Table 3: Gabapentin Dosage Guidelines in Adults, Adolescents 12 Years of Age and Older with Renal Impairment

  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)
  anephric patients maintenance doses based on CrCl estimates, with supplemental doses of 125 mg to 350 mg administered after every 4-hour hemodialysis session
Gabapentin extended-release    
Gralise®    
  60 ml/min or greater no dosage adjustment needed – 1800 mg once daily with evening meal
  30 – 59 ml/min 600 mg to 1800 mg once daily with evening meal
  Less than 30 ml/min avoid administering Gralise®
  hemodialysis patients avoid administering Gralise®
Horizant®    
Restless legs syndrome 60 ml/min or greater no dosage adjustment needed
  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 no dosage adjustment needed
  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