Neonatal Drug Therapy Manual


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): 
Anticonvulsant; agent for neuropathic pain
Original Date: 
April 2023
  • 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
  • PO
  • 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 
  • 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)
  • 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.

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.