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Gabapentin Considerations and Patient Teaching [Drug Guide]

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By Gil Wayne BSN, R.N.

Gabapentin is a medication commonly prescribed to treat various conditions, including epilepsy, neuropathic pain, and restless legs syndrome. This guide aims to educate patients about important considerations, including dosage instructions, potential side effects, and precautions, to ensure safe and effective use of gabapentin.

Table of Contents

What is Gabapentin?

Gabapentin is an anticonvulsant medication that is primarily used to treat epilepsy. It is also prescribed for other conditions such as neuropathic pain, restless legs syndrome, and hot flashes. It works by affecting the activity of certain neurotransmitters in the brain, specifically targeting calcium channels. Gabapentin works by affecting the activity of certain neurotransmitters in the brain, specifically targeting calcium channels. By modulating these channels, it helps to reduce the excessive electrical activity in the brain that can lead to seizures in individuals with epilepsy. Gabapentin has shown efficacy in relieving neuropathic pain, which is caused by damage or dysfunction of the nerves. It is believed to work by inhibiting the transmission of pain signals in the nervous system. While gabapentin is generally well-tolerated, it may cause side effects such as drowsiness, dizziness, and coordination problems. It can also interact with certain medications, so it is important to inform the healthcare provider about all current medications and medical conditions before starting treatment.

Generic Name

  • gabapentin

Brand Names

Here are some common brand names under which gabapentin is marketed:

  • Neurontin
  • Gralise
  • Horizant
  • Gabarone
  • Fanatrex
  • Gabapin
  • Gabapentin Intas
  • Gabapentin Sandoz
  • Gabapentin Teva
  • Neurontin

Drug Classification of Gabapentin

The drug classification of gabapentin is:

Therapeutic Class

  • analgesic adjuncts
  • anticonvulsant
  • mood stabilizers

Indications and Therapeutic Effects

Gabapentin is indicated for the treatment of various conditions, including:

1. Epilepsy. It is commonly prescribed as an adjunctive therapy for the treatment of partial seizures in adults and children.

2. Neuropathic pain. Gabapentin is used to alleviate neuropathic pain, which can result from conditions such as diabetic neuropathy, postherpetic neuralgia (nerve pain following shingles), and peripheral neuropathy.

3. Restless Legs Syndrome (RLS). It can be prescribed to reduce the uncomfortable sensations and urge to move the legs that characterize RLS.

4. Fibromyalgia. Gabapentin may be used to help manage the pain associated with fibromyalgia, a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness.

5. Hot flashes. It has been found to be effective in reducing the frequency and severity of hot flashes experienced by menopausal women.

6. Off-label uses. Gabapentin may be prescribed off-label for conditions such as anxiety disorders, bipolar disorder, migraine prevention, and alcohol withdrawal symptoms.

Mechanism of Action

The mechanism of action is not known, but it is believed to work through multiple mechanisms. Gabapentin primarily acts by binding to a specific subunit of voltage-gated calcium channels in the central nervous system. This binding reduces the release of several neurotransmitters, including glutamate, norepinephrine, and substance P, which are involved in the transmission of pain signals.

Also, gabapentin increases the synthesis and release of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that helps regulate neuronal excitability. By enhancing GABA levels, gabapentin promotes a calming effect on overactive nerve signals and may contribute to its antiepileptic and anxiolytic properties.

Furthermore, gabapentin has been shown to modulate certain neurotransmitter receptors, such as the alpha-2-delta subunit of voltage-gated calcium channels. This modulation may further contribute to its analgesic and anticonvulsant effects.

Precautions and Contraindications

Before taking gabapentin, it is important to be aware of the following precautions and contraindications:

1. Allergy. Individuals with a known allergy or hypersensitivity to gabapentin should avoid its use.

2. Kidney problems. Gabapentin is primarily eliminated from the body through the kidneys. Therefore, individuals with impaired kidney function or those undergoing dialysis may require dosage adjustments or close monitoring.

3. Mental health disorders. Gabapentin has been associated with an increased risk of suicidal thoughts and behaviors. Individuals with a history of depression, mood disorders, or suicidal tendencies should be closely monitored while taking gabapentin.

4. Substance abuse. Gabapentin has the potential for abuse and dependence, particularly when combined with other substances. Individuals with a history of substance abuse or addiction should exercise caution and be closely monitored while taking gabapentin.

5. Pregnancy and breastfeeding. The use of gabapentin during pregnancy or breastfeeding should be discussed with a healthcare professional. It may pose certain risks to the developing fetus or nursing infant.

6. Interactions with other medications. Gabapentin may interact with certain medications, such as opioids or central nervous system depressants, leading to increased sedation and respiratory depression. It is crucial to inform the healthcare provider about all current medications, including over-the-counter drugs and herbal supplements, before starting gabapentin.

7. Driving and operating machinery. Gabapentin may cause drowsiness, dizziness, and coordination problems. It is important to avoid driving or operating machinery until the individual knows how the medication affects them.

Drug Interactions

Gabapentin can interact with various medications, natural products, and food. It is important to be aware of these potential drug interactions.


Gabapentin can potentially interact with several other medications, and it is important to be aware of these drug-drug interactions. Here are some examples:

1. Opioids. Combining gabapentin with opioids, such as morphine or oxycodone, can increase the risk of central nervous system depression, respiratory depression, and sedation. Close monitoring is necessary, and dosage adjustments may be required.

2. CNS depressants. Gabapentin can enhance the sedative effects of other central nervous system depressants, including benzodiazepines, sedatives, tranquilizers, and alcohol. The combination can lead to excessive drowsiness, dizziness, and impaired coordination. Caution and dosage adjustments may be necessary.

3. Antacids. Taking gabapentin with aluminum or magnesium-containing antacids can reduce the absorption of gabapentin from the gastrointestinal tract. To avoid this interaction, it is recommended to separate the administration of gabapentin and antacids by at least 2 hours.

4. Naproxen. Combining gabapentin with naproxen, a nonsteroidal anti-inflammatory drug (NSAID), can increase the risk of kidney damage. Close monitoring of kidney function is advised when using these medications together.

5. Diuretics: Some diuretics, such as hydrochlorothiazide, can increase the elimination of gabapentin from the body, potentially reducing its effectiveness. Dosage adjustments may be necessary in such cases.

6. Morphine. Gabapentin may increase the levels of morphine in the body, leading to an increased risk of side effects. Close monitoring is important if these medications are used concomitantly.

Drug-Natural Products

Gabapentin may interact with certain natural products, and it is important to be aware of these potential interactions. Here are some examples:

1. St. John’s Wort. St. John’s Wort is an herbal supplement used for mood disorders. It can induce liver enzymes, which may decrease the levels of gabapentin in the body, potentially reducing its effectiveness. Close monitoring and dosage adjustments may be necessary if these are used together.

2. Melatonin. Melatonin is a natural hormone that helps regulate sleep-wake cycles. Combining gabapentin with melatonin may increase the sedative effects and cause excessive drowsiness. Caution is advised when using these together, especially when driving or operating machinery.

3. Herbal sedatives. Certain herbal sedatives, such as valerian root and kava, may enhance the sedative effects of gabapentin, leading to increased drowsiness and impaired coordination. Caution is advised, and it may be necessary to adjust the dosage or timing of administration.

4. Ginkgo Biloba. Ginkgo biloba is an herbal supplement commonly used for memory enhancement. There have been reports of seizures occurring in individuals taking gabapentin and ginkgo biloba concurrently. Close monitoring is important if using these together.

5. Cannabis. Cannabis products, particularly those containing tetrahydrocannabinol (THC), may increase the sedative effects of gabapentin. Caution is advised when combining these substances, as it may result in excessive drowsiness and impaired cognitive function.


When it comes to food interactions, gabapentin generally does not have any significant interactions with specific foods. However, there are a few factors related to food that should be considered when taking gabapentin:

1. Absorption. Gabapentin is better absorbed by the body when taken with food. While it can be taken with or without food, taking it with a meal may enhance its absorption and increase its effectiveness.

2. Timing. If the physician has prescribed gabapentin to be taken multiple times a day, it’s important to maintain a consistent schedule with regard to food intake. Taking it with meals or snacks at regular intervals may be considered to ensure a steady level of medication in the system.

Adverse Effects

Gabapentin, like any medication, can potentially cause side effects and adverse reactions in some individuals. Not everyone will experience these effects, and the severity and frequency of side effects can vary. Here are some common side effects associated with gabapentin:

1. Drowsiness or dizziness. Gabapentin can cause drowsiness or dizziness, especially when initially taking it or when the dosage is increased. It’s important to avoid activities that require mental alertness, such as driving or operating machinery.

2. Fatigue. Some individuals may experience increased fatigue or tiredness while taking gabapentin.

3. Coordination difficulties. Gabapentin can affect coordination and balance in some people, leading to difficulties in movements.

4. Nausea and vomiting. These gastrointestinal symptoms can occur, particularly at the beginning of treatment, but they usually improve with time.

5. Weight gain. Some individuals may experience weight gain while taking gabapentin. It is important to maintain a healthy lifestyle and discuss any concerns with the healthcare provider.

6. Mood changes. In rare cases, gabapentin may cause mood changes, including increased anxiety or depression.

7. Allergic reactions. While rare, some individuals may experience allergic reactions to gabapentin, such as skin rash, itching, swelling, or difficulty breathing.

Administration Considerations

Available Forms

Gabapentin is available in the following forms:

  • Capsules: 100 mg, 300 mg, 400 mg.
  • Tablets: 600 mg, 800 mg.
  • Extended-release tablets (Horizant): 600 mg.
  • Sustained-release tablets (Gralise): 300 mg, 600 mg.
  • Oral solution (cool strawberry anise flavor): 250 mg/5 mL.

Dosage for Children


  • PO (Children >12 yr): 300 mg 3 times daily initially. Titration may be continued until desired (range is 900 – 1800 mg/day in 3 divided doses; doses should not be more than 12 hr apart). Doses up to 2400 – 3600 mg/day have been well tolerated.
  • PO (Children ≥5 – 12 yr): 10 – 15 mg/kg/day in 3 divided doses initially titrated upward over 3 days to 25– 35 mg/kg/day in 3 divided doses; dosage interval should not exceed 12 hr (doses up to 50 mg/kg/day have been used).
  • PO (Children 3 – 4 yrs): 10 – 15 mg/kg/day in 3 divided doses initially titrated upward over 3 days to 40 mg/kg/day in 3 divided doses; dosage interval should not exceed 12 hr (doses up to 50 mg/kg/day have been used).

Renal Impairment

  • PO (Children >12 yr): CCr 30 – 59 mL/ min—200–700 mg twice daily; CCr 15–29 mL/ min — 200 – 700 mg once daily; CCr 15 mL/min — 100 – 300 mg once daily; CCr <15 mL/min — Reduce daily dose in proportion to CCr.

Neuropathic Pain (unlabeled use)

  • PO (Children): 5 mg/kg/dose at bedtime initially, then increase to 5 mg/kg BID on day 2 and 5mg/kg TID on day 3. Titrate to effect up to 8 – 35 mg/kg/day in 3 divided doses.

Dosage for Adults


  • PO (Adults): 300 mg 3 times daily initially. Titration may be continued until desired (range is 900 – 1800 mg/day in 3 divided doses; doses should not be more than 12 hr apart). Doses up to 2400 – 3600 mg/day have been well tolerated.

Renal Impairment

  • PO (Adults): CCr 30 – 59 mL/ min—200–700 mg twice daily; CCr 15–29 mL/ min — 200 – 700 mg once daily; CCr 15 mL/min — 100 – 300 mg once daily; CCr <15 mL/min — Reduce daily dose in proportion to CCr.
  • PO (Adults): CCr 30 – 59 mL/min — 200 – 700 mg twice daily (immediate-release); 600 – 1800 mg once daily (sustained-release [Gralise]); 300 mg once daily in the morning on days 1 – 3, then 300 mg twice daily thereafter (may increase to 600 mg twice daily, as needed) (extended-release [Horizant]); CCr 15 – 29 mL/min — 200 – 700 mg once daily (immediate-release); sustained release [Gralise] not recommended; 300 mg in the morning on days 1 and 3, then 300 mg once daily in the morning thereafter (may increase to 300 mg twice daily, as needed) (extended-release [Horizant]); CCr 15 mL/ min — 100 – 300 mg once daily (immediate-release); sustained release [Gralise] not recommended; CCr 15 mL/min—decrease daily dose in proportion to CCr (im- mediate release); sustained release [Gralise] not recommended; 300 mg every other day in the morning (may increase to 300 mg once daily in the morning, as needed) (extended-release [Horizant]); CCr <15 mL/ min (on hemodialysis) — 300 mg after each dialysis session (may increase to 600 mg after each dialysis sessions, as needed)(extended-release [Horizant]).
  • (Adults): CCr 30 – 59 mL/min — 300 mg once daily at 5 PM; may increase to 600 mg once daily at 5 PM as needed; CCr 15–29 mL/min—300 mg once daily at 5 PM; CCr <15 mL/min — 300 mg every other day; CCr <15 mL/ min (on hemodialysis) — Not recommended.

Postherpetic Neuralgia

  • PO (Adults): Immediate-release — 300 mg once daily on first day, then 300 mg 2 times daily on second day, then 300 mg 3 times/day on day 3, may then be titrated upward as needed up to 600 mg 3 times/day; Sustained-release (Gralise) — 300 mg once daily on first day, then 600 mg once daily on second day, then 900 mg once daily on days 3 – 6, then 1200 mg once daily on days 7 – 10, then 1500 mg once daily on days 11 – 14, then 1800 mg once daily thereafter; Extended-release (Horizant) — 600 mg once daily in the morning on days 1 – 3, then 600 mg twice daily thereafter.

Restless Legs Syndrome

  • PO (Adults): Extended-release (Horizant)—600 mg once daily at 5 PM.

Neuropathic Pain (unlabeled use)

  • PO (Adults): 100 mg 3 times daily initially. Titrate weekly by 300 mg/day up to 900 – 2400 mg/day (maximum: 3600 mg/day).


Understanding the pharmacokinetics of gabapentin helps healthcare professionals determine appropriate dosages and consider potential drug interactions or adjustments based on renal function.

1. Absorption. Gabapentin is well-absorbed after oral administration, with peak plasma concentrations typically reached within 2 to 3 hours. Food may slightly delay its absorption.

2. Bioavailability. The bioavailability of gabapentin is approximately 60%, meaning that about 60% of the dose taken reaches the systemic circulation.

3. Protein binding. Gabapentin has minimal plasma protein binding, with less than 3% bound to proteins in the blood.

4. Distribution. Gabapentin is widely distributed throughout the body, including crossing the blood-brain barrier. It has a relatively large volume of distribution, indicating extensive tissue distribution.

5. Metabolism. Gabapentin undergoes minimal metabolism in the liver. It is not extensively metabolized by cytochrome P450 enzymes and does not significantly inhibit or induce these enzymes.

6. Elimination. Gabapentin is primarily eliminated unchanged through the kidneys.

7. Half-life. It has an elimination half-life of approximately 5 to 7 hours in individuals with normal kidney function. However, in individuals with impaired renal function, the elimination half-life may be prolonged.

8. Renal adjustment. Dose adjustments may be necessary for individuals with impaired renal function to avoid gabapentin accumulation. The exact adjustment depends on the individual’s renal function and should be determined by a healthcare professional.

Nursing Considerations for Gabapentin

When administering or caring for patients taking gabapentin, nurses should consider several important factors.

Nursing Assessment

1. Assess the patient’s medical history, including any known allergies, previous adverse reactions to gabapentin or similar medications, and relevant medical conditions.
This information helps identify potential contraindications or precautions for gabapentin use.

2. Evaluate the patient’s current symptoms, such as seizures, nerve pain, or restless legs syndrome.
To determine the appropriateness of gabapentin as a treatment option and to establish baseline data for assessing treatment effectiveness.

3. Review the patient’s medication history, including prescription and over-the-counter medications, to identify any potential drug interactions with gabapentin.
This assessment helps prevent adverse drug reactions and ensures safe medication administration.

4. Assess the patient’s renal function through laboratory tests such as serum creatinine and estimated glomerular filtration rate (eGFR).
Gabapentin is primarily eliminated through the kidneys, so impaired renal function may require dosage adjustments to prevent drug accumulation and associated side effects.

5. Perform a neurological assessment, including assessment of sensory and motor function, reflexes, and coordination.
This assessment helps establish a baseline for comparison and identifies any potential neurological side effects of gabapentin.

6. Evaluate the patient’s pain level, location, intensity, and quality.
Gabapentin is often prescribed for neuropathic pain, so monitoring pain levels and response to treatment is crucial for assessing the effectiveness of the medication.

7. Assess the patient’s mental health status, including mood, anxiety levels, and any history of depression or suicidal ideation.
Gabapentin may cause mood changes or increase the risk of suicidal thoughts, so monitoring mental health is important for early detection and intervention.

8. Monitor and assess for potential side effects of gabapentin, such as drowsiness, dizziness, fatigue, or gastrointestinal symptoms.
Assessing for these adverse effects helps ensure patient safety and well-being.

9. Evaluate the patient’s understanding of gabapentin, including its purpose, dosage regimen, potential side effects, and the importance of medication adherence.
Assessing the patient’s compliance and educational needs allows for appropriate support and reinforcement of medication instructions.

Gabapentin Nursing Interventions

1. Administer gabapentin according to the prescribed dosage and schedule.
This ensures that the patient receives the appropriate dose of medication at the right time, promoting therapeutic effects.

2. Provide comprehensive education to the patient about gabapentin, including its purpose, expected benefits, potential side effects, and proper administration techniques.
Education empowers the patient to make informed decisions, adhere to the medication regimen, and recognize and report any adverse effects.

3. Educate the patient about potential side effects of gabapentin, such as drowsiness, dizziness, or coordination difficulties.
By providing information about potential side effects, patients can make informed decisions about their treatment. They can weigh the benefits of gabapentin against the potential risks and decide whether the medication is suitable for them.

4. Advise the patient to exercise caution when engaging in activities that require alertness, such as driving or operating machinery.
Side effects such as drowsiness, dizziness, or coordination difficulties can pose safety risks. Patients need to be aware of these potential effects to take necessary precautions.

5. Promote the use of safety measures, such as handrails or assistive devices.
To prevent falls.

6. Collaborate with the healthcare team to develop a comprehensive pain management plan.
Pain management requires a holistic approach that considers the patient’s unique needs, medical history, and current condition. By collaborating with the healthcare team, including physicians, nurses, pharmacists, and other specialists, a comprehensive pain management plan can be developed that takes into account various factors contributing to the patient’s pain, such as the underlying condition, severity of pain, and potential interactions with other medications.

7. Adjust pain management interventions as necessary.
To ensure optimal pain control.

8. Document any changes or improvements in symptoms, as well as any new or worsening symptoms.
For timely intervention or adjustment of the treatment plan.

9. Provide emotional support and counseling to patients who may experience mood changes, anxiety, or other mental health effects associated with gabapentin.
Mood changes, anxiety, or other mental health effects can significantly impact a patient’s well-being and quality of life. By providing emotional support and counseling, healthcare providers can help patients cope with these effects, reduce distress, and improve their overall mental health.

10. Offer resources or referral to mental health professionals if needed.
Some patients may experience severe or persistent mental health symptoms while taking gabapentin, such as severe depression, suicidal thoughts, or significant anxiety. These symptoms may require specialized mental health interventions that extend beyond the scope of the primary healthcare provider.

Patient Education and Teaching

1. Explain the purpose of gabapentin, such as managing seizures, nerve pain, or other conditions.
Understanding why they are taking the medication helps patients recognize the potential benefits and motivates adherence to the prescribed treatment plan.

2. Provide clear instructions on the proper dosage and schedule for taking gabapentin.
Taking the medication as prescribed ensures consistent levels in the body, optimizing its effectiveness and minimizing the risk of missed or double doses.

3. Emphasize the importance of adherence to the prescribed regimen and explain the potential consequences of missed doses or inconsistent use.
Consistent use of gabapentin is necessary to maintain therapeutic levels in the body and achieve the desired treatment outcomes.

4. Educate patients about potential side effects of gabapentin, such as drowsiness, dizziness, or gastrointestinal symptoms.
Being aware of potential side effects helps patients recognize and attribute these symptoms to the medication, promoting early reporting and appropriate management.

5. Discuss safety precautions related to gabapentin, such as avoiding activities that require alertness or using caution when driving or operating machinery due to potential drowsiness or dizziness.
Patient understanding and adherence to safety precautions reduce the risk of accidents or falls, promoting overall safety and well-being.

6. Explain any specific food or drug interactions that may affect gabapentin’s absorption or effectiveness, such as taking it with or without food and avoiding alcohol.
Proper administration and avoidance of interactions optimize the absorption and therapeutic effects of gabapentin.

7. Highlight the importance of attending follow-up appointments with healthcare providers to monitor the effectiveness of gabapentin, assess for side effects, and make any necessary adjustments to the treatment plan.
Regular follow-up ensures that the treatment remains appropriate and effective, and allows for timely interventions or modifications if needed.

8. Instruct patients to promptly report any unusual or severe side effects or adverse reactions to their healthcare provider.
Timely reporting of adverse reactions facilitates early intervention, minimizes potential harm, and allows for appropriate management.

9. Provide instructions on how to store gabapentin properly, such as at room temperature, away from moisture and heat.
Proper storage ensures medication integrity and effectiveness.

10. Encourage patients to ask questions, seek clarification, or express concerns regarding gabapentin.
Open communication and patient engagement promote understanding, enhance treatment adherence, and allow for comprehensive patient-centered care.

Evaluation and Desired Outcomes

When evaluating the use of gabapentin, healthcare providers assess the patient’s response to treatment and measure the achievement of desired outcomes. Here are some evaluation criteria and desired outcomes for gabapentin:

1. Reduction in seizures. For patients prescribed gabapentin to manage seizures, the desired outcome is a reduction in the frequency, duration, or severity of seizures. Evaluation involves tracking the number and intensity of seizures over time and assessing any changes or improvements.

2. Pain relief. In cases where gabapentin is used for the management of nerve pain, the desired outcome is a reduction in pain intensity or improved pain control. Evaluation includes assessing the patient’s pain levels, using pain scales or subjective reports, and monitoring changes in pain perception and functionality.

3. Improved sleep. Gabapentin is sometimes prescribed to manage conditions like restless legs syndrome that can interfere with sleep. The desired outcome is an improvement in sleep quality and the reduction of sleep disturbances. Evaluation involves assessing changes in sleep patterns, duration, and subjective reports of sleep quality.

4. Decreased anxiety or mood stabilization. In some instances, gabapentin may be prescribed to manage anxiety disorders or stabilize mood in certain conditions. The desired outcome is a reduction in anxiety symptoms or mood fluctuations. Evaluation includes assessing changes in anxiety levels, mood stability, and overall emotional well-being.

5. Enhanced functionality. The goal of gabapentin treatment is to improve a patient’s overall functionality and quality of life. Evaluation involves assessing changes in the patient’s ability to perform daily activities, engage in social interactions, and participate in hobbies or work.

6. Minimized side effects. Evaluating the occurrence and severity of side effects associated with gabapentin is crucial. The desired outcome is the prevention or mitigation of side effects, such as drowsiness, dizziness, or gastrointestinal symptoms. Healthcare providers assess the presence and impact of side effects through patient reports and objective observations.

7. Treatment adherence. Evaluation also involves assessing the patient’s adherence to the prescribed gabapentin regimen. The desired outcome is consistent and proper use of the medication as instructed. Healthcare providers may inquire about medication adherence, assess refill history, or use other measures to determine compliance.

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Gil Wayne ignites the minds of future nurses through his work as a part-time nurse instructor, writer, and contributor for Nurseslabs, striving to inspire the next generation to reach their full potential and elevate the nursing profession.

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