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

Carpal tunnel syndrome

Fibromyalgia

Painful diabetic neuropathy

Phantom limb pain

Postherpetic neuralgia

• The only FDA approved use besides partial seizures

Radicular pain

Trigeminal neuralgia

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

Ataxia/gait disturbance

Dizziness

Peripheral edema

Somnolence/drowsiness (most common)

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.