Neurontin

Renal impairment

Gabapentin is cleared almost entirely by glomerular filtration. Gabapentin clearance decreases in proportion to the decrease in creatinine clearance in patients with renal insufficiency.51 Following are the recommended decreases in gabapentin dosing rate as a function of decreased creatinine clearance:

Creatinine clearance (mL/min)	Total daily dose (mg/day)	Dose regimen (mg)
> 60	1,200	400 t.i.d.
30–60	600	300 b.i.d.
15–30	300	300 q.d.
< 15	150	300 q.o.d.

Hemodialysis

Gabapentin is water soluble, has low protein binding, and has a low volume of distribution. Large amounts of gabapentin are lost during hemodialysis.52 A loading dose of 200–300 mg of gabapentin following each 4 hours of hemodialysis is recommended.51,53

Adapted from: Browne TR. Renal disorders. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;49-62.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised February 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.