Disclaimer: This is for informational purposes only. This does not replace the instructions you received from Dr. Anderson or any other practitioner,
constitute medical treatment, establishment of a patient-physician relationship, constitute any form of recommendation, prescription or medical
advice, or imply that the medication is appropriate or FDA approved for any condition. This information may be outdated and is not a complete
listing of instructions, doses, uses, or side effects. If this was prescribed to you, you must review this information with your pharmacist and
prescriber before starting the medication. Any medication may interfere with the ability to drive, concentrate, or operate machinery; patients must
be responsible for their own behavior and should not engage in any dangerous activity if there is any question of impairment. All medications have
side effects and drug interactions, some serious, some fatal. Let all of your practitioners and pharmacist know about every substance used. Alcohol,
herbals, or illegal drugs are not considered safe with these medications. Assume no medication is safe during pregnancy or while breast feeding. The
medication may interfere with birth control. Almost any medication can cause sleepiness, insomnia, dizziness, confusion, hallucinations, anxiety,
panic, constipation or diarrhea, headache, chest pain and nausea or vomiting, among others. These could cause physical injury, such as dizziness
causing one to fall down stairs. Many reduce blood pressure, which could cause fainting, dizziness, stroke, or other problems. Most medications
should NOT be stopped suddenly because of the risk of withdrawal. This is a supplement to the standardized drug information sheets.
Drug: GABAPENTIN
Wayne E. Anderson, D.O.
A Medical Corporation
Chronic Intractable Pain Disorders
Headache & Facial Pain Disorders
Neurotoxin Therapy
FDA-approved uses: Neuropathic pain related to shingles and
certain types of seizures.
Common off-label uses: Gabapentin is, apparently, one of the most
prescribed medications in the United States and has been used for
almost all types of chronic pain. Other specialists have used
gabapentin for other non-painful conditions as well.
Alternatives: Non-medication modalities, pain interventions and
other medications that may work in a similar manner.
Board Certified Neurology
American Board of Psychiatry & Neurology
Board Certified Pain Medicine
American Board of Psychiatry & Neurology
in association with the
American Board of Anesthesiology
Subspecialty Certified Headache Medicine
United Council for Neurological
Subspecialties
Qualified Medical Evaluator
Member of the
California Pacific Neuroscience Institute
45 Castro Street Suite 225
San Francisco CA 94114
415.558.8584 tel
415.513.4521 fax
www.wayneanderson.net
How it works: The medication works on a specific subunit of nerve
calcium channels.
Side effects: Please see the standardized drug information sheet for
detailed information about risks, side effects, interactions, and other
important information. All medications in this category have a
depression and suicide warning. Although the medication appears
quite safe, side effects do occur and can include fluid retention (puffy
ankles, for example), weight gain, tiredness, and others.
Common doses: There are two types of gabapentin used: regular
gabapentin and controlled-release gabapentin.
Regular gabapentin sample schedule: There is regular gabapentin,
which does not last long and is used three times daily. The usual dose
is between 900-2400mg per day. Patients should use the lowest
effective dose. Patients should not increase to the next higher dose if
the current dose is helpful and patients should not increase to the
next higher dose if the present dose is not tolerated.
Week (not day)
Morning dose
Afternoon dose
Nighttime dose
1
None
None
1 capsule
2
1 capsule
None
1 capsule
3 and on
1 capsule
1 capsule
1 capsule
(This schedule is for generic gabapentin capsules only)
Once-daily gabapentin sample schedule: There also is a once-daily gabapentin called Gralise, which
is taken only at dinnertime with the dinner meal. Typical doses of the once-daily gabapentin are 900mg1800mg. The once-daily gabapentin is titrated more quickly.
Day (not week)
Dinnertime dose
Day (not week)
Dinnertime dose
1
300 mg
7-10
1200 mg
2
600 mg
11-14
1500 mg
3-6
900 mg
15 and on
1800 mg
(This schedule is for controlled-release Gralise gabapentin tablets only)
Time to effect: Regular release gabapentin takes longer to titrate to the effective dose and it may
therefore take 8 weeks before clear benefit is noted. Controlled-release gabapentin (Gralise) doses are
increased much more quickly and benefit may be noted sooner.
Financial: Dr. Anderson has never received payment in exchange for prescribing a medication. Dr.
Anderson has no financial relationship with either generic gabapentin or Neurontin. Dr. Anderson has
served on an advisory board and has been compensated for medical education lectures by the makers of
Gralise. Patients may request a medication made by a company for which Dr. Anderson has never
provided lectures, if desired.
Insurance coverage: Many medications, especially in painful conditions, are off-label as discussed
above. Insurance companies do not need to cover medications used off label but typically do provide
coverage for most medications that have good scientific evidence. There is no guarantee that any
medication will be covered. Gabapentin generically typically is covered by insurance. The controlledrelease form (Gralise) typically is covered when the generic form fails either due to tolerability or lack
of efficacy.
Clinical and Scientific evidence: Some scientific evidence supportive of the use of the medication is
listed in this section. Of course, scientific information changes rapidly and the information listed may
become outdated or incorrect overnight. Gabapentin has literature supportive of use in neuropathic pain
conditions. It is an alpha-2-delta nerve calcium channel modulator (1,2). Gabapentin has been shown
efficacious in reducing neuropathic pain and has been shown to have anti-allodynic effects (2).
Gabapentin also has evidence supportive of benefit in migraine treatment in Group 2 at doses from 9002400mg/day, with grade B scientific evidence, 2+ clinical efficacy (1). References:
1.
2.
3.
4.
5.
Levin M, ed. Comprehensive Review of Headache Medicine. Oxford University Press. 2008.
Kusunose N, Koyanagi S, Hamamura K, Matsunaga N, Yoshida M, Uchida T, Tsuda M, Inoue K, Ohdo S. Molecular basis for the
dosing time-dependency of anti-allodynic effects of gabapentin in a mouse model of neuropathic pain. Mol Pain. 2010 Nov
26;6(1):83.
Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain. 2010 Sep;150(3):57381.
Bestard JA, Toth CC. An Open-Label Comparison of Nabilone and Gabapentin as Adjuvant Therapy or Monotherapy in the
Management of Neuropathic Pain in Patients with Peripheral Neuropathy. Pain Pract. 2010 Nov 18.
Malemud CJ. Focus on pain mechanisms and pharmacotherapy in the treatment of fibromyalgia syndrome. Clin Exp Rheumatol.
2009 Sep-Oct;27(5 Suppl 56):S86-91.