Alternate Name(s):
Neurontin®
Classification:
Anticonvulsant; agent for neuropathic pain
Original Date:
April 2023
Indications:
- adjunct in the treatment of neuropathic pain
- chronic pain/visceral hyperalgesia caused by a variety of neurologic and gastrointestinal morbidities
- ongoing or refractory irritability/agitation
Administration:
- PO
Dosage:
- Starting dose: 2.5-5 mg/kg/dose po once daily, increasing to BID then TID over first few days as tolerated
- Further titration of dose can be made Q 3-5 days as needed to effect
- Suggested max daily dose in the literature: 25.5- 35 mg/kg/day
- Lower starting doses may be used if patient is on other sedating medications, or has renal dysfunction
Side Effects:
- Constipation, vomiting, decreased oral secretions, nausea
- Irritability, sleepiness, nystagmus
- Fever
- Bradycardia (usually dose-related), respiratory depression
- hypersensitivity reactions (immediate or delayed)
Parameters to Monitor:
- Renal function (baseline and periodic)
- Pain/sedation scores as indicated
Notes:
- Withdrawal has been described following abrupt discontinuation of gabapentin in infants; reported symptoms included episodic tachycardia, emesis, and irritability; symptoms resolved after gabapentin was restarted. Avoid abrupt discontinuation, especially in patients on prolonged therapy (>1 week)
References:
- Edwards L, DeMeo S, Hornik CD, Cotten CM, Smith PB, Pizoli C, Hauer JM, Bidegain M. Gabapentin Use in the Neonatal Intensive Care Unit. J Pediatr. 2016 Feb;169:310-2.
- Sacha GL, Foreman MG, Kyllonen K, Rodriguez RJ. The Use of Gabapentin for Pain and Agitation in Neonates and Infants in a Neonatal ICU. J Pediatr Pharmacol Ther. 2017 May-Jun;22(3):207-211.
- Carter BS, Brunkhorst J. Neonatal pain management. Semin Perinatol. 2017 Mar;41(2):111-116.
- Burnsed JC, Heinan K, Letzkus L, Zanelli S. Gabapentin for pain, movement disorders, and irritability in neonates and infants. Dev Med Child Neurol. 2020 Mar;62(3):386-389.
- Lexi-Comp Online Database, accessed March 2023.