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Neurontin

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Neurontin

INDICATIONS

NEURONTIN® (gabapentin) is indicated for:

  • Management of postherpetic neuralgia in adults
  • Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization, in adults and pediatric patients 3 years and older with epilepsy

DOSAGE AND ADMINISTRATION

NEURONTIN is given orally with or without food. Patients should be informed that, should they break the scored 600 mg or 800 mg tablet in order to administer a half-tablet, they should take the unused half-tablet as the next dose. Half-tablets not used within 28 days of breaking the scored tablet should be discarded.

NEURONTIN capsules should be swallowed whole with plenty of water.

If NEURONTIN dose is reduced, discontinued, or substituted with an alternative medication, this should be done gradually over a minimum of 1 week (a longer period may be needed at the discretion of the prescriber).

Postherpetic Neuralgia

In adults with postherpetic neuralgia, NEURONTIN therapy may be initiated on Day 1 as a single 300 mg dose, on Day 2 as 600 mg/day (300 mg two times a day), and on Day 3 as 900 mg/day (300 mg three times a day). The dose can subsequently be titrated up as needed for pain relief to a dose of 1800 mg/day (600 mg three times a day). In clinical studies, efficacy was demonstrated over a range of doses from 1800 mg/day to 3600 mg/day with comparable effects across the dose range; however, in these clinical studies, the additional benefit of using doses greater than 1800 mg/day was not demonstrated.

Epilepsy With Partial Onset Seizures

NEURONTIN is recommended for add-on therapy in patients 3 years of age and older. Effectiveness in pediatric patients below the age of 3 years has not been established.

Patients 12 years of age and above

The starting dose is 300 mg three times a day. The effective dose of NEURONTIN is 300 mg to 600 mg three times a day. Dosages up to 2400 mg/day have been well tolerated in long-term clinical studies. Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated. NEURONTIN should be administered three times a day using 300 mg or 400 mg capsules, or 600 mg or 800 mg tablets. The maximum time between doses should not exceed 12 hours.

Pediatric Patients Age 3 to 11 years

The starting dose range is 10 mg/kg/day to 15 mg/kg/day, given in three divided doses, and the effective dose reached by upward titration over a period of approximately 3 days. The effective dose of NEURONTIN in patients 3 to 4 years of age is 40 mg/kg/day, given in three divided doses. The effective dose of NEURONTIN in patients 5 to 11 years of age is 25 mg/kg/day to 35 mg/kg/day, given in three divided doses. NEURONTIN may be administered as the oral solution, capsule, or tablet, or using combinations of these formulations. Dosages up to 50 mg/kg/day have been well tolerated in a long-term clinical study. The maximum time interval between doses should not exceed 12 hours.

It is not necessary to monitor gabapentin plasma concentrations to optimize NEURONTIN therapy. Further, because there are no significant pharmacokinetic interactions among NEURONTIN and other commonly used antiepileptic drugs, the addition of NEURONTIN does not alter the plasma levels of these drugs appreciably.

If NEURONTIN is discontinued and/or an alternate anticonvulsant medication is added to the therapy, this should be done gradually over a minimum of 1 week.

Patients With Renal Impairment

Dosage adjustment in patients 12 years of age and older with compromised renal function or undergoing hemodialysis is recommended, as follows (see dosing recommendations above for effective doses in each indication):

TABLE 1: NEURONTIN Dosage Based on Renal Function

Renal Function Creatinine Clearance (mL/min) Total Daily Dose Range (mg/day) Dose Regimen (mg)
≥ 60 900 to 3600 300 TID 400 TID 600 TID 800 TID 1200 TID
> 30 to 59 400 to 1400 200 BID 300 BID 400 BID 500 BID 700 BID
> 15 to 29 200 to 700 200 QD 300 QD 400 QD 500 QD 700 QD
15a 100 to 300 100 QD 125 QD 150 QD 200 QD 300 QD
Post-Hemodialysis Supplemental Dose (mg)b
Hemodialysis 125b 150b 200b 250b 350b
TID = Three times a day; BID = Two times a day; QD = Single daily dose
aFor patients with creatinine clearance < 15 mL/min, reduce daily dose in proportion to creatinine clearance (e.g., patients with a creatinine clearance of 7.5 mL/min should receive one-half the daily dose that patients with a creatinine clearance of 15 mL/min receive).
bPatients on hemodialysis should receive maintenance doses based on estimates of creatinine clearance as indicated in the upper portion of the table and a supplemental post-hemodialysis dose administered after each 4 hours of hemodialysis as indicated in the lower portion of the table.

Creatinine clearance (CLCr) is difficult to measure in outpatients. In patients with stable renal function, creatinine clearance can be reasonably well estimated using the equation of Cockcroft and Gault:

Males: (weight in kg) x (140 – age)
(72) x serum creatinine (mg/100 mL)
Females (0.85) x (above value)

The use of NEURONTIN in patients less than 12 years of age with compromised renal function has not been studied.

Dosage In Elderly

Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and dose should be adjusted based on creatinine clearance values in these patients.

HOW SUPPLIED

Dosage Forms And Strengths

Capsules
  • 100 mg: white hard gelatin capsules printed with “PD” on the body and “Neurontin/100 mg” on the cap
  • 300 mg: yellow hard gelatin capsules printed with “PD” on the body and “Neurontin/300 mg” on the cap
  • 400 mg: orange hard gelatin capsules printed with “PD” on the body and “Neurontin/400 mg” on the cap
Tablets
  • 600 mg: white elliptical film-coated scored tablets debossed with “NT” and “16” on one side
  • 800 mg: white elliptical film-coated scored tablets debossed with “NT” and “26” on one side

Oral solution: 250 mg per 5 mL (50 mg per mL), clear colorless to slightly yellow solution

Storage And Handling

NEURONTIN (gabapentin) capsules, tablets, and oral solution are supplied as follows:

100 mg Capsules

White hard gelatin capsules printed with “PD” on the body and “Neurontin/100 mg” on the cap; available in: Bottles of 100: NDC 0071-0803-24

300 mg Capsules

Yellow hard gelatin capsules printed with “PD” on the body and “Neurontin/300 mg” on the cap; available in: Bottles of 100: NDC 0071-0805-24 Unit dose 50's: NDC 0071-0805-40

400 mg Capsules

Orange hard gelatin capsules printed with “PD” on the body and “Neurontin/400 mg” on the cap; available in: Bottles of 100: NDC 0071-0806-24 Unit dose 50's: NDC 0071-0806-40

600 mg Tablets

White elliptical film-coated scored tablets debossed with “NT” and “16” on one side; available in: Bottles of 100: NDC 0071-0513-24

800 mg Tablets

White elliptical film-coated scored tablets debossed with “NT” and “26” on one side; available in: Bottles of 100: NDC 0071-0401-24

250 mg per 5 mL oral solution

Clear colorless to slightly yellow solution; each 5 mL of oral solution contains 250 mg of gabapentin; available in: Bottles containing 470 mL: NDC 0071-2012-23

Store NEURONTIN Tablets and Capsules at 25°C (77°F); excursions permitted between 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature].

Store NEURONTIN Oral Solution refrigerated, 2°C to 8°C (36°F to 46°F)

Distributed by: Pake - Davis, Division of Pfizer Inc., NY, NY 10017. Revised August 2014

Last reviewed on RxList: 8/28/2014
This monograph has been modified to include the generic and brand name in many instances.

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