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Section IconGabapentin
Overview
Gabapentin, voltage-gated calcium channels, has evidence to support its use in the management of diabetic neuropathy, postherpetic neuralgia, and other neuropathic pain.1-6,8
It is safe and inexpensive however there is growing concern regarding misuse and abuse.4,5,6
Indications2,3,8
Carpal tunnel syndrome
Fibromyalgia
Painful diabetic neuropathy
Phantom limb pain
Postherpetic neuralgia
  • The only FDA approved use besides partial seizures
Radicular pain
Trigeminal neuralgia
Equipment & Dosing2,7
Typical analgesic dosing in the ED is 300-600 mg
At home dosing:
  • Day 1: 300 mg PO qhs x 3 days, if tolerated then
  • Day 4: 300 mg BID x 3 days, if tolerated then
  • Day 7+: 300 mg TID, should have primary care follow up to continue titration regimen
Doses may be titrated over weeks
Titration should be done in close follow up with outpatient provider most common reasons for discontinuing med is somnolence and dizziness
Complications5,8
Ataxia/gait disturbance
Dizziness
Peripheral edema
Somnolence/drowsiness (most common)
Special Considerations
Take caution when using in elderly or frail individuals consider cutting dose to 150 mg PO in the ED and in half for at home dosing. Gabapentin withdrawal can occur with abrupt cessation. It causes agitation, confusion, disorientation, diaphoresis, hypertension, and insomnia.5 Educate on gradually tapering gabapentin when discontinuing.
References
  1. Alles S, Smith PA. The anti-allodynic gabapentinoids: myths, paradoxes, and acute effects. Neuroscientist. 2016 Apr 26.
  2. Baker K. Chronic pain syndromes in the emergency department: identifying guidelines for management. Emerg Med Australas. 2005 Feb;17(1):57–64.
  3. Cooper TE, Derry S, Wiffen PJ, et al. Gabapentin for fibromyalgia pain in adults. Cochrane Database Syst Rev. 2017 Jan 3;1:CD 012188. doi:10.14651858
  4. Goodman CW, Brett AS. Gabapentin and Pregabalin for pain – is increased prescribing a cause for concern? N Engl J Med. 2017 Aug 3;377(5):411–3.
  5. Mersfelder TL, Nichols WH. Gabapentin: abuse, dependence, and withdrawal. Ann Pharmacother. 2016 Mar;50(3):229–33.
  6. Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016 Jul; 111(7):1160–74.
  7. Wiffen PJ, Derry S, Bell R, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017 Jun 9;6:CD007938. doi: 10.1002/14651858
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