?

Clinical studies have shown that Horizant and Gralise effectively treat nerve pain. We’ll take a look at how well they work for their FDA-approved uses below.

Postherpetic neuralgia

Clinical trials compared various doses of Horizant with placebo (a pill with nothing in it). After 12 weeks of treatment, over 300 people rated their pain. All Horizant doses were more effective at improving pain than placebo. And a 1,200 mg dose of Horizant was just as effective as higher doses.

Another clinical trial looked at over 450 people taking Gralise 1,800 mg daily or a placebo pill for 8 weeks. People taking Gralise had more improvement in pain than the people taking a placebo.

We don’t have much research that compares Horizant and Gralise for postherpetic neuralgia. But it’s been found that Horizant leads to more steady gabapentin levels in the body over the course of a day. And Horizant generally requires a lower daily dose (600 mg to 1,200 mg of Horizant versus 1,800 mg of Gralise). This could potentially minimize side effects.

RLS

Horizant was studied for RLS treatment in two 12-week clinical trials. Both Horizant 600 mg and 1,200 mg were studied. Both doses were better than placebo at relieving symptoms of RLS.

Other types of pain

There’s not much research on Horizant and Gralise for other types of pain. While some small studies of Gralise have found that it may be effective for other types of pain, they were small studies and they didn’t have the best study design.

However, another study looking at Gralise for nerve pain from diabetes found that it did reduce pain. This was a slightly larger study of close to 150 people. And it was a randomized controlled trial (the best type of study to look for cause and effect).

Keep in mind: IR gabapentin is recommended as a first-choice treatment for some types of nerve pain, such as diabetic nerve pain. But how well it works for other types of pain is unclear. It also hasn’t been shown to be the best option for types of chronic pain, including back pain.

May 17, 2023

What Ingredients Are in Gabapentin?

Gabapentin is an anti-epileptic drug, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain.

Some inactive ingredients in the gabapentin tablets or capsules include:

- - Lactose
  - Talc
  - Cornstarch
  - Gelatin
  - Colors such as FD&C blue no. 2, yellow iron oxide
  - Titanium dioxide
  - Poloxamer 407
  - Magnesium stearate
  - Copovidone, cornstarch
  - Candelilla wax
  - Hydroxypropyl cellulose

Dosing information

Usual Adult Dose for Epilepsy:

Initial dose: 300 mg orally on day one, 300 mg orally 2 times day on day two, then 300 mg orally 3 times a day on day three
Maintenance dose: 300 to 600 mg orally 3 times a day
Maximum dose: 3600 mg orally daily (in 3 divided doses)
-Maximum time between doses in the 3 times a day schedule should not exceed 12 hours

-The safety and effectiveness of gabapentin available under the trade name Gralise or Horizant in patients with epilepsy has not been studied.

Use: Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization

Usual Adult Dose for Postherpetic Neuralgia:

-Initial dose: 300 mg orally on day one, 300 mg orally 2 times day on day two, then 300 mg orally 3 times a day on day three
-Titrate up as needed for pain relief
-Maximum dose: 1800 mg per day (600 mg orally 3 times a day)
Gabapentin available under the trade name Gralise:
-Maintenance dose: Gralise should be titrated to 1800 mg orally once daily with the evening meal.
-Recommended titration schedule:
Day 1: 300 mg orally with the evening meal
Day 2: 600 mg orally with the evening meal
Days 3 through 6: 900 mg orally with the evening meal
Days 7 through 10: 1200 mg orally with the evening meal
Days 11 through 14: 1500 mg orally with the evening meal
Day 15: 1800 mg orally with the evening meal

COMMENT:
-Gralise is not interchangeable with other gabapentin products because of differing pharmacokinetic profiles that affect the frequency of administration.

Gabapentin enacarbil extended release tablets are available under the trade name Horizant:

-The recommended dosage is 600 mg orally 2 times a day. Therapy should be initiated at a dose of 600 mg orally in the morning for 3 days of therapy, then increased to 600 mg 2 times a day (1200 mg/day) on day four.

COMMENT:
Gabapentin enacarbil extended release tablets available under the trade name Horizant and gabapentin are not interchangeable.

Use: Postherpetic neuralgia

Usual Adult Dose for Restless Legs Syndrome:

Gabapentin enacarbil available under the trade name Horizant:
600 mg orally once daily with food at about 5 PM

Use: For the treatment of moderate-to-severe primary Restless Legs Syndrome (RLS) in adults

Usual Pediatric Dose for Epilepsy:

Less than 3 years: Not recommended

Greater than or equal to 3 and less than 12 years:
Starting Dose: Ranges from 10 to 15 mg/kg/day in 3 divided doses
Effective Dose: Reached by upward titration over a period of approximately 3 days; the effective dose in patients 5 years of age and older is 25 to 35 mg/kg/day in divided doses (3 times a day).

The effective dose in pediatric patients ages 3 and 4 years is 40 mg/kg/day and given in divided doses (3 times a day). Gabapentin may be administered as the oral solution, capsule, or tablet, or using combinations of these formulations. Dosages up to 50 mg/kg/day have been well tolerated in a long term clinical study. The maximum time interval between doses should not exceed 12 hours.

Greater than 12 years:
-Initial dose: 300 mg orally on day one, 300 mg orally 2 times a day on day two, then 300 mg orally 3 times a day on day three
-Maintenance dose: 900 to 1800 mg orally in 3 divided doses; the dose may be increased up to 1800 mg/day. Dosages up to 2400 mg/day have been well tolerated in long term clinical studies. Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated. The maximum time between doses in the three times a day schedule should not exceed 12 hours.

Use: Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization in patients 3 years of age and older

Gabapentin is used together with other medicines to treat partial seizures in adults and children at least 3 years old.

Gabapentin is also used to treat neuropathic pain (nerve pain) caused by herpes virus or shingles (herpes zoster) in adults.

Use only the brand and form of gabapentin your doctor has prescribed. Check your medicine each time you get a refill to make sure you receive the correct form.

The Gralise brand of gabapentin is indicated for the management of neuropathic pain only. It is not used for epilepsy.

Horizant is used to treat nerve pain and restless legs syndrome (RLS).

The Neurontin brand is used to treat seizures in adults and children who are at least 3 years old, in addition to neuropathic pain.

Gabapentin is part of its own drug class, called gabapentinoids. Typical dosages range from 100 milligrams to 800 milligrams of the drug.

May 17, 2023

Gabapentin is Used to Treat Diabetic Peripheral Neuropathy

What is Diabetic Peripheral Neuropathy: A common complication of diabetes mellitus in which nerves are damaged as a result of hyperglycemia (high blood sugar levels)

Not many people are aware of the medical condition that is known as Diabetic Neuropathy however more and more people are being diagnosed with having it, and if you have been recently diagnosed with Diabetic Neuropathy then you will need to start to take drug to help manage and control that condition.

Causes of Neuropathic Pain

Exposure to drugs, alcohol, toxins Neuropathic Pain Surgical procedures/ Amputation Traumatic Nerve injury/ compression Metabolic disturbance Viral infection Neuropathic pain is a disease, like myocardial infarction is a disease. Myocardial infarction may be caused by smoking, or hypertension, or diabetes. Multiple different things contribute to the cause of myocardial infarction, but myocardial infarction is the disease. Similarly, neuropathic pain is a disease, and this slide shows many of the different conditions that can result in neuropathic pain.

But the pain is nonprotective. It is something that persists and behaves separately as a disease itself. Cancer related (disease or treatment Vascular related neurodegenerative Nutritional deficiency

The best drug you can take is the fast acting Gabapentin and one of the main reasons why many people who do have Diabetic Neuropathy will take that drug is that it is not only fast acting as mentioned but it is also a very low cost drug to purchase too.

Drugs associated with Diabetic Peripheral Neuropathy

If you do want to take Gabapentin to treat diabetic neuropathy then please do be aware there can be some side effects, and before you make a purchase of Gabapentin you will be best advised to find out what the side effect of Gabapentin when taking it to treat diabetic neuropathy, and if at any time you start to experience any of those side effects then please seek the advice of a Doctor or a medical professional.

Pharmacologic Treatment for Neuropathic pain

Lidocaine patch 5%, capsaicinOpioidsOxycodone, Tramadol, Fentanyl, Morphine, HydrocodoneAntidepressantsTricyclic AntidepressantsAmitryptiline, Nortryptiline, Desipramine, Imipramine, DoxepinSelective Noredrinaline reuptake inhibitorsDuloxetine, VenlafaxineAnticonvulsantsCarbamazepine, Valproate, Lamotrigine, Topiramate, Gabapentin, Pregabalin

May 17, 2023May 18, 2023

How is Gabapentin Supplied and Stored ?

NEURONTIN (gabapentin) capsules, tablets, and oral solution are supplied as follows:

100 mg capsules:

White hard gelatin capsules printed with “PD” on the body and “Neurontin/100 mg” on the cap; available in:
Bottles of 100: NDC 0071-0803-24

300 mg capsules:

Yellow hard gelatin capsules printed with “PD” on the body and “Neurontin/300 mg” on the cap; available in:
Bottles of 100: NDC 0071-0805-24
Unit dose 50’s: NDC 0071-0805-40

400 mg capsules:

Orange hard gelatin capsules printed with “PD” on the body and “Neurontin/400 mg” on the cap; available in:
Bottles of 100: NDC 0071-0806-24
Unit dose 50’s: NDC 0071-0806-40

600 mg tablets:

White elliptical film-coated scored tablets debossed with “NT” and “16” on one side; available in:
Bottles of 100: NDC 0071-0513-24

800 mg tablets:

White elliptical film-coated scored tablets debossed with “NT” and “26” on one side; available in:
Bottles of 100: NDC 0071-0401-24

250 mg per 5 mL oral solution:

Clear colorless to slightly yellow solution; each 5 mL of oral solution contains 250 mg of gabapentin; available in:
Glass bottles containing 470 mL: NDC 0071-2012-23
Bottles containing 470 mL: NDC 0071-2012-44

Store NEURONTIN Tablets and Capsules at 25°C (77°F); excursions permitted between 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature].

Store NEURONTIN Oral Solution refrigerated, 2°C to 8°C (36°F to 46°F).

May 17, 2023

Does Gabapentin Help Nerve Pain?

Gabapentin is approved to treat the type of nerve pain (neuralgia) that results from nerve damage. Gabapentin is used to treat neuralgia caused by a herpes zoster viral infection, also known as shingles. Gabapentin is an anticonvulsant medication used in the management of peripheral neuropathic pains, postherpetic neuralgia, and partial-onset seizures.

This pain is called post-herpetic neuralgia (PHN), and it can be severe and chronic. Gabapentin is also used to treat pain from diabetic neuropathy, which happens when nerves in the feet damaged by diabetes cause chronic burning pain.

The exact way that gabapentin works to relieve pain is not known. It may change the way the body senses and reacts to pain. Gabapentin is used to manage long-term (chronic) pain, not to be taken for pain as needed. Chronic pain can interfere with sleep and work, and lead to depression.

Studies show that pain relief may start within one week and reach a maximum effect in about 4 weeks. It can take this long because gabapentin is usually started at a low dose and gradually increased over time until it works.

For treating neuralgia, gabapentin is often started at 300 mg per day and gradually raised by 300 mg per day. One 2017 review of 37 studies found that pain relief usually occurs at a dose of 1,200 mg or more.

The same review compared gabapentin to an inactive medicine (placebo) in almost 6,000 adults with chronic pain from PHN or diabetic neuropathy. Study participants were given either gabapentin or a placebo for 4 to at least 12 weeks. The results showed that 30-40% of people taking gabapentin were able to reduce their pain by half or more, compared to 10-20% of people taking the placebo.

Although some people may get significant relief, others may have side effects without relief of pain. More than half of people taking gabapentin did not get significant relief and had side effects from the drug.

According to the review, about 60% of people taking gabapentin had side effects, including:

- - Dizziness
  - Sleepiness
  - Water retention (edema)
  - Clumsiness while walking (ataxia)

It does not typically make pain worse: In trials comparing gabapentin side effects to placebo side effects, only 1% of people reported increased pain, and this was the same for gabapentin and placebo.

Once you find the dose that relieves neuralgia for you, it is important not to stop taking it suddenly. Stopping suddenly can lead to withdrawal symptoms such as:

- - Anxiety
  - Insomnia
  - Nausea
  - Pain
  - Sweating

May 17, 2023

NT16 Neurontin 600mg, NT26 Neurontin 800mg – Pfizer U.S. Pharmaceuticals Group

Pill with imprint NT 16 is White, Elliptical/Oval and has been identified as Neurontin 600 mg. It is supplied by Pfizer U.S. Pharmaceuticals Group.

Neurontin is used in the treatment of postherpetic neuralgia; epilepsy and belongs to the drug class gamma-aminobutyric acid analogs.

Risk cannot be ruled out during pregnancy. Neurontin 600 mg is not a controlled substance under the Controlled Substances Act (CSA).

Neurontin

Generic Name

gabapentin

Imprint

NT 16

Strength

600 mg

Color

White

Size

18.00 mm

Shape

Elliptical/Oval

Availability

Prescription only

Drug Class

Gamma-aminobutyric acid analogs

Pregnancy Category

C – Risk cannot be ruled out

CSA Schedule

Not a controlled drug

Labeler / Supplier

Pfizer U.S. Pharmaceuticals Group

Inactive Ingredients

poloxamer 407, copovidone, corn starch, magnesium stearate, hydroxypropyl cellulose, magnesium silicate, candelilla wax, water

Note: Inactive ingredients may vary.

Labelers / Repackagers

NDC Code	Labeler / Repackager
00071-0513	Pfizer Inc.
54868-4491 (Discontinued)	Physicians Total Care Inc. (repackager)
63874-1073	Altura Pharmaceuticals Inc. (repackager)
55289-0850	PDRX Pharmaceuticals Inc. (repackager)

NT 26 (Neurontin 800 MG)

Pill with imprint NT 26 is White, Elliptical/Oval and has been identified as Neurontin 800 MG. It is supplied by Pfizer U.S. Pharmaceuticals Group.

Neurontin is used in the treatment of postherpetic neuralgia; epilepsy and belongs to the drug class gamma-aminobutyric acid analogs. Risk cannot be ruled out during pregnancy. Neurontin 800 MG is not a controlled substance under the Controlled Substances Act (CSA).

Neurontin

Generic Name

gabapentin

Imprint

NT 26

Strength

800 MG

Color

White

Size

19.00 mm

Shape

Elliptical/Oval

Availability

Prescription only

Drug Class

Gamma-aminobutyric acid analogs

Pregnancy Category

C – Risk cannot be ruled out

CSA Schedule

Not a controlled drug

Labeler / Supplier

Pfizer U.S. Pharmaceuticals Group

Inactive Ingredients

poloxamer 407, copovidone, corn starch, magnesium stearate, hydroxypropyl cellulose, magnesium silicate, candelilla wax, water

Note: Inactive ingredients may vary.

Labelers / Repackagers

NDC Code	Labeler / Repackager
00071-0401	Pfizer Inc.
54868-4600 (Discontinued)	Physicians Total Care Inc. (repackager)
35356-0061	Lake Erie Medical and Surgical Supply (repackager)

May 17, 2023May 18, 2023

Is Gabapentin ( Neurontin ) Addictive and How to Treat Gabapentin Addiction ?

Gabapentin is used with other medications to prevent and control seizures. It is also used to relieve nerve pain following shingles (a painful rash due to herpes zoster infection) in adults. Gabapentin is known as an anticonvulsant or antiepileptic drug.

Gabapentin, also known by the brand name Neurontin, is a prescription painkiller belonging to its own drug class, Gabapentinoids. It is considered an anti-convulsant, and is most commonly used to treat epilepsy, restless leg syndrome, hot flashes, and neuropathic pain. It is often used as a less-addictive alternative to opioids; however, Gabapentin addiction and abuse still occur in many patients.

Gabapentin has a similar chemical structure to Gamma-aminobutyric acid (GABA), the brain chemical which affects the body’s nervous system. It can produce feelings of relaxation and calmness, which can help with nerve pain, anxiety, and even poor sleep.

Gabapentin is prescribed to treat nerve pain, alcohol and cocaine withdrawals, restless leg syndrome, diabetic neuropathy, fibromyalgia, and seizures. It works by altering one’s calcium channels to reduce seizures and ease nerve pain. Some brand names of Gabapentin are Neurontin and Gralise. The drug’s known street names are “gabbies” or “johnnies.”

Dosages of Gabapentin

Adult and pediatric dosages:

Capsule

- - 100 mg
  - 300 mg
  - 400 mg

Tablet

- - 300 mg (Gralise)
  - 600 mg (Gralise, Neurontin)
  - 800 mg (Neurontin)

Dosage Considerations – Should be Given as Follows:

Reducing the dose, discontinuing the drug, or substituting an alternative medication should be done gradually over a minimum of 1 week or longer.

Geritric dosing considerations:

Renal impairment is present, gabapentin dose reduction may be required, depending on renal function.

Partial Seizures

Neurontin

Adjunctive therapy for partial seizures with or without secondary generalization.

Initial: 300 mg orally every 8 hours.

May increase up to 600 mg orally every 8 hours; up to 2400 mg/day administered and tolerated in clinical studies; up to 3600 mg administered for short duration and tolerated

Post herpetic Neuralgia

Neurontin

Day 1: 300 mg orally once per day.

Day 2: 300 mg orally every 12 hours.

Day 3: 300 mg orally every 8 hours.

Maintenance: Subsequently titrate as needed up to 600 mg orally every 8 hours; doses greater than 1800 mg/day have demonstrated no additional benefit.

Gralise

Dose gradually to 1800 mg/day orally; take once a day with evening meal.

Day 1: 300 mg orally once a day.

Day 2: 600 mg orally once a day.

Days 3-6: 900 mg orally once a day.

Days 7-10: 1200 mg orally once a day.

Days 11-14: 1500 mg orally once a day.

Day 15 and after (maintenance): 1800 mg orally once a day.

Dosing considerations:

Gralise tablets swell in gastric fluid and gradually release gabapentin. Swallow Gralise tablets whole; do not cut, crush, or chew them.

Dosing Modifications:

Renal impairment (Neurontin)

Creatinine clearance greater than 60 mL/min: 300-1200 mg orally twice daily

Creatinine clearance 30-60 mL/min: 200-700 mg every 12 hours

Creatinine clearance 15-29 mL/min: 200-700 mg once per day

Creatinine clearance less than 15 mL/min: 100-300 mg once per day

Hemodialysis (Creatinine clearance less than 15 mL/min):

Administer supplemental dose (range 125-350 mg) post hemodialysis, after each 4 hour dialysis interval; further dose reduction should be in proportion to Creatinine clearance (a Creatinine clearance of 7.5 mL/min should receive one-half daily post hemodialysis dose)

Renal impairment (Gralise):

Creatinine clearance is greater than or equal to 60 mL/min: 1800 mg daily with evening meal

Creatinine clearance 30-59 mL/min: 600-1800 mg daily with evening meal

Creatinine clearance greater than 30 mL/min or hemodialysis: Do not administer

In addition its potentially addictive nature, Gabapentin can cause suicidal thoughts, moods swings, and abrupt changes in a user’s behavior. It can also cause elevated blood pressure, fever, sleep problems, appetite changes, and chest pain.

Gabapentin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

- - drowsiness
  - tiredness or weakness
  - dizziness
  - headache
  - uncontrollable shaking of a part of your body
  - double or blurred vision
  - unsteadiness
  - anxiety
  - memory problems
  - strange or unusual thoughts
  - unwanted eye movements
  - nausea
  - vomiting
  - heartburn
  - diarrhea
  - dry mouth
  - constipation
  - increased appetite
  - weight gain
  - swelling of the hands, feet, ankles, or lower legs
  - back or joint pain
  - fever
  - runny nose, sneezing, cough, sore throat, or flu-like symptoms
  - ear pain
  - red, itchy eyes (sometimes with swelling or discharge)

Some side effects may be serious. If you experience any of the following symptoms, call your doctor immediately:

- - rash
  - itching
  - swelling of the face, throat, tongue, lips, or eyes
  - hoarseness
  - difficulty swallowing or breathing
  - seizures
  - difficulty breathing; bluish-tinged skin, lips, or fingernails; confusion; or extreme sleepiness

Gabapentin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Gabapentin Abuse

Gabapentin abuse tends to occur in people who already have an addiction to opioids or other drugs. The effects of Gabapentin intoxication have been described as a sense of calm, euphoria, and a high similar to marijuana.

A 2013 study in Kentucky found that of the 503 participants reporting illegal drug use, 15% reported using Gabapentin in addition to other drugs to get high in the previous six months. Another study, working with a sample of participants meant to represent the national population, found almost a quarter of patients with co-prescriptions of opioids and Gabapentin were getting more than three times their prescribed amount to supply their addiction. People using the drug without a prescription is a growing problem in many areas. Due to the drug’s legal status, this is difficult to address from a policing standpoint. States where Gabapentin abuse is becoming more common are beginning to classify the drug as a more strictly controlled substance.

Signs of a Gabapentin Overdose

Effects of excessive Gabapentin use include:

- - Drowsiness
  - Coordination problems
  - Tremors
  - Dizziness
  - Depression
  - Suicidal thoughts/behaviors
  - Changes in mood
  - Dizziness
  - Poor coordination
  - Forgetfulness
  - Anxiety
  - Difficulty speaking
  - Inability to feel pleasure

It is important to try to recognize these symptoms and to be wary of other red flags, such as the presence or abundance of pill bottles. These effects can be detrimental to one’s health, livelihood, and overall safety.

Many Gabapentin users in early recovery abuse Gabapentin because at high doses (800mg or more), they may experience a euphoric-like high that does not show up on drug screens. Gabapentin abusers typically take the drug in addition to opioids to produce their desired high, a dangerous and potentially deadly combination. It is possible to fatally overdose on Gabapentin, both on its own or in conjunction with other drugs. However, there is currently no antidote that can be administered to someone in the case of a Gabapentin overdose as there is with opioid overdoses. If you find a loved one showing signs of an overdose–drowsiness, muscle weakness, lethargy and drooping eyelids, diarrhea, and sedation—seek medical attention immediately.

Signs of Gabapentin Addiction

- - Lying about or exaggerating symptoms to doctors
  - Seeking out multiple doctors to get extra doses
  - Switching doctors after the original doctor refuses to continue prescribing the medication
  - Changes in social habits and/or circles
  - Changes in personal hygiene and grooming habits
  - Constant preoccupation with the drug
  - Unease at the thought of the drug being unavailable
  - Refusal to quit despite social, financial, or legal consequences
  - Failed attempts to quit

Treating a Gabapentin Addiction

Frequent and excessive use of Gabapentin can lead to a physical and psychological dependence on the drug. This is when someone becomes so accustomed to taking a drug that they need it to feel and function normally. Quitting a drug like Gabapentin cold turkey can be dangerous and induce several withdrawal symptoms of varying severity.

These include anxiety, insomnia, nausea, pain, and sweating. Quitting also increases one’s likelihood of having a seizure which can lead to personal injury or the development of medical problems and life-threatening emergencies. Trying to quit should be done at a rehab facility or with the guidance and supervision of a professional during a medical detox.