Tablets: 600 mg & 800 mg Indications Adjunctive therapy in treatment of partial seizures with or without secondary generalization in patients above 12 yr with epilepsy; adjunctive therapy for partial seizures in children 3 to 12 years; management of postherpetic neuralgia in adults. Route/Dosage Epilepsy Adults and children above 12 years: PO 900 to 1800 mg/day in divided doses tid. Initial dose: 300 mg on day 1 and calculate upward rapidly. To minimize CNS side effects, administer initial dose on day 1 at bedtime. Children 3 to 12 years: PO Initiate therapy at 10 to 15 mg/kg/day in divided doses (ie, 3 times/day) and calculate dose upward over a period of about 3 dayears to the effective dose. Then .. Children 3 TO 4 YR: PO The effective dose is 40 mg/kg/day in divided doses (ie, 3 times/day). Children at least 5 years: PO The effective dose is 25 to 35 mg/kg/day in divided doses (ie, 3 times/day). Postherpetic Neuralgia Adults: PO Start with a single 300 mg dose on day 1, 600 mg on day 2 (divided twice daily), and 900 mg on day 3 (divided 3 times daily). Subsequently, calculate the dose upward as needed for pain relief to a daily dose of 1800 mg (divided 3 times daily). Interactions Antacids: May reduce bioavailability of gabapentin. Cimetidine: Reduces renal clearance of gabapentin. Side effects: CV Hypertension. CNS Somnolence, dizziness, ataxia, tremor, nervousness, dysarthria, amnesia, depression, abnormal thinking, twitching, abnormal coordination, vertigo, hyperkinesia, parasthesia, reflex abnormality, hostility, anxiety. DERM Pruritus, abrasion, purpura. EENT Diplopia, amblyopia, nystagmus, abnormal vision, gingivitis. GI Dyspepsia, dry mouth or throat, constipation, dental abnormalities, increased appetite, anorexia, flatulence. RESP Rhinitis, pharyngitis, coughing, pneumonia. OTHER Fatigue, weight increase, back pain, peripheral edema, impotence, leukopenia, vasodilation, asthenia, malaise, facial edema, arthralgia. Precautions Pregnancy: Category C. Lactation: Secreted in breast milk. Children: Safety and efficacy in children below 3 yr not established; safety and efficacy in management of postherpetic neuralgia in pediatric patients not established. Elderly and debilitated patients: Because of age-related renal impairment, dosage adjustment may be required. Carcinogenesis: May have carcinogenic potential. Renal impairment: Dose reduction recommended. Serious adverse effects: During clinical trials, some patients experienced status epilepticus, and 8 sudden, unexplained deaths occurred. The association of these events with gabapentin use is unclear. Withdrawal: Do not discontinue antiepileptic drugs abruptly because of possible increased seizure frequency from drug withdrawal.
PATIENT CARE CONSIDERATIONS Administration/Storage Administer medication with or without food and at least 2 hr after antacid administration. Administer initial dose on day 1 at bedtime to minimize CNS side effects. Calculate the effective dose given tid up to 1800 mg/day; maximum time between doses in tid schedule should not exceed 12 hr. Discontinue medication gradually over minimum of 1 wk. Store medication in tightly sealed container. OVERDOSAGE: SIGNS & SYMPTOMS Ataxia, labored breathing, ptosis, sedation, hypoactivity or excitation, double vision, slurred speech, drowsiness, lethargy, diarrhea
Patient/Family Education Instruct patient to take medication at least 2 hr after taking antacid. Explain that missed dose should be taken as soon as remembered but that 2 doses should not be taken together. Instruct patient to call health care provider if at least 2 doses are missed. Instruct patient to report the following symptoms to health care provider: excessive fatigue or weakness, dizziness, somnolence, incoordination, tremor or other symptoms of CNS depression, change in normal behavior, weight gain, back pain, alterations in GI syearstem, alteration in skin or mucous membranes, fluid retention, general body discomfort, anorexia, visual disturbances, impotence. Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.