Neonatal Drug Therapy Manual

Gabapentin

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

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.

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