1.3. Renal Impairment

Gabapentin dosing guidelines for adult with renal impairment are summarized in Table 3. Dosing guidelines for gabapentin immediate-release are also applicable for adolescents 12 years of age and older with renal impairment. Gabapentin use in pediatric patients younger than 12 years of age with impaired renal function has not been evaluated^1-5.

Table 3. Gabapentin Dosage Guidelines in Adults, Adolescents 12 Years of Age and Older with Renal Impairment^1-5

	Creatinine Clearance (CrCl)	Recommended Dosage Adjustments
Gabapentin immediate-release	60 ml/min or greater	900 mg to 3600 mg daily, in three divided doses
	30-59 ml/min	400 mg to 1400 mg daily, in two divided doses
	15-29 ml/min	200 mg to 700 mg once daily
	15 ml/min	100 mg to 300 mg once daily
	Less than less than 15 ml/min	daily dose decreased in proportion to CrCl (e.g., CrCl = 7.5 ml/min – administer 50% of dose for CrCl of 15 ml/min)
	hemodialysis patients	maintenance doses based on CrCl estimates, with supplemental doses of 125 mg to 350 mg administered after each 4 hours of hemodialysis
Gabapentin extended-release
Gralise
	60 ml/min or greater	no dosage adjustment needed – 1800 mg once daily with evening meal
	30 – 60 ml/min	600 mg to 1800 mg once daily with evening meal
	Less than 30 ml/min	should not be administered
	hemodialysis patients	should not be administered
Horizant
Restless legs syndrome	60 ml/min or greater	no dosage adjustment needed – 600 mg daily
	30 – 59 ml/min	start with 300 mg daily with evening meal (~ 5 pm), increasing to 600 mg daily with evening meal as needed
	15-29 ml/min	300 mg daily with evening meal (~ 5 pm)
	Less than 15 ml/min	300 mg every other day with evening meal (~ 5 pm)
	15-29 ml/min	300 mg daily with evening meal (~ 5 pm)
	Less than 15 ml/min on hemodialysis	Horizant not recommended for use
Postherpetic neuralgia	60 ml/min or greater	Titration: 600 mg in morning for 3 days Maintenance: 600 mg twice daily Tapering: 600 mg in morning for 1 week
	30 – 59 ml/min	Titration: 300 mg in morning for 3 days Maintenance: 300 mg twice daily; increase to 600 mg twice daily if needed Taper: reduce current maintenance dose to once daily in morning for 1 week before drug discontinuation
	15-29 ml/min	Titration: 300 mg in morning on day 1 and day 3 Maintenance: 300 mg in morning; increase to 300 mg twice daily if needed Taper: if taking 300 mg twice daily, decrease to 300 mg once daily in morning for 1 week; if taking 300 mg once daily in morning, no taper needed
	Less than 15 ml/min	Titration: none Maintenance: 300 mg every other day in morning; increase to 300 mg once daily in morning if needed Taper: none
	Less than 15 ml/min on hemodialysis	Titration: none Maintenance: 300 mg following every dialysis; increase to 600 mg after every dialysis if needed Taper: none