Gabapentin

Gabapentin is a anticonvulsant / neuropathic pain agent (gabapentinoid) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

Doctors prescribe Gabapentin for:

• Neuropathic pain — burning, shooting or electric-shock-like pain from diabetic peripheral neuropathy, post-herpetic neuralgia (after shingles), nerve injury or nerve compression
• Epilepsy — as add-on treatment for focal (partial) seizures in adults and children, at the specialist's discretion
• Sometimes, on specialist advice, for restless legs syndrome or certain chronic pain conditions

Gabapentin is a prescription-only medicine. It does not help ordinary musculoskeletal pain, and it should never be taken casually as a general painkiller or sleep aid.

Gabapentin is strictly prescription-only; your doctor will set and adjust your dose. General information:

• Adults: treatment usually starts low — for example 300 mg at night on day 1, 300 mg twice daily on day 2, 300 mg three times daily on day 3 — then increases gradually as needed, commonly up to 900–3600 mg per day in three divided doses.
• Kidney disease: the dose must be reduced — gabapentin is cleared by the kidneys.
• Spread doses evenly; do not let more than 12 hours pass between doses in epilepsy.

Never stop Gabapentin suddenly — abrupt withdrawal can cause anxiety, insomnia, nausea, pain flare-ups and, in epilepsy, rebound seizures. The dose should be tapered over at least a week under your doctor's guidance. Avoid alcohol and be careful driving until you know how drowsy it makes you.

Common side effects of Gabapentin, especially in the first weeks or after dose increases:

• Dizziness and drowsiness — the most frequent; usually eases as the body adjusts
• Unsteadiness, poor coordination
• Fatigue, blurred or double vision
• Swelling of the feet and ankles
• Weight gain, increased appetite
• Dry mouth, constipation or nausea

Seek medical help urgently for: rash with fever and swollen glands (rare severe reaction), unusual mood changes or thoughts of self-harm, severe dizziness with falls, breathing difficulty (particularly in elderly people, those with lung disease, or when combined with opioids or sedatives).

Take these precautions with Gabapentin:

• Use only as prescribed, and never stop suddenly — taper gradually under medical guidance.
• Avoid alcohol: it greatly increases dizziness and drowsiness.
• Driving caution: do not drive, ride or operate machinery until you are sure the medicine does not impair you — particularly in the first weeks and after every dose increase.
• Combining with opioids (such as tramadol or morphine) or other sedatives increases the risk of dangerous breathing suppression — only do so under close medical supervision.
• Tell your doctor about kidney disease, breathing problems, depression, mood disorders or any history of substance misuse — gabapentin has some misuse potential and should be used carefully in such cases.
• Elderly people are more prone to dizziness, unsteadiness and falls.

Tell your doctor about all your medicines. Important interactions with Gabapentin:

• Opioid painkillers (tramadol, morphine, codeine) — increased sedation and risk of serious breathing suppression; morphine can also raise gabapentin levels.
• Alcohol, sleeping pills, benzodiazepines and sedating antihistamines — additive drowsiness and unsteadiness.
• Antacids containing aluminium or magnesium — reduce gabapentin absorption; keep a gap of at least 2 hours.
• Pregabalin or other sedating nerve-pain medicines — combined use only on specialist advice.

Gabapentin must not be used in:

• Known allergy to Gabapentin or any ingredient of the preparation

Use with special caution — and only under close medical supervision — in people with significant kidney impairment (dose must be reduced), severe breathing problems, a history of drug or alcohol misuse, depression with self-harm thoughts, and in the elderly. It is not a first-line medicine for children except in specific seizure indications decided by a specialist.

Pregnancy: safety data for Gabapentin in pregnancy are limited. Gabapentin should be used only if the doctor judges the benefit clearly outweighs the risk. If you take it for epilepsy, do not stop suddenly on discovering a pregnancy — uncontrolled seizures are also dangerous; contact your specialist promptly to review the plan and start folic acid as advised.

Breastfeeding: Gabapentin passes into breast milk in small amounts. Breastfeeding may be possible with medical agreement; observe the baby for unusual sleepiness or poor feeding and report concerns to your doctor.

Store Gabapentin below 30°C in a cool, dry place away from direct sunlight and moisture, in its original packaging. Keep it strictly out of the reach of children. Do not use the medicine after its expiry date, and return unused capsules or tablets to a pharmacy instead of throwing them into household waste.