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
  • 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