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 evaluated1-7.
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 |
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15-29 ml/min |
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Less than 15 ml/min |
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Less than 15 ml/min on hemodialysis |
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