What to Know About Neurontin (Gabapentin)

Neurontin (gabapentin) is a prescription medication used for the treatment of epilepsy and for reduction of pain in conditions such as postherpetic neuralgia. It is available as a capsule, tablet, and oral solution. This medication is intended for consistent daily use and is not considered effective when used as an acute treatment for any condition.

Neurontin is also commonly used off-label for management of a number of medical conditions, such as neuropathic pain and migraine prevention. The recommended dose differs depending on the condition for which you are prescribed Neurontin.

Uses

You may experience side effects from using this medication, including drowsiness, dizziness, and allergic reactions. While it is rare, the manufacturer warns of an increased risk of suicidal behavior.

The United States Food and Drug Administration (FDA) has approved Neurontin for two indications.

• Epilepsy: Adjunctive therapy in the treatment of partial-onset seizures, with and without secondary generalization, in adults and children who are three years old or older
• Pain: Postherpetic neuralgia in adults

Partial Epilepsy

Epilepsy is a condition characterized by a tendency to have recurrent seizures. Partial-onset seizures are the most common type of seizure. A seizure is defined as partial-onset if the epileptic activity begins in one region of the brain, rather than beginning throughout the whole brain.

Partial onset seizures may generalize throughout the brain, causing changes in consciousness, or they may remain focal (in one region of the brain), manifesting with symptoms such as involuntary jerking.

Adjunctive therapy is an add-on therapy.

Postherpetic Neuralgia

Postherpetic neuralgia is a rare, painful condition that can develop after a bout of shingles. It is characterized by severe, persistent pain. Shingles is caused by reactivation of the herpes zoster virus. While you have shingles, you can transmit the herpes zoster virus, causing another person to develop chickenpox.

By the time postherpetic neuralgia develops, you should no longer be contagious.

Off-Label Uses

• Migraine prophylaxis (used to prevent migraines from occurring)
• Diabetic neuropathy
• Alcoholic neuropathy
• Trigeminal neuralgia
• Generalized anxiety disorders
• Restless leg syndrome
• Hot flashes

While Neurontin is approved as an add-on therapy for epilepsy, it has been used off-label as the only anticonvulsant in the control of seizures.

Before Taking

If you have had a negative reaction to Neurontin in the past, it is important that you tell your healthcare provider. Your reaction could mean that you are unable to tolerate this medication.

Precautions and Contraindications

Neurontin is not classified as a scheduled drug and is not considered highly addictive or a drug of abuse or dependence.

There are few reports of misuse and abuse, particularly among individuals who have a history of substance abuse. Using higher doses than recommended can predispose you to more severe side effects and can make it more likely to develop withdrawal symptoms.

Gabapentin is available in generic form. Other brand names for gabapentin include:

• FusePaq Fanatrex
• Gralise
• Gabarone
• Horizant (gabapentin enacarbil tablet, extended-release)

Lyrica (pregabalin) is a medication that is similar to gabapentin, but it is not identical.

Dosage

Neurontin is available in several forms and doses.

• Tablet form: 600 milligrams (mg) and 800 mg
• Capsule form: 100 mg, 300 mg, and 400 mg
• Oral solution: Delivers a dose of 250 mg per 5 milliliters (mL)

Recommended Dose

The recommended dose of Neurontin is lower when it is used for postherpetic neuralgia than for epilepsy. Because you may have other health issues, you should follow the dosing instructions on your prescription, as your dose may differ from the standard recommended dose.

Postherpetic neuralgia: It is recommended to start with a single 300 mg dose on the first day, two doses of 300 mg each on the second day, and three doses of 300 mg each on the third day. Your maintenance dose may range between 900 to 1800 mg/day, taken in three, equally spaced doses per day.

Epilepsy (adults and children age 12 and above): It is recommended to start with 300 mg three times a day. Your maintenance dose may range between 300 mg to 600 mg three times a day, up to a total dose of 2400 mg/day. In special circumstances, 3600 mg/day may be needed to control seizures.

For children with epilepsy: The recommended starting dose is 10 mg per kilograms (kg) a day to 15 mg/kg/day, in three divided doses. Over a period of three days, the dose is increased to a maintenance dose.

The recommended maintenance dose of for children ages three to four is 40 mg/kg/day in three divided doses. The recommended maintenance dose for children ages five to 11 is 25 mg/kg/day to 35 mg/kg/day in three divided doses.

Modifications 

Your prescribed dose will be reduced if you have kidney function problems. According to the manufacturer, the reduced dose should be calculated based on creatinine clearance, which is a measure of kidney function.

How to Take and Store

Neurontin tablets and capsules should be stored at 25 degrees Celsius (77 degrees Fahrenheit); excursions are permitted between 15 degrees to 30 degrees Celsius (59 degrees to 86 degrees Fahrenheit).

Neurontin oral solution should be refrigerated at 2 degrees Celcius to 8 degrees Celcius (36 degrees to 46 degrees Fahrenheit).

If you divide scored tablets, you should use your half-tablet within 28 days of dividing.

Side Effects

Neurontin can produce a number of side effects. The most common are dizziness and somnolence (extreme tiredness). This can affect your ability to drive safely and to operate equipment.

Besides dizziness and somnolence, other side effects of Neurontin include:

• Allergic reaction
• Swelling of the legs
• Behavioral changes, especially in children ages three to 12 years old

Severe Side Effects

Rarely, Neurontin causes life-threatening side effects, including:

• Angioedema
• Suicidal thinking and/or behavior
• Sudden and Unexplained Death in Epilepsy (SUDEP)

Withdrawal

Abruptly stopping Neurontin or quickly reducing your dose can cause serious side effects. If you are having side effects or if you want to discontinue or reduce your medication, speak to your healthcare provider first.

Effects of withdrawal can include:

• Seizures
• Status epilepticus
• Behavioral changes

Warnings and Interactions

Neurontin interacts with other anti-epileptic medications and with pain medications such as opioids. These interactions can cause severe lethargy or somnolence.

Antacids containing magnesium interact with Neurontin, and it is recommended that you take Neurontin at least two hours before using these types of antacids.