Tag: Neuropathic pain

Gabapentin 100mg, Ascend Laboratories, 216 Pill – white capsule/oblong, 14mm

Pill with imprint 216 is White, Capsule/Oblong and has been identified as Gabapentin 100 mg. It is supplied by Ascend Laboratories, LLC.

Gabapentin is used in the treatment of Back Pain; Postherpetic Neuralgia; Epilepsy; Chronic Pain; Seizures and belongs to the drug class gamma-aminobutyric acid analogs. Risk cannot be ruled out during pregnancy. Gabapentin 100 mg is not a controlled substance under the Controlled Substances Act (CSA).

Gabapentin

Imprint
216
Strength
100 mg
Color
White
Size
14.00 mm
Shape
Capsule/Oblong
Availability
Prescription only
Drug Class
Gamma-aminobutyric acid analogs
Pregnancy Category
C – Risk cannot be ruled out
CSA Schedule
Not a controlled drug
Labeler / Supplier
Ascend Laboratories, LLC
Inactive Ingredients
corn starch, lactose anhydrous, magnesium silicate, gelatin, sodium lauryl sulfate, titanium dioxide

Note: Inactive ingredients may vary.

Labelers / Repackagers

NDC Code Labeler / Repackager
67877-0222 Ascend Laboratories LLC
16714-0503 NorthStar Rx LLC

What Is Gabapentin and What I should Know Before I Buy Gabapentin Online ?

Gabapentin is a prescription medication primarily used to treat epilepsy, neuropathic pain, and restless legs syndrome (RLS). It belongs to a class of drugs known as anticonvulsants. Here’s a more detailed look at its uses and mechanisms:

  1. Uses:
    • Seizure Management: Gabapentin is used as an adjunctive therapy to reduce the frequency of partial-onset seizures in adults and children aged three and older.
    • Neuropathic Pain: It is commonly prescribed for the management of neuropathic pain, such as postherpetic neuralgia (pain following shingles).
    • Restless Legs Syndrome (RLS): Gabapentin enacarbil, a prodrug of gabapentin (brand name Horizant), is used to treat moderate-to-severe RLS.
    • Off-Label Uses: Gabapentin may also be used off-label for conditions like fibromyalgia, persistent hiccups, migraine prevention, and hot flashes.
  2. Mechanism of Action:
    • While the exact mechanism is not fully understood, gabapentin is thought to work by modulating the activity of certain neurotransmitters in the brain and affecting the way the nervous system transmits pain signals.

What You Should Know Before Buying Gabapentin Online

  1. Prescription Requirement:
    • Gabapentin is a prescription medication, meaning it legally requires a doctor’s prescription. Always ensure you have a valid prescription before purchasing it online.
  2. Source Legitimacy:
    • Only buy gabapentin from reputable online pharmacies. Verify that the pharmacy is licensed and requires a prescription for purchase. Look for certifications like the Verified Internet Pharmacy Practice Sites (VIPPS) seal in the U.S.
  3. Potential Risks:
    • Side Effects: Common side effects include dizziness, drowsiness, tiredness, fever, and nystagmus (rapid, uncontrollable eye movements). Gabapentin can also cause behavioral changes in children, blurred vision, dry mouth, peripheral edema, tremor, and gastrointestinal disturbances.
    • Mental Health Risks: Gabapentin may increase the risk of depression and suicidal thoughts, particularly in young adults under 24 years old.
    • Withdrawal Symptoms: Abruptly stopping gabapentin can lead to withdrawal symptoms such as anxiety, insomnia, nausea, pain, and sweating. It should be tapered off slowly under a doctor’s guidance.
    • Drug Interactions: Gabapentin can interact with other medications, including antacids, hydrocodone, morphine, and other drugs that cause sedation or dizziness. It may also cause false-positive results on some urinary protein tests.
  4. Dosage Adjustments:
    • The dosage of gabapentin needs to be adjusted for individuals with kidney disease. Always follow your doctor’s instructions regarding dosage.
  5. Quality and Authenticity:
    • Be cautious of counterfeit medications. Authentic gabapentin should come from a reliable source, and the packaging should be intact with proper labeling.
  6. Misuse and Abuse Potential:
    • Gabapentin has been associated with misuse and abuse, particularly in individuals with a history of drug abuse. Be mindful of this potential and use the medication only as prescribed.
  7. Cost and Insurance:
    • Check if the online pharmacy accepts your insurance or offers competitive pricing. Compare prices from different legitimate sources to ensure you are getting a fair deal.

Ascend Laboratories

Ascend Laboratories is a pharmaceutical company that specializes in the development, manufacturing, and distribution of generic pharmaceuticals. Ascend Laboratories, as a subsidiary of Alkem Laboratories, plays a significant role in the generic pharmaceutical industry. With a strong focus on quality, regulatory compliance, and affordability, Ascend Laboratories continues to expand its presence in the U.S. market. The company’s commitment to sustainable practices and community engagement further underscores its dedication to improving healthcare access and quality of life for patients.

 

Here is an overview of Ascend Laboratories:

Company Overview

  1. Headquarters:
    • Location: Montvale, New Jersey, USA.
  2. Parent Company:
    • Alkem Laboratories: Ascend Laboratories is a wholly-owned subsidiary of Alkem Laboratories, a leading Indian pharmaceutical company that is known for its wide range of generic medicines and active pharmaceutical ingredients (APIs).

Operations and Facilities

  1. Manufacturing:
    • Ascend Laboratories benefits from the extensive manufacturing network of Alkem Laboratories, which includes facilities in India and the United States. These facilities are designed to meet stringent regulatory standards set by agencies like the U.S. Food and Drug Administration (FDA), the European Medicines Agency (EMA), and other global health authorities.
  2. Product Development:
    • The company focuses on developing high-quality generic medications across various therapeutic areas. The product development process involves rigorous research, formulation, and testing to ensure that the generics are bioequivalent to their branded counterparts.

Product Portfolio

  1. Generics:
    • Ascend Laboratories offers a broad range of generic pharmaceuticals covering multiple therapeutic categories, including cardiovascular, central nervous system, anti-infective, gastrointestinal, and pain management drugs.
    • The company’s products are known for their affordability and quality, making essential medications accessible to a wider patient population.
  2. OTC Products:
    • In addition to prescription medications, Ascend Laboratories also offers over-the-counter (OTC) products that address common health concerns.

Key Areas of Operation

  1. Regulatory Compliance:
    • Quality Assurance: Ascend Laboratories adheres to rigorous quality control measures and regulatory requirements to ensure the safety, efficacy, and quality of its products.
    • GMP Compliance: The company’s manufacturing processes comply with Good Manufacturing Practices (GMP), ensuring that all products meet high standards of quality.
  2. Market Strategy:
    • Product Launches: The company focuses on the timely introduction of generic medications to the market, providing affordable options as patents for branded drugs expire.
    • Competitive Pricing: Ascend’s pricing strategy ensures that its products remain affordable without compromising on quality.
  3. Distribution Networks:
    • Ascend Laboratories has established robust distribution networks that ensure the widespread availability of its products across the United States.

Strategic Growth

  1. Acquisitions and Partnerships:
    • Ascend Laboratories leverages the global presence and expertise of Alkem Laboratories to expand its market reach through strategic acquisitions and partnerships.
    • The company continuously seeks opportunities to enhance its product portfolio and enter new markets.
  2. Innovation:
    • The company is committed to innovation in generic pharmaceuticals, focusing on developing complex generics and novel drug delivery systems to address unmet medical needs.

Corporate Responsibility

  1. Sustainability:
    • Ascend Laboratories is committed to sustainable business practices, including minimizing environmental impact through efficient resource use and waste management.
  2. Community Engagement:
    • The company engages in corporate social responsibility (CSR) initiatives aimed at improving healthcare access, supporting education, and contributing to the well-being of the communities it serves.

 

I Want to Buy Gabapentin, What Should I know Before I see A doctor ?

If you’re considering gabapentin, it’s important to consult with a doctor beforehand. Here are some key points to consider before your appointment:

  1. Medical History: Be prepared to discuss your medical history with your doctor, including any past or current conditions, medications you’re taking, and any allergies you may have.
  2. Reason for Use: Be ready to explain why you believe gabapentin may be necessary for your health. Whether it’s for epilepsy, neuropathic pain, or another condition, your doctor will need to understand your symptoms and medical needs.
  3. Potential Side Effects: Familiarize yourself with the potential side effects of gabapentin. These can include dizziness, drowsiness, and coordination problems. Understanding the possible risks can help you make an informed decision.
  4. Interactions: Gabapentin can interact with other medications, including over-the-counter drugs and supplements. Make sure to inform your doctor of all medications you’re taking to avoid any potential interactions.
  5. Dosage and Administration: Your doctor will determine the appropriate dosage of gabapentin based on your condition and medical history. Be prepared to discuss dosing instructions and how to take the medication correctly.
  6. Monitoring: Your doctor may recommend regular check-ups to monitor your progress and adjust your treatment plan if necessary. It’s important to follow up with your doctor as directed to ensure the medication is working effectively and safely.
  7. Pregnancy and Breastfeeding: If you are pregnant, planning to become pregnant, or breastfeeding, discuss this with your doctor. Gabapentin may not be suitable during pregnancy or while breastfeeding, and your doctor can advise you on the best course of action.
  8. Alternative Treatments: Explore alternative treatments or therapies that may be available for your condition. Your doctor can help you weigh the benefits and risks of gabapentin compared to other options.

By discussing these points with your doctor, you can ensure that gabapentin is the right choice for you and that you understand how to use it safely and effectively.

 

 

Gabapentin 100 mg IG321 Pill InvaGen Pharmaceuticals, Inc. – white capsule/oblong, 16mm

Pill with imprint 100 mg IG321 is White, Capsule/Oblong and has been identified as Gabapentin 100 mg. It is supplied by InvaGen Pharmaceuticals, Inc.

Gabapentin is used in the treatment of Back Pain; Postherpetic Neuralgia; Epilepsy; Chronic Pain; Seizures and belongs to the drug class gamma-aminobutyric acid analogs. Risk cannot be ruled out during pregnancy. Gabapentin 100 mg is not a controlled substance under the Controlled Substances Act (CSA).

Images for 100 mg IG321

Gabapentin 100 mg IG321

Imprint
100 mg IG321
Strength
100 mg
Color
White
Size
16.00 mm
Shape
Capsule/Oblong
Availability
Prescription only
Drug Class
Gamma-aminobutyric acid analogs
Pregnancy Category
C – Risk cannot be ruled out
CSA Schedule
Not a controlled drug
Labeler / Supplier
InvaGen Pharmaceuticals, Inc.
National Drug Code (NDC)
31722-0221
Inactive Ingredients
mannitol, corn starch, magnesium silicate, FD&C Red No. 40, D&C Yellow No. 10, titanium dioxide

Note: Inactive ingredients may vary.

What is Gabapentin ?

Gabapentin is a medication primarily used to treat epilepsy and neuropathic pain. It is also commonly prescribed for other conditions such as restless legs syndrome (RLS) and certain anxiety disorders. Here is a detailed overview of gabapentin:

Mechanism of Action

Gabapentin’s exact mechanism of action is not completely understood, but it is known to interact with the α2δ subunit of voltage-gated calcium channels in the central nervous system. This interaction reduces the release of excitatory neurotransmitters, which helps to stabilize neuronal activity and alleviate symptoms associated with neuropathic pain and seizures.

Therapeutic Uses

  • Epilepsy: Gabapentin is used as an adjunctive therapy in the treatment of partial seizures with or without secondary generalization in adults and children over the age of 3.
  • Neuropathic Pain:Effective in managing pain from conditions such as diabetic neuropathy, postherpetic neuralgia (pain following shingles), and other forms of nerve pain.
  • Restless Legs Syndrome (RLS):Gabapentin can help reduce the symptoms of RLS, improving sleep quality and reducing leg discomfort.
  • Anxiety Disorders:Sometimes used off-label for the treatment of anxiety disorders, including generalized anxiety disorder (GAD) and social anxiety disorder (SAD).
  • Fibromyalgia:Can be used to manage the chronic pain associated with fibromyalgia.
  • Seizure Management: Gabapentin may be used alongside other medications to reduce seizure frequency in adults and children aged three and older who experience partial-onset seizures.
  • Postherpetic Neuralgia: In adults, gabapentin is effective for managing postherpetic neuralgia, which is persistent nerve pain following a Shingles infection.
  • Horizant (Gabapentin Enacarbil): This long-acting prodrug of gabapentin is taken once daily, usually around 5 PM, to relieve restless legs syndrome (RLS) or nerve pain associated with postherpetic neuralgia.
  • Generic Availability: Gabapentin is available in generic forms, though not all generics are interchangeable with some branded versions.
  • Off-Label Uses: Gabapentin may also be prescribed off-label for conditions such as fibromyalgia, persistent hiccups, migraine prevention, and hot flashes. Different brands and formulations of gabapentin exist, each with specific uses and dosing instructions.
  • Neurontin: Used to treat pain from shingles (postherpetic neuralgia) and, when combined with other seizure medications, treats partial-onset seizures in adults and children over three years old.
  • Gralise: Specifically designed for treating postherpetic neuralgia and should not be used for other conditions.
  • Horizant: An extended-release tablet intended for restless legs syndrome and postherpetic neuralgia.
  • Generic Gabapentin Capsules: Used for treating postherpetic neuralgia and as an additional therapy for partial-onset seizures in adults and children over three years old.

Pharmacokinetics

  1. Absorption:
    • Gabapentin is absorbed from the gastrointestinal tract, with peak plasma concentrations occurring within 2 to 3 hours after oral administration. Its bioavailability decreases as the dose increases.
  2. Distribution:
    • Widely distributed throughout the body but does not significantly bind to plasma proteins.
  3. Metabolism:
    • Unlike many other medications, gabapentin is not significantly metabolized in the liver.
  4. Elimination:
    • Excreted unchanged by the kidneys. The half-life of gabapentin is about 5 to 7 hours in individuals with normal renal function.

Side Effects

Common side effects of gabapentin include:

  • Dizziness
  • Drowsiness
  • Peripheral edema (swelling of the extremities)
  • Fatigue
  • Ataxia (lack of coordination)
  • Nystagmus (involuntary eye movement)

Less common but more serious side effects can include:

  • Mood changes such as depression or anxiety
  • Suicidal thoughts or behaviors
  • Severe allergic reactions (rare)

Dosage

Gabapentin is available in various forms, including capsules, tablets, and an oral solution. Dosage depends on the condition being treated and individual patient factors, but it typically starts at a low dose and is gradually increased. Common dosing regimens include:

  • Epilepsy: Starting at 300 mg once daily and increasing based on response.
  • Neuropathic Pain: Starting at 100-300 mg once daily and titrating up as needed.
  • RLS: Typically 600 mg once daily in the evening.

Drug Interactions

Gabapentin has relatively few drug interactions compared to many other medications, but it can interact with:

  • Antacids (reduce gabapentin’s absorption)
  • CNS depressants (increased risk of sedation and respiratory depression)

InvaGen Pharmaceuticals, Inc

InvaGen Pharmaceuticals, Inc. is a generic pharmaceutical company that develops, manufactures, and markets a wide range of affordable and high-quality generic medications. It is a subsidiary of the global pharmaceutical company, Cipla Ltd., based in India. Here is an overview of InvaGen Pharmaceuticals, Inc.:

Company Overview

  1. Parent Company:
    • Cipla Ltd.: InvaGen Pharmaceuticals is a subsidiary of Cipla Ltd., a leading global pharmaceutical company headquartered in Mumbai, India. Cipla is known for its commitment to providing access to affordable and high-quality medicines.
  2. Headquarters:
    • Location: Hauppauge, New York, USA.

Operations and Facilities

  1. Manufacturing:
    • InvaGen Pharmaceuticals operates manufacturing facilities that are designed to comply with stringent regulatory standards, including those of the U.S. Food and Drug Administration (FDA).
    • The company’s facilities are equipped with advanced technology and have significant production capacities to meet both domestic and international demand.
  2. Research and Development:
    • InvaGen focuses on research and development to bring new generic formulations to market and improve existing products.
    • The company’s R&D efforts are aimed at ensuring the highest standards of product quality, safety, and efficacy.

Product Portfolio

  1. Generics:
    • InvaGen Pharmaceuticals offers a diverse range of generic medications across various therapeutic categories, including cardiovascular, central nervous system, anti-infective, gastrointestinal, and pain management drugs.
    • The company provides cost-effective generic alternatives to brand-name medications, making them accessible to a broader patient population.

Key Areas of Operation

  1. Regulatory Compliance:
    • Quality Assurance: InvaGen adheres to rigorous quality control measures and regulatory requirements set by the FDA and other global regulatory bodies.
    • GMP Compliance: The company ensures that its manufacturing processes comply with Good Manufacturing Practices (GMP) to guarantee the safety, efficacy, and quality of its products.
  2. Market Strategy:
    • Product Launches: InvaGen focuses on the timely launch of generic medications to capture market share and provide affordable options to patients.
    • Competitive Pricing: The company’s competitive pricing strategy ensures that its products are accessible to a broad patient population.
  3. Partnerships and Collaborations:
    • Expansion: InvaGen pursues strategic partnerships and collaborations to enhance its product offerings and expand its market reach.
    • Distribution Networks: The company has established robust distribution networks to ensure the widespread availability of its products.

Strategic Growth

  1. Acquisitions and Investments:
    • Cipla Ltd.’s acquisition of InvaGen Pharmaceuticals has strengthened Cipla’s presence in the U.S. market and expanded its global footprint.
    • Ongoing investments in manufacturing and R&D facilities ensure that InvaGen remains at the forefront of the generic pharmaceutical industry.
  2. Innovation:
    • InvaGen continues to invest in the development of complex generics and novel drug delivery systems to address unmet medical needs and provide innovative solutions for patients.

Corporate Responsibility

  1. Sustainability:
    • The company is committed to sustainable manufacturing practices, focusing on minimizing its environmental impact through efficient resource use and waste management.
  2. Community Engagement:
    • InvaGen participates in various corporate social responsibility (CSR) initiatives aimed at improving healthcare access, supporting education, and contributing to community development.

Gabapentin 800mg – G 13 Pill, Glenmark Generics Inc. – white oval, 19mm

Pill with imprint G 13 is White, Oval and has been identified as Gabapentin 800 mg. It is supplied by Glenmark Generics Inc.

Gabapentin is used in the treatment of Back Pain; Postherpetic Neuralgia; Epilepsy; Chronic Pain; Seizures and belongs to the drug class gamma-aminobutyric acid analogs. Risk cannot be ruled out during pregnancy. Gabapentin 800 mg is not a controlled substance under the Controlled Substances Act (CSA).

Gabapentin

Imprint
G 13
Strength
800 mg
Color
White
Size
19.00 mm
Shape
Oval
Availability
Prescription only
Drug Class
Gamma-aminobutyric acid analogs
Pregnancy Category
C – Risk cannot be ruled out
CSA Schedule
Not a controlled drug
Labeler / Supplier
Glenmark Generics Inc.
Inactive Ingredients
corn starch, copovidone, poloxamer 407, magnesium stearate, titanium dioxide, magnesium silicate, polysorbate 80, water

Note: Inactive ingredients may vary.

Labelers / Repackagers

NDC Code Labeler / Repackager
68462-0127 Glenmark Pharmaceuticals Inc.
54868-5195 (Discontinued) Physicians Total Care Inc. (repackager)

What is Gabapentin and How to Use it ?

Gabapentin is a medication primarily used to treat seizures (epilepsy) and nerve pain (neuropathic pain). It belongs to a class of medications known as anticonvulsants or antiepileptic drugs. Gabapentin works by affecting certain chemicals and neurotransmitters in the brain involved in seizures and nerve pain.

Here’s how gabapentin is typically used:

  1. Seizures (Epilepsy): Gabapentin is commonly prescribed as an adjunctive treatment for partial seizures in adults and children aged 3 years and older. It is often used in combination with other antiepileptic medications to help control seizures.
  2. Nerve Pain (Neuropathic Pain): Gabapentin is also frequently used to treat various types of nerve pain, including diabetic neuropathy, postherpetic neuralgia (nerve pain following shingles), and peripheral neuropathy. It is effective in relieving shooting or burning sensations, tingling, or numbness associated with nerve damage.

Gabapentin is usually taken orally in the form of capsules, tablets, or an oral solution. Here are some general guidelines for using gabapentin:

  1. Dosage: The dosage of gabapentin varies depending on the individual’s medical condition, age, and response to treatment. It’s essential to follow your doctor’s instructions and the dosage prescribed on the medication label carefully.
  2. Administration: Gabapentin is typically taken by mouth with or without food. Swallow the capsule or tablet whole with a full glass of water. Do not crush, chew, or break the tablet or capsule unless directed to do so by your doctor.
  3. Timing: Take gabapentin exactly as prescribed by your doctor. It’s important to take it regularly and at the same times each day to maintain a consistent level of the medication in your body.
  4. Gradual Dosing: If you are starting gabapentin treatment or increasing the dosage, your doctor may recommend starting with a low dose and gradually increasing it over time to minimize side effects.
  5. Duration of Treatment: Continue taking gabapentin for the full duration of treatment prescribed by your doctor, even if you start to feel better. Stopping gabapentin suddenly can increase the risk of seizures or other withdrawal symptoms.
  6. Monitor Side Effects: Pay attention to any side effects you may experience while taking gabapentin and report them to your doctor. Common side effects may include dizziness, drowsiness, fatigue, and weight gain.
  7. Storage: Store gabapentin at room temperature away from moisture and heat. Keep it out of reach of children and pets.

It’s important to note that gabapentin can interact with other medications, so it’s essential to inform your doctor about all the medications you are taking, including prescription drugs, over-the-counter medications, and supplements. Additionally, never adjust your gabapentin dosage or stop taking it without consulting your doctor first, as sudden changes can lead to serious complications.

Glenmark Generics Inc.

Glenmark Generics Inc. is a subsidiary of Glenmark Pharmaceuticals Ltd., an Indian multinational pharmaceutical company headquartered in Mumbai, India. Glenmark Generics focuses on developing, manufacturing, and distributing generic pharmaceutical products for the U.S. and other international markets. Here is a detailed overview of Glenmark Generics Inc.:

Company Overview

  1. Parent Company: Glenmark Pharmaceuticals Ltd.
    • Founded: 1977 by Gracias Saldanha.
    • Headquarters: Mumbai, Maharashtra, India.
    • Global Presence: Glenmark Pharmaceuticals operates in over 50 countries with a strong presence in North America, Europe, and Asia.
  2. Glenmark Generics Inc.:
    • Focus: Specializes in the development, manufacture, and distribution of generic pharmaceutical products.
    • Market: Primarily targets the U.S. market, one of the largest and most regulated pharmaceutical markets globally.
  3. Product Portfolio:
    • Generics: Glenmark Generics offers a wide range of generic medications across various therapeutic categories, including dermatology, respiratory, oncology, cardiovascular, and central nervous system (CNS) disorders.
    • Specialty Products: The company also works on developing specialty and complex generics, including injectables and inhalation products.
  4. Manufacturing and R&D:
    • Facilities: Glenmark has multiple manufacturing facilities in India and other countries that comply with international regulatory standards such as the U.S. Food and Drug Administration (FDA), European Medicines Agency (EMA), and others.
    • Research and Development: Significant investment in R&D to develop new generic formulations and improve existing ones. Glenmark has several R&D centers globally, including a notable facility in Mahape, Navi Mumbai.
  5. Regulatory Compliance:
    • Quality Standards: Glenmark Generics ensures adherence to stringent quality control and regulatory standards set by global regulatory bodies, including the FDA.
    • Inspections and Approvals: The company regularly undergoes inspections and audits to maintain compliance with Good Manufacturing Practices (GMP).
  6. Market Strategy:
    • Product Launches: Glenmark Generics is known for timely launches of first-to-file generic products, which can be highly profitable due to market exclusivity periods.
    • Competitive Pricing: Focus on providing cost-effective alternatives to brand-name medications, making healthcare more affordable.
  7. Acquisitions and Partnerships:
    • Glenmark Pharmaceuticals has expanded its generics business through strategic acquisitions and partnerships, enhancing its product portfolio and market reach.
  8. Corporate Responsibility:
    • Sustainability: Glenmark is committed to sustainable practices in its operations, focusing on environmental protection, efficient use of resources, and reducing its carbon footprint.
    • Community Engagement: The company engages in various corporate social responsibility (CSR) activities, including healthcare initiatives, education, and community development projects.

Key Achievements and Initiatives

  1. Innovation in Generics: Glenmark Generics has introduced several first-to-market generics, providing affordable alternatives to expensive brand-name drugs.
  2. Global Expansion: The company has significantly expanded its footprint in the U.S. and other international markets, establishing itself as a reputable player in the generic pharmaceuticals industry.
  3. R&D Excellence: With a strong focus on research and development, Glenmark has developed numerous complex generics and innovative drug delivery systems.

Conclusion

Glenmark Generics Inc., a subsidiary of Glenmark Pharmaceuticals Ltd., plays a crucial role in the global generics market, particularly in the U.S. With a broad product portfolio, rigorous regulatory compliance, and a strong commitment to quality and innovation, Glenmark Generics continues to be a significant contributor to making healthcare more accessible and affordable worldwide. The company’s ongoing efforts in research and development, along with strategic market strategies, position it well for continued growth and success in the pharmaceutical industry.

Gabapentin – Dosage information for RLS, Epilepsy and Postherpetic Neuralgia

The Gabapentin dosage differs in each individual depending upon the age of the person, current medical condition and patient’s tolerance to the medicine. This article will help you know about the general Gabapentin dosage information for RLS, Epilepsy and Postherpetic Neuralgia.

Again the dosage can differ thus you should take Gabapentin as recommended by your doctor.

Normal Dose for Epilepsy- In Adults

Initial dose: 300mg to be taken orally on first day

300 mg to be taken orally two times a day on the second day

300mg to be taken orally thrice a day on third day

Maintenance dose: 300-600mg to be taken orally thrice a day

Maximum dose: 3600mg to be taken orally daily in 3 split doses

Maximum time gap between doses in a schedule wherein the patient is taking the medicine thrice a day should not be more than 12 hours

Note:  Gabapentin can be taken with/without food

If you have not used the half tablets (broken) within 28 days after breaking, the tablet should be disposed.

Normal Dose for Postherpetic Neuralgia – In Adults

Initial dose: 300mg to be taken orally on first day

300 mg to be taken orally two times a day on the second day

300mg to be taken orally thrice a day on third day

The dosage can be adjusted as required

Maintenance dose: 1800mg/day (600mg to be taken orally three times a day)

Note: Gabapentin can be taken with/without food

If you have not used the half tablets (broken) within 28 days after breaking, the tablet should be disposed

Gabapentin available under the brand name GRALISE(R)

Maintenance dose: GRALISE(R) should be adjusted to 1800mg to be taken orally once in a day during meal.

Recommended dosage schedule

Day 1: 300 mg to be taken orally with meal in the evening

Day 2: 600 mg to be taken orally with meal in the evening

From Day 3 to day 6: 900 mg to be taken orally with meal in the evening

From Day 7 to day 10: 1200 mg to be taken orally with meal in the evening

From Day 11 to day 14: 1500 mg to be taken orally with meal in the evening

Day 15: 1800 mg to be taken orally with meal in the evening

Gabapentin (enacarbil extended release tablets) are sold under brand name HORIZANT (R)

The recommended dosage – 600 mg to be taken orally twice a day

Therapy should be started at a dose of 600mg to be taken orally in the morning till 3 days of therapy and can be increased up to 600mg to be taken twice a day and 1200 mg/day on fourth day.

Normal Dose for Restless Leg Syndrome- In Adults

600mg to be taken orally once daily during 5 PM with food

The medication is used to treat mild to severe RLS in adults

The above dosage information is general dosage information that can vary from person to person depending upon his/her medical condition and age. Your doctors can advice the right dose for you. [1]

Appropriate Gabapentin Dosing for Neuropathic Pain

Neuropathic pain is a chronic debilitating pain syndrome that is complex to treat. Current medication management for neuropathic pain includes select neuromodulating agents such as anticonvulsants, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and certain opioids.1,2 Gabapentin remains among the most commonly used anticonvulsants for neuropathic pain.

The established therapeutic dosing for gabapentin in neuropathic pain trials is 1800-3600 mg/day in 3 divided doses in patients with normal renal function.3 This means the minimum effective dose is 600 mg 3 times a day. Renal adjustments are recommended in patients with CrCl below 60 mL/min. For patients on dialysis, gabapentin can often be 3 times weekly following dialysis.4,5

Several cross-sectional studies have reported gabapentin being used in subtherapeutic doses among most patients.6-8 In a retrospective analysis of 939 patients with post-herpetic neuralgia, the mean daily dose of gabapentin was 826 mg.7 In another 2-year retrospective study of 151 veterans with various neuropathic pain syndromes, the median daily dose for gabapentin was 900 mg.8 In both studies, the most prevalent gabapentin dosing was half the therapeutic dosing.

The cornerstones of effective pharmacotherapy are the right patient, the right drug, and the right dose. If an analgesic medication is being used at a suboptimal dose, oftentimes a knee-jerk reaction is to add another analgesic for synergy.

While this may well be indicated under appropriate circumstances, it is inappropriate without maximizing the dose of each single agent with careful attention to dose titration in order to minimize toxicity of each add-on. Consider for example a patient who starts low dose gabapentin that was not properly titrated, returns for follow-up and is given an additional prescription for duloxetine for neuropathic pain since gabapentin “does not work,” assuming there are no tolerability issues. This adds to polypharmacy, increased costs, and the pain remains inadequately treated.

Pharmacists as medication experts can collaborate with prescribers to optimize the rational use of gabapentin in neuropathic pain. First, let’s take a look into the pharmacology of gabapentin.

Gabapentin is a gaba aminobutyric acid (GABA) analogue anticonvulsant but does not exhibit any significant agonistic effects at the GABA receptor.  Gabapentin inhibits the alpha-2-delta subunit of the N-type voltage-gated calcium channels. Receptor binding causes presynaptic inhibition of excitatory neurotransmitter release (i.e. glutamate) thereby attenuating neuropathic pain.

Gabapentin’s counterpart, pregabalin, shares the same mechanism of action but there are key pharmacologic differences between both medications. Gabapentin has saturable, non-linear absorption kinetics, where bioavailability decreases as the dose increases.

Following oral administration, gabapentin’s bioavailability is 60%, 47%, 34%, and 33%, following 900, 1200, 2400, and 3600 mg/day in 3 divided doses, respectively. On the other hand, pregabalin has ≥90% bioavailability irrespective of the dose, leading to more predictable kinetics. Pregabalin boasts a binding affinity for the alpha-2-delta receptor that is six times greater than that of gabapentin.

What Every Patient Should Know
Patients should be aware of the therapeutic dosing for neuropathic pain to establish realistic expectations and improve compliance and likelihood of remaining on therapy. The conversation may be as follows: “Gabapentin may reduce nerve pain at 600 mg 3 times a day but patients usually start on a low dose to make sure they tolerate it and is then increased slowly to give the body a chance to get used to it.  If dose increases along the titration cause intolerable side effects such as dizziness or drowsiness, this can often be overcome by reducing back to the previous dose and escalating more slowly over a longer period of time.” Patients should be encouraged to follow-up with their prescriber for continued titration.

Gabapentin Is Not a “PRN” Medication
Another mishap with gabapentin that contributes to treatment failure is when patients take it on an as needed basis. Gabapentin exhibits its activity by impeding calcium trafficking and is required to be present at the alpha-2-delta receptor for 17-20 hours in order to ensure efficacy.11 Therefore, gabapentin needs to be taken around the clock to exert its analgesic effects rather than used on an as needed basis. This is another area that pharmacists can educate patients at initiation of therapy to improve compliance.

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 .