Gabapentin immediate-release |
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60 ml/min or greater |
900 mg to 3600 mg daily, in three divided doses |
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30-59 ml/min |
400 mg to 1400 mg daily, in two divided doses |
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15-29 ml/min |
200 mg to 700 mg once daily |
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15 ml/min |
100 mg to 300 mg once daily |
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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) |
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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 |
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Gralise® |
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60 ml/min or greater |
no dosage adjustment needed – 1800 mg once daily with evening meal |
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30 – 59 ml/min |
600 mg to 1800 mg once daily with evening meal |
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Less than 30 ml/min |
avoid administering Gralise® |
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hemodialysis patients |
avoid administering Gralise® |
Horizant® |
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Restless legs syndrome |
60 ml/min or greater |
no dosage adjustment needed |
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30 – 59 ml/min |
start with 300 mg daily with evening meal (~ 5 pm), increasing to 600 mg daily with evening meal as needed |
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15-29 ml/min |
300 mg daily with evening meal (~ 5 pm) |
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Less than 15 ml/min |
300 mg every other day with evening meal (~ 5 pm) |
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15-29 ml/min |
300 mg daily with evening meal (~ 5 pm) |
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Less than 15 ml/min on hemodialysis |
Horizant® not recommended for use |
Postherpetic neuralgia |
60 ml/min or greater |
no dosage adjustment needed |
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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
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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
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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
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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
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