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Gabapentin is Used for Neuropathic Pain (other than Postherpetic Neuralgia)

In a meta-analysis of trials evaluating the treatment of neuropathic pain, including painful polyneuropathy and spinal cord injury pain, gabapentin was shown to be safe and effective .

Data from meta-analyses support the use of immediate-release gabapentin for reducing pain by more than 50% in diabetic neuropathy.

 

Diabetic Peripheral Neuropathy
Diabetic Peripheral Neuropathy

Data from a limited number of clinical trials support the use of extended-release gabapentin in reducing pain by more than 50% and improving sleep in diabetic neuropathy.

Gabapentin (Neurontin) has FDA indication to treat postherpetic neuralgia and partial onset seizures.  Controlled clinical trials in diabetic neuropathy and postherpetic neuralgia show that gabapentin at 2400-3600 mg/day has a similar efficacy to tricyclic antidepressants and carbamazepine.  Consistent, though less compelling clinical evidence supports its use for neuropathic cancer pain, pain associated with HIV infection, chronic back pain and others (readers wanting more in depth research findings are urged to consult Reference 1).

Due to this emerging evidence, it is widely used for the treatment of neuropathic pain.  The exact mechanism and site of action of gabapentin is unknown.   Gabapentin is generally well-tolerated, easily titrated, has few drug interactions, and does not require laboratory monitoring.  However, cost may be a limiting factor for some patients.

Patients suitable for gabapentin should have a clear neuropathic pain syndrome, characterized by sharp, shooting, lancinating and/or burning pain, in a nerve root (radicular) or stocking/glove distribution. See Fast Fact #289 for a comparison of gabapentin with pregabalin a similar neuropathic analgesic.

Adult Dosing    Gabapentin is started at low doses (100 mg to 300 mg total daily) and increased by 100 – 300 mg every 1-3 days to effect.  A typical schedule might be: day 1-2: 300 mg nightly; day 3-4: 300 mg twice daily; day 5-7: 600 mg twice daily; day 8 onwards: 600 mg three times a day.  The usual effective total daily dose is 900-3600 mg, administered in three divided doses per day.  Titration should proceed more slowly in elderly patients. If gabapentin is discontinued, it should be done over a minimum of a week to prevent withdrawal seizures.

Pediatric Use    There is limited data available assessing its effectiveness in neuropathic pain in children. The American Pain Society recommends that gabapentin be considered for pediatric neuropathic pain especially when concurrent analgesics are found to be too sedating.  Their recommended initial dose is 2 mg/kg/day with a usual dosage range of 8 to 35 mg/kg/day divided into 3 daily doses.

Dosing in Renal Failure   Gabapentin doses must be reduced for patients with renal insufficiency.

  • Creatinine Clearance (CrCl) 30-60 ml/min: maximum daily dose is 1400 mg, divided.
  • CrCl 16-30 ml/min: maximum daily dose is 700 mg, given once daily.
  • CrCl 15ml/min: maximum daily dose is 300 mg, once daily.  Doses should decrease proportionally for CrCl less than 15 ml/min (e.g. 300 mg every other day for a CrCl of ~7.5 ml/min).
  • For patients on hemodialysis a supplemental dose is usually given after dialysis (usually 100-300 mg).

Adverse Reactions    Sedation, confusion, dizziness, and ataxia are the most common side effects, especially with rapid dose titration.  Tolerance to these effects appears to develop within a few days if the dose is held at the highest tolerated dose until symptoms improve or stabilize.

Dosage Formulations    Gabapentin is available in 100 mg, 300 mg, and 400 mg capsules, 600 mg and 800 mg tablets, and as a liquid (250mg/5mL).

Cost    Gabapentin is more expensive than older agents used for neuropathic pain (tricyclic antidepressants and older anti-epileptic drugs such as carbamazepine).  Generic gabapentin is available, although can cost ~$100 for 90 600 mg tablets.

Other Palliative Care Uses of Gabapentin    Small scale published trials have shown efficacy in the treatment of severe chronic hiccups, pruritus, postoperative pain and delirium, restless leg syndrome and hot flashes. Perhaps more compelling is its potential efficacy for chronic cough for which a randomized double-blind placebo controlled trial demonstrated significant improvement in cough-specific quality of life, cough frequency, and cough severity. See Fast Fact #200.

Summary    Gabapentin is a safe and effective adjuvant analgesic for neuropathic pain.  Physicians should become comfortable using and titrating gabapentin in patients with neuropathic pain syndromes.

Based on guidelines from the International Association for the Study of Pain (IASP), European Federation of Neurological Societies (EFNS), and Society of Critical Care Medicine (SCCM), gabapentin is effective and recommended for the management of peripheral neuropathy .

Based on guidelines from the EFNS, IASP, and National Institute for Health and Care Excellence (NICE), gabapentin is effective and recommended as first-line therapy, supported by strong evidence, in the management of diabetic neuropathy.

The IASP guidelines recommend both immediate- and extended-release gabapentin . In contrast, a guideline from the American Academy of Neurology (AAN), American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation states that gabapentin is probably effective and should be considered an alternative treatment for painful diabetic neuropathy based on limited benefit in 2 controlled trials.

Similarly, a position statement from the American Diabetes Association (ADA) recommends gabapentin as a second-line option .

Gabapentin Pharmacology

Gabapentin is structurally related to GABA. However, it does not bind to GABAA or GABAB receptors, and it does not appear to influence synthesis or uptake of GABA.

High affinity gabapentin binding sites have been located throughout the brain; these sites correspond to the presence of voltage-gated calcium channels specifically possessing the alpha-2-delta-1 subunit.

Gabapentin 800 mg Tab-IVA
Gabapentin 800 mg Tab-IVA

This channel appears to be located presynaptically, and may modulate the release of excitatory neurotransmitters which participate in epileptogenesis and nociception.

Mechanism of Gabapentin Action

The precise mechanisms by which gabapentin produces its analgesic and antiepileptic actions are unknown. Gabapentin is structurally related to the neurotransmitter gamma-aminobutyric acid (GABA) but has no effect on GABA binding, uptake, or degradation. In vitro studies have shown that gabapentin binds with high-affinity to the α2δ subunit of voltage-activated calcium channels; however, the relationship of this binding to the therapeutic effects of gabapentin is unknown.

Pharmacokinetics

All pharmacological actions following gabapentin administration are due to the activity of the parent compound; gabapentin is not appreciably metabolized in humans.

Oral Bioavailability

Gabapentin bioavailability is not dose proportional; i.e., as dose is increased, bioavailability decreases. Bioavailability of gabapentin is approximately 60%, 47%, 34%, 33%, and 27% following 900, 1200, 2400, 3600, and 4800 mg/day given in 3 divided doses, respectively. Food has only a slight effect on the rate and extent of absorption of gabapentin (14% increase in AUC and Cmax).

Distribution

Less than 3% of gabapentin circulates bound to plasma protein. The apparent volume of distribution of gabapentin after 150 mg intravenous administration is 58±6 L (mean ±SD). In patients with epilepsy, steady-state predose (Cmin) concentrations of gabapentin in cerebrospinal fluid were approximately 20% of the corresponding plasma concentrations.

Elimination

Gabapentin is eliminated from the systemic circulation by renal excretion as unchanged drug. Gabapentin is not appreciably metabolized in humans.

Gabapentin elimination half-life is 5 to 7 hours and is unaltered by dose or following multiple dosing. Gabapentin elimination rate constant, plasma clearance, and renal clearance are directly proportional to creatinine clearance. In elderly patients, and in patients with impaired renal function, gabapentin plasma clearance is reduced. Gabapentin can be removed from plasma by hemodialysis.

Absorption

Variable, from proximal small bowel by L-amino transport system; saturable process; dose-dependent

Vd: 58 ± 6 L; CSF concentrations are ~20% of plasma concentrations

Metabolism

Not metabolized

Excretion

Proportional to renal function; urine (as unchanged drug)

Clearance: Apparent oral clearance is directly proportional to CrCl: Clearance in infants is highly variable; oral clearance (per kg) in children <5 years of age is higher than in children ≥5 years of age

Time to Peak

Immediate release: Infants 1 month to Children 12 years: 2 to 3 hours; Adults: 2 to 4 hours; Extended release: 8 hours

Half-Life Elimination

Infants 1 month to Children 12 years: 4.7 hours

Adults, normal: 5 to 7 hours; increased half-life with decreased renal function; anuric adult patients: 132 hours; adults during hemodialysis: 3.8 hours

Protein Binding

<3%

Gabapentin Side Effects For Healthcare Professionals

Applies to gabapentin: compounding powder, oral capsule, oral solution, oral tablet, oral tablet extended release

Cardiovascular

Common (1% to 10%): Peripheral edema, vasodilation, hypertension

Rare (less than 0.1%): Atrial fibrillation, heart failure, myocardial infarction, cerebrovascular accident, ventricular extrasystoles, bradycardia, premature atrial contraction, pericardial rub, heart block, pericardial effusion, pericarditis

Postmarketing reports: Cardiac arrest, chest pain, palpitation, tachycardia[Ref]

Dermatologic

Common (1% to 10%): Abrasion, facial edema, purpura, rash, pruritus, acne

Uncommon (0.1% to 1%): Alopecia, eczema, dry skin, increased sweating, urticaria, hirsutism, seborrhea, cyst, herpes simplex

Rare (less than 0.1%): Stevens-Johnson syndrome, angioedema, erythema multiforme, drug rash (with eosinophilia and systemic symptoms), herpes zoster, skin discolor, skin papules, photosensitive reaction, psoriasis, desquamation, maceration, skin nodules, subcutaneous nodule, melanosis, skin necrosis, local swelling

Frequency not reported: DRESS/multiorgan hypersensitivity[Ref]

Endocrine

Rare (less than 0.1%): Hyperthyroid, hypothyroid, goiter, hypoestrogenism, ovarian failure, epididymitis, cushingoid appearance[Ref]

Gastrointestinal

Common (1% to 10%): Diarrhea, dry mouth or throat, constipation, nausea, vomiting, dyspepsia, dental abnormalities, gingivitis, abdominal pain, flatulence

Uncommon (0.1% to 1%): Glossitis, gum hemorrhage, thirst, stomatitis, increased salivation, gastroenteritis, hemorrhoids, bloody stools, fecal incontinence

Rare (less than 0.1%): Pancreatitis, dysphagia, eructation, pancreatitis, peptic ulcer, colitis, blisters in mouth, tooth discoloration, perlèche, salivary gland enlarged, lip hemorrhage, esophagitis, hiatal hernia, hematemesis, proctitis, irritable bowel syndrome, rectal hemorrhage, esophageal spasm

Frequency not reported: Dehydration[Ref]

General

The most common adverse reactions associated with the use of this drug were dizziness, somnolence, and peripheral edema.[Ref]

Genitourinary

Common (1% to 10%): Incontinence, impotence

Uncommon (0.1% to 1%): Hematuria, dysuria, urinary frequency, cystitis, urinary retention, vaginal hemorrhage, amenorrhea, dysmenorrhea, menorrhagia

Frequency not reported: Breast hypertrophy, gynecomastia, sexual dysfunction (including changes in libido, ejaculation disorders, and anorgasmia)[Ref]

Hematologic

Common (1% to 10%): Leucopenia, purpura

Uncommon (0.1% to 1%): Anemia, lymphadenopathy

Rare (less than 0.1%): Thrombocytopenia, thrombophlebitis, leukocytosis, lymphocytosis, increased bleeding time

Frequency not reported: Blood creatine phosphokinase increased, coagulation defect[Ref]

Rare (less than 0.1%): Hepatitis, jaundice, elevated liver function tests SGOT (AST), SGPT (ALT), and bilirubin, hepatomegaly, hepatotoxicity[Ref]

Hypersensitivity

Very rare (less than 0.01%): Hypersensitivity syndrome, a systemic reaction with a variable presentation that can include fever, rash, hepatitis, lymphadenopathy, eosinophilia, and sometimes other signs and symptoms[Ref]

Metabolic

Common (1% to 10%): Weight gain, hyperglycemia

Postmarketing reports: Hyponatremia[Ref]

Musculoskeletal

Common (1% to 10%): Back pain, arthralgia, myalgia, twitching

Uncommon (0.1% to 1%): Tendonitis, arthritis, joint stiffness, joint swelling

Frequency not reported: Rhabdomyolysis, myoclonus

Postmarketing reports: Elevated creatine kinase, rhabdomyolysis[Ref]

Nervous system

Very common (10% or more): Somnolence (21%), dizziness (17%), ataxia (13%)

Common (1% to 10%): Abnormal gait, incoordination, neuralgia, tremor, dysarthria, hyperkinesia, seizures, dysarthria, paresthesia, hypesthesia, coordination abnormal, increased/decreased/absent reflexes, vertigo

Uncommon (less than 1%): Hypokinesia

Rare (less than 0.1%): Movement disorders (e.g., choreoathetosis, dyskinesia, dystonia), loss of consciousness

Frequency not reported: Withdrawal precipitated seizure/status epilepticus

Postmarketing reports: Movement disorder[Ref]

Ocular

Common (1% to 10%): Amblyopia, conjunctivitis, diplopia, nystagmus

Uncommon (0.1% to 1%): Cataract, dry eyes, eye pain, visual field defect, photophobia, bilateral or unilateral ptosis, eye hemorrhage, hordeolum, eye twitching

Rare (less than 0.1%): Eye itching, abnormal accommodation, eye focusing problem, watery eyes, retinopathy, glaucoma, iritis, corneal disorders, lacrimal dysfunction, degenerative eye changes, blindness, retinal degeneration, miosis, chorioretinitis, strabismus[Ref]

Oncologic

Uncommon (0.1% to 1%): Breast cancer

Rare (less than 0.1%): Non-Hodgkin’s lymphoma[Ref]

Other

Very common (10% or more): Fatigue (11%), fever (11%)

Common (1% to 10%): Asthenia, accidental injury, otitis media, tremor, pain

Rare (0.01% to 0.1%): Tinnitus

Very rare (less than 0.01%): Sudden unexplained death in patients with epilepsy

Frequency not reported: Sleepwalking, withdrawal symptoms, hearing loss, earache, tinnitus, inner ear infection, otitis, taste loss, unusual taste, ear fullness, perforated ear drum, sensitivity to noise, eustachian tube dysfunction, otitis externa, odd smell, labyrinthitis[Ref]

Common (1% to 10%): Abnormal thinking, amnesia, depression, hostility, confusion, emotional liability, anxiety, nervousness, insomnia

Uncommon (0.1% to 1%): Mental impairment

Rare (less than 0.1%): Hallucinations

Frequency not reported: Suicidal behavior and ideation, hypomania[Ref]

Renal

Rare (less than 0.1%): Acute renal failure[Ref]

Respiratory

Common (1% to 10%): Pharyngitis, dyspnea, cough, bronchitis, respiratory infection, rhinitis

Rare (less than 0.1%): Pulmonary thrombosis, pulmonary embolism

Frequency not reported: Pseudo-croup, hoarseness

Gabapentin Side Effects

Applies to gabapentin: oral capsule, oral solution, oral suspension, oral tablet

gabapentin-side-effects
gabapentin-side-effects

 

Along with its needed effects, gabapentin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking gabapentin:

More common

  • Clumsiness or unsteadiness
  • continuous, uncontrolled, back-and-forth, or rolling eye movements

More common in children

  • Aggressive behavior or other behavior problems
  • anxiety
  • concentration problems and change in school performance
  • crying
  • depression
  • false sense of well-being
  • hyperactivity or increase in body movements
  • rapidly changing moods
  • reacting too quickly, too emotional, or overreacting
  • restlessness
  • suspiciousness or distrust

Less common

  • Black, tarry stools
  • chest pain
  • chills
  • cough
  • depression, irritability, or other mood or mental changes
  • fever
  • loss of memory
  • pain or swelling in the arms or legs
  • painful or difficult urination
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Incidence not known

  • Abdominal or stomach pain
  • blistering, peeling, or loosening of the skin
  • clay-colored stools
  • coma
  • confusion
  • convulsions
  • dark urine
  • decreased urine output
  • diarrhea
  • dizziness
  • fast or irregular heartbeat
  • headache
  • increased thirst
  • itching or skin rash
  • joint pain
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • loss of appetite
  • muscle ache or pain
  • nausea
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • unpleasant breath odor
  • vomiting of blood
  • yellow eyes or skin

Some side effects of gabapentin may occur that usually do not need medical attention.

These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Blurred vision
  • cold or flu-like symptoms
  • delusions
  • dementia
  • hoarseness
  • lack or loss of strength
  • lower back or side pain
  • swelling of the hands, feet, or lower legs
  • trembling or shaking

Less common or rare

  • Accidental injury
  • appetite increased
  • back pain
  • bloated or full feeling
  • body aches or pain
  • burning, dry, or itching eyes
  • change in vision
  • change in walking and balance
  • clumsiness or unsteadiness
  • congestion
  • constipation
  • cough producing mucus
  • decrease in sexual desire or ability
  • difficulty with breathing
  • dryness of the mouth or throat
  • earache
  • excess air or gas in the stomach or intestines
  • excessive tearing
  • eye discharge
  • feeling faint, dizzy, or lightheadedness
  • feeling of warmth or heat
  • flushed, dry skin
  • flushing or redness of the skin, especially on the face and neck
  • frequent urination
  • fruit-like breath odor
  • impaired vision
  • incoordination
  • increased hunger
  • increased sensitivity to pain
  • increased sensitivity to touch
  • increased thirst
  • indigestion
  • noise in the ears
  • pain, redness, rash, swelling, or bleeding where the skin is rubbed off
  • passing gas
  • redness or swelling in the ear
  • redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
  • runny nose
  • sneezing
  • sweating
  • tender, swollen glands in the neck
  • tightness in the chest
  • tingling in the hands and feet
  • trouble sleeping
  • trouble swallowing
  • trouble thinking
  • twitching
  • unexplained weight loss
  • voice changes
  • vomiting
  • weakness or loss of strength
  • weight gain

You can not take Prescription for a long time, you need find a way to treat your pain without prescription. Exercising is the best way to relieve your pain. because exercising can enhance your immune system and increase your muscle strength and make your nerve strong.

You can also take some natural nutritions to increase your immune system too. Some anti-aging products can also increase your immune ability. You can try USANA Products ro make you strong. I take USANA Essentials every day and I find my health get better and better. You can also try to become a usana distributor or associate and eat health organic food to get rid of your headache or nerve pain.

If you want to make yourself happy and more beautiful without any pain, please check Celavive Skin Care and Whitening Teeth

Gabapentin Risks during Pregnancy and when Breastfeeding

Neurontin (gabapentin) is an anti-epileptic medication used to treat seizures. Neurontin is used alone or in combination with other medications to treat seizures caused by epilepsy in adults and children who are at least 12 years old. Neurontin is also used to treat nerve pain caused by shingles (herpes zoster).

People who are pregnant, or intend to become pregnant, should tell their doctor before taking gabapentin.

Pregnant women should only take the drug if it is absolutely necessary. However, it is also essential to control seizures while pregnant.

Do not start or stop taking gabapentin for seizure control before talking to the doctor, who will assess the potential risks and benefits.

Gabapentin passes into breast milk, but its effects on babies are unknown. It is best to discuss this issue with a doctor before breastfeeding.

Potential for a drug allergy

Individuals with gabapentin allergies should not take the drug.

Also, the medication may contain other ingredients that can trigger allergy symptoms in some people. Discuss all drug and food allergies with a doctor before taking gabapentin.

Other safety considerations

Because gabapentin can cause drowsiness, anyone taking the drug should exercise caution while driving or using machinery.

Do not take antacids within 2 hours of taking gabapentin, as antacids reduce the body’s ability to absorb the drug.

People should also avoid alcohol or limit their intake while on gabapentin because there is a risk of adverse reactions.

Takeaway

Doctors prescribe gabapentin to control seizures, treat RLS, and reduce nerve pain.

Several types of gabapentin are available, and different forms can treat different medical issues.

The right dosage will vary, depending on the condition and other factors. A doctor can best advise about drug interactions and other safety considerations.

Although gabapentin has the potential to cause several adverse reactions, many people experience no serious side effects.

What is the Side Effects of Gabapentin and Can Gabapentin Causes Erectile Dysfunction ?

I was just hoping that you might have the answer I am hoping for? I started taking gabapentin 300mg twice a day, then 3 times a day, then 600mg twice a day then 3 times a day, now after 2 to 3 years later 800mg 3 times a day.

My doctor says it won’t cause erectile dysfunction but it started very soon after the 300mg 3 times a day. I tried Viagra and Cialis very little help. My wife is very displeased and sometimes thinks it is something to do with her. I know it has nothing to do with her as she is my bride of 24 years and my soul mate spirit. I have very bad pain that the gabapentin used to help with but it now seems it helps no more.

I would rather have my manhood back and my bride be happy and me than be in pain that just won’t go away. To get to the real question, how slowly should I get off the gabapentin and will I ever be able to get back to normal?

I will have to just have to tolerate the pain now that I have my diabetes under control. I rarely have to take my diabetes medicine but a few times a week because it makes my numbers to low and I black out when they get to low.

Usually 82 morning, 92 lunch, and 98 dinner. Any help will be greatly appreciated.

Answers:

Unfortunately gabapentin can cause impotence.

Side effects of the Urogenital System:

Infrequent: urinary tract infection, dysuria, impotence, urinary incontinence, vaginal moniliasis, breast pain, menstrual disorder, polyuria, urinary retention

Rare: cystitis, ejaculation abnormal, swollen penis, gynecomastia, nocturia, pyelonephritis, swollen scrotum, urinary frequency, urinary urgency, urine abnormality.

Talk to your doctor about coming off gabapentin and he/she could put you on some other medicine to help the pain. You don’t have to ween off gabapentin but please get your doctor to monitor you once you are off.

Gabapentin Drug Interaction

Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Monitor therapy

Alizapride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Aluminum Hydroxide: May decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after administration of antacids containing aluminum hydroxide or magnesium hydroxide. Consider therapy modification

Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). Avoid combination

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Consider therapy modification

Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Monitor therapy

Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Bromopride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Avoid combination

Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Consider therapy modification

Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Cannabis: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Consider therapy modification

Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Monitor therapy

Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Monitor therapy

Dronabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Droperidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Consider therapy modification

Esketamine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Consider therapy modification

HYDROcodone: CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Monitor therapy

Magnesium Salts: May enhance the CNS depressant effect of Gabapentin. Specifically, high dose intravenous/epidural magnesium sulfate may enhance the CNS depressant effects of gabapentin. Magnesium Salts may decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after use of a magnesium-containing antacid. Monitor patients closely for evidence of reduced response to gabapentin therapy. Monitor for CNS depression if high dose IV/epidural magnesium sulfate is used. Consider therapy modification

Mefloquine: May diminish the therapeutic effect of Anticonvulsants. Mefloquine may decrease the serum concentration of Anticonvulsants. Management: Mefloquine is contraindicated for malaria prophylaxis in persons with a history of convulsions. Monitor anticonvulsant concentrations and treatment response closely with concurrent use. Consider therapy modification

Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. Consider therapy modification

MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Monitor therapy

Mianserin: May diminish the therapeutic effect of Anticonvulsants. Monitor therapy

Minocycline: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Morphine (Systemic): Gabapentin may enhance the CNS depressant effect of Morphine (Systemic). Morphine (Systemic) may increase the serum concentration of Gabapentin. Monitor therapy

Nabilone: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Orlistat: May decrease the serum concentration of Anticonvulsants. Monitor therapy

Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Avoid combination

Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Avoid combination

OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Avoid combination

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Consider therapy modification

Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Monitor therapy

ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Monitor therapy

Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Monitor therapy

Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Monitor therapy

Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Monitor therapy

Sodium Oxybate: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. Consider therapy modification

Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Consider therapy modification

Tapentadol: May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Tetrahydrocannabinol and Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Avoid combination

Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Consider therapy modification.

Opioids

Hydrocodone

Coadministration of NEURONTIN with hydrocodone decreases hydrocodone exposure [see CLINICAL PHARMACOLOGY]. The potential for alteration in hydrocodone exposure and effect should be considered when NEURONTIN is started or discontinued in a patient taking hydrocodone.

Morphine

When gabapentin is administered with morphine, patients should be observed for signs of CNS depression, such as somnolence, sedation and respiratory depression .

Maalox® (Aluminum Hydroxide, Magnesium Hydroxide)

The mean bioavailability of gabapentin was reduced by about 20% with concomitant use of an antacid (Maalox®) containing magnesium and aluminum hydroxides. It is recommended that gabapentin be taken at least 2 hours following Maalox administration [see CLINICAL PHARMACOLOGY].

Drug/Laboratory Test Interactions

Because false positive readings were reported with the Ames N-Multistix SG® dipstick test for urinary protein when gabapentin was added to other antiepileptic drugs, the more specific sulfosalicylic acid precipitation procedure is recommended to determine the presence of urine protein.

For more pain and pain relief articles, please check here.

Where to buy Neurontin?

You can buy Neurontin at any drug store, if you have a prescription. But if you want to save your money, the best variant for you is to buy Neurontin or generic Neurontin (Gabapentin) from an online pharmacy.

Our online pharmacy offers you to buy original Neurontin and its high quality generics at much lower prices. Generics of Neurontin are significantly cheaper in comparison with the brand medicine.

Why should you pay for the brand name, if first of all you need a high quality treatment?

Do not waste your time and money, buy generic Neurontin from our online pharmacy and start the treatment. We also offer special discounts on big orders and in repeated orders.

If you have some difficulties ordering Neurontin from our online pharmacy, at your disposal there is a free consultation of our pharmacist available 24 hours a day, 7 days a week.

Neurontin (Gabapentin): review of the medicine

Neurontin is a medicine based on the active substance Gabapentin. Gabapentin is is a pharmaceutical medicine that was originally developed for the treatment of epilepsy, but currently it is widely used to relieve pain, neuropathic pain, however in combined therapy of epilepsy, it is also used.

Neurontin is a trade mark that is owned by Pfizer company.

Gabapentin is also manufactured and marketed by other pharmaceutical companies all over the world. However it can not be marketed under the brand name Neurontin, so you can find many other medicines having absolutely the same compound, effect and safety level as Neurontin, some of those medicines are: Fanatrex, Gabarone, Gralise, Nupentin. All of these medicines are called “generics of Neurontin”.

These medicines, as they are less advertised, are much cheaper than Neurontin. However they can be hardly found at local drug stores, the only option you have, if you want to save your money and receive a high quality medicine, is to buy generic

Neurontin at our online pharmacy, which guarantees you the highest quality of the medicine, and affordable price at the same time.

When Neurontin (Gabapentin) is prescribed?

Neurontin is prescribed for the treatment of the following conditions in adults and children over 3 years:

Various forms of epilepsy. Usually doctors prescribe prescribe Neurontin for patients to help them to treat your epilepsy when a current treatment is not fully controlling his/her condition. Neurontin is used as addition to the main treatment of epilepsy.

Peripheral neuropathic pain (long lasting pain caused by damaged nerves). This disease can occur and develop in various conditions: injury, diabetes, shingles, and others.

Your doctor may prescribe you Neurontin for the treatment of other diseases, if he thinks that it is a right medicine for your case.

Before you start the treatment with Neurontin

When your doctor prescribes you Neurontin, you should necessarily inform him about the following:

  • If you are hypersensitive to Gabapentin
  • If you have any allergy
  • If you have any chronic or acute disease
  • If you are on haemodialysis
  • If you are taking some other medicines at the moment
  • If you are pregnant, breastfeeding, or plan to become pregnant or breastfeed in near future

Pharmaceutical form of Neurontin (Gabapentin)

Capsules

Neurontin is supplied in a form of capsules by 100 mg, 300 mg or 400 mg of Gabapentin.

Capsules also contain lactose monohydrate, maize starch, talc, gelatin, purified water, and sodium lauryl sulphate.

Film-Coated Tablets

Neurontin is supplied in a form of film-coated tablets by 600 mg or 800 mg of Gabapentin.

Tablets of Neurontin also contain poloxamer 407 (ethylene oxide and propylene oxide), copovidone, maize starch and magnesium stearate, opadry white YS-1-18111 (hydroxypropylcellulose, talc), candelilla wax.

Oral solution

Neurontin oral solution if supplied in bottles containing 470 ml.

Dosage of Neurontin and special recommendations

For the treatment of postherpetic neuralgia in adults, the following daily dosage is prescribed: a single 300mg dose of Neurontin on Day 1, 600 mg/day on Day 2 (divided in 2 intakes), and 900 mg day on Day 3 (divided in 3 intakes). If the effect of Neurontin is insufficient, the daily dose may be gradually increased to 1800 mg (divided in 3 intakes).

Clinical studies show that the most effective and optimal daily dosage is 1800 mg daily, doses exceeding this amount do not show improvement of the effect achieved by the daily dose of 1800 mg.

For the treatment of epilepsy, Neurontin is used in different doses for children over 3 years and for adults, the daily dose of Neurontin for adults and children over 12 years is: from 900 to 1800 mg/day taken in divided doses (three times a day), using 300 or 400 mg capsules, or 600 or 800 mg tablets. The starting dose is 300 mg three times a day.

If necessary, the daily dose may be increased using 300 or 400 mg capsules, or 600 or 800 mg tablets three times a day up to 1800 mg/day. The interval between the previous dose and increased dose should be no less than 12 hours.

For the treatment of epilepsy in children under 12 years the following dosage is prescribed: the starting dose should range from 10–15 mg/kg/day, the dose should be divided in 3 doses. In order to find the correct dose, it is recommended to increase the dose gradually in 3 days.

The optimal dose of Neurontin in patients of 5 years and older is 25–35 mg/kg/day, the maximum dose is 40mg of Neurontin taken in 3 intakes. Neurontin in children can be administered as the oral solution, capsule, or tablet, or using combinations of these formulations.

Patients with diabetes and acute renal failure should take reduced doses of Neurontin.

Contraindications for Neurontin (Gabapentin) use:

Neurontin is contraindicated to:

  • children under 3 years
  • people suffering from pancreatitis
  • people suffering from generalized epileptic seizures.

Side effects of Neurontin (Gabapentin)

As any medicine, Neurontin may cause the occurrence of some side effects, however the following side effects were noticed in less than 2% of patients:

  • belly pain
  • diarrhea
  • dry mouth
  • bad sleep

If you experience some of these side effects, or some other side effects, you should reduce the daily dose and consult your doctor right away.

What Gabapentin is used for?

Posted on  by admin

Lots of people, including adults and children, suffer from various epileptic disorders. Such conditions can be inherited or develop due to certain factors. The most bothering thing about such disorders is convulsions (or seizures) and pain, that usually occur when certain chemicals in a patient’s brain become unbalanced. To cope with such problems patients are often prescribed anti-epileptic medications. Gabapentin is a very effective medicine that is quite often used in treating epileptic conditions.

You may buy gabapentin for the treating of seizures caused by epilepsy. This medicine acts by affecting certain chemicals in the brain and nerves in the body that cause convulsions and pain.

You may think of buying gabapentin for the treating of an epileptic disorder in your child if s/he is at least 3 years of age. For such purposes the medicine is usually used in combination with other meds.

You can also purchase gabapentin to treat nerve pain that is caused by shingles or herpes virus. The med may also be used for the treating of restless leg syndrome.

Where can a patient purchase gabapentin?

If your doctor advised you to use this med, you should decide whether to buy gabapentin online or at a regular drug store.

Actually, there is no difference in quality of meds that are for sale at regular and online pharmacies, but there are some differences in quality of regular and online shopping. For instance, when you shop online, you have an opportunity to buy medications at lower prices than at regular drug stores.

What’s more, you can enjoy such options as round-the-clock service, fast delivery, discounts and special offers. Buying meds online means a lot of saved time and money.

But no matter what way of purchasing meds you will choose, it is strongly recommended to learn some information about the medicine you need. You can find a lot of important facts about gabapentin on the pages of this website.

eurontin information

Posted on  by admin

You can Buy Generic Neurontin from any online source that is a reputed internet medicine store. This will help you get the most deserved discounts and it will surely help you save some pennies.

If you feel that there are more problems after starting the medication and you want to stop the same then ask your doctor first. Never leave the medication course in between with out consulting the doctor.

You should take doses properly and daily as mentioned by the doctor. If you skip the doses in between then perhaps the effectiveness of the medication treatment may be reduced and there would be relapse of symptoms.

You may have to undergo a few blood tests and health check up sessions when you are on Neurontin. This is important if you have to take medication for longer duration.

You should never miss out the dose. If by mistake you forget taking one dose then take it as and when you remember. But if it is time for the next dose then take only one dose at that time.

Even though you buy this medication from apt sources and you have surety of quality, some side effects with this medication are always there. This happens with almost all the medications that are available in the market.

Some people face less number of side effects while some patients have more side effects with some medications. Some of the most common side effects of this medication include fatigue, nausea, dizziness, headache, agitation and loss of appetite.

Just like you should have information about side effects you also be very clear about drug interactions that may come up.

Following are some of the drugs that would interact with Neurontin:

  • Hydrocodone
  • Morphine
  • Naproxen
  • HIV medications
  • Blood pressure medications
  • Heart medications
  • Pain relief medications
  • Warfarin
  • Cholesterol medications
  • Kidney and Liver medications
  • Asthma medications
  • COPD medications

However, this is not a complete list. There are many other drugs that would create drug interactions in combination with Neurontin.

You must tell your healthcare provider about all the medications that you take. This includes even the vitamin supplements and herbal items. You should be very cautious to start new prescription or over the counter medications.

You must avoid taking an antacid within a couple of hours before as well as after you take Generic Neurontin.

It is still not known that whether this medication can be taken safely by pregnant women or not. But still, it is vital that you tell the doctor about pregnancy and plans to become pregnant so that he can guide you over the issue. This medication can get into the blood and via that into the breast milk. Thus females who are nursing mothers should avoid generic Neurontin or Neurontin.

You should ask your doctor about all the instructions that are required to be followed when he tells you to buy this medication. You should ask about all the doubts that you have. You must also read the instruction list that comes with the medication.

Gabapentin Side Effects & Warnings

Neurontin is a reputed medication that helps in treating epilepsy and symptoms of the same. It is also important to note that some doctors prescribe other medications also along with Neurontin so as to get effective treatment for the problem.

It is important to note that Neurontin Gabapentin is used in youngsters as well to cure nerve pain which is caused by shingles or herpes virus.

You can buy generic Neurontin (Gabapentin) from any online source that is a reputed internet medicine store. This will help you get the most deserved discounts and it will surely help you save some pennies.

Even though you buy this medication from apt sources and you have surety of quality, some side effects with this medication are always there.

This happens with almost all the medications that are available in the market. Some people face less number of side effects while some patients have more side effects with some medications. Thus like every other medication even generic Neurontin comes with this package.

Here is vital info about side effects of generic Neurontin or Neurontin

People who may have allergy of the ingredients present in Neurontin may have some problems like swollen glands, hives, swelling of face and problems in breathing.
Some patients may come across severe side effects like:

  • increased problem of seizures
  • Body pain
  • Flu
  • Fever
  • Skin rashes
  • Bleeding
  • Skin peeling
  • Loss of appetite
  • Dark stool
  • Dark urine
  • Jaundice
  • Worsening of cough
  • Urination problems
  • Vision problems etc

Less serious Neurontin side effects may include:

  • Dizziness
  • Constipation
  • Abdominal discomfort
  • Breast swelling
  • Nausea
  • Fatigue
  • Dry mouth
  • Headache

Children may be highly prone to side effects like agitation, memory problems, aggression, changes in behavior etc.

There may be many other side effects that some people may come across. These may be unusual, intense or those creating discomfort to a higher extent.

You should take doses properly and daily as mentioned by the doctor. If you skip the doses in between then perhaps the effectiveness of the medication treatment may be reduced and there would be relapse of symptoms.

You may have to undergo a few blood tests and health check up sessions when you are on Neurontin. This is important if you have to take medication for longer duration.

You should also know about the effects that may come up on account of an over dose. These may include persistent sweating, imbalance, vision disturbance etc.

You must also keep an account of drug interaction information that your doctor may give. You should be very cautious when you have to start some new medication.

You should ask your doctor about all the instructions that are required to be followed when he tells you to buy this medication. You should ask about all the doubts that you have. You must also read the instruction list that comes with the medication.

It is also important to note that some doctors prescribe other medications also along with Neurontin so as to get effective treatment for the problem. You should ask him if you have any doubts in mind.

Uses for Gabapentin

Neurontin is a medication that is available these days for the purpose of treating problems in relation to epilepsy. It is an anticonvulsant medication that helps you in controlling seizure symptoms. In case when you need to buy this medication, you can do that online. But you should be cautious when you buy it.

Buy this from a reputed online pharmacy store. When you take generic Neurontin there will be a cost benefit as available to you. But make sure you know that how you should take this medication and all the precautions that you need to take.

When you are on Gabapentin or Neurontin you should wear an ID card having personal info and your physicians contact number. In case of any serious complication in an emergency there can be some help that can be demanded.

Gabapentin Usage

You should use Gabapentin exactly as per your doctors advice. You should report him in case when you have some allergic reactions like hives, skin rashes and breathing problems. You should also tell your doctor if there are any side effects.

Patients having heart diseases, liver diseases and kidney diseases should be very much cautious when this medication is used. It should be taken only with doctors instructions and also there should be some amount of special medical attention that will be needed.

It is important to note that Gabapentin may give you suicidal thoughts and this can happen and you should therefore be in touch with your doctor when this medication is going on.

If you feel that the problems have worsened and there is depression, agitation, anxiety and seizures you must immediately tell your doctor about this. He may have to change the dose or at least change the medication.

It is up to the care givers to give extra attention to patients going through this phase and who are on Generic Neurontin.

It is still not known that whether this medication can be taken safely by pregnant women or not. But still, it is vital that you tell the doctor about pregnancy and plans to become pregnant so that he can guide you over the issue.

This medication can get into the blood and via that into the breast milk. Thus females who are nursing mothers should avoid generic Neurontin or Neurontin.

You should ask your doctor about all the instructions that are required to be followed when he tells you to buy this medication. You should ask about all the doubts that you have. You must also read the instruction list that comes with the medication.

It is also important to note that some doctors prescribe other medications also along with Neurontin so as to get effective treatment for the problem. It is vital to know that this epilepsy medication is not apt for children below3 years of age. The combination drugs with Neurontin are apt for children who are above 12 years of age.

If you are aware of the mentioned precautions you can take safe steps for treatment.

This medication may create a few risks for patients who are already suffering from problems like kidney, liver or heart problems. Thus if you have any such problems or you are tasking any medication in relation to these disorders then you should tell this to your doctor in advance.

You should be very specific about the scheduled appointments. Make sure that you check your doctor regularly and this is something for your safety.

If after starting the medication you feel that the problems have worsened then in that case you should be quite cautious. You should tell about this to the doctor and he will take the required action that may be needed.

 

How does Gabapentin Work ?

Gabapentin is a medicine that may be used for the treatment of certain seizure disorders or nerve pain.

Neurontin (gabapentin) is an anti-epileptic medication used to treat seizures. Neurontin is used alone or in combination with other medications to treat seizures caused by epilepsy in adults and children who are at least 12 years old. Neurontin is also used to treat nerve pain caused by shingles (herpes zoster).

The active ingredient in NEURONTIN capsules, tablets, and oral solution is gabapentin,which has the chemical name 1-(aminomethyl)cyclohexaneacetic acid.

The molecular formula of gabapentin is C9H17NO2 and the molecular weight is 171.24. The structural formula of gabapentin is:

NEURONTIN® (gabapentin) - Structural Formula Illustration

Gabapentin is a white to off-white crystalline solid with a pKa1 of 3.7 and a pKa2 of 10.7. It is freely soluble in water and both basic and acidic aqueous solutions. The log of the partition coefficient (noctanol/ 0.05M phosphate buffer) at pH 7.4 is –1.25.

Each Neurontin capsule contains 100 mg, 300 mg, or 400 mg of gabapentin and the following inactive ingredients: lactose, cornstarch, talc, gelatin, titanium dioxide, FD&C Blue No. 2, yellow iron oxide (300 mg and 400 mg only), and red iron oxide (400 mg only).

Each Neurontin tablet contains 600 mg or 800 mg of gabapentin and the following inactive ingredients: poloxamer 407, copovidone, cornstarch, magnesium stearate, hydroxypropyl cellulose, talc, and candelilla wax

Neurontin oral solution contains 250 mg of gabapentin per 5 mL (50 mg per mL) and the following inactive ingredients: glycerin, xylitol, purified water, and artificial cool strawberry anise flavor.

How gabapentin works
How gabapentin works

Experts aren’t sure exactly how gabapentin works, but research has shown that gabapentin binds strongly to a specific site (called the alpha2-delta site) on voltage-gated calcium channels. This action is thought to be the mechanism for its nerve-pain relieving and anti-seizure properties.

Gabapentin  (brand name Horizant) is a prodrug of gabapentin which has been designed to overcome the limitations of gabapentin, such as poor absorption and a short duration of action. Gabapentin enacarbil is effective for restless legs syndrome (RLS) and postherpetic neuralgia (nerve pain that occurs following Shingles).

Gabapentin belongs to the group of medicines known as anticonvulsants.