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Neurology > Gabapentin > Flashcards

Gabapentin Flashcards

1
Q

What are the indications of gabapentin?

A

Adjunctive treatment/monotherapy in focal seizures with or without secondary generalisation

Peripheral neuropathic pain

Menopausal symptoms, especially hot flushes, in women with breast cancer

Oscillopsia/spasticity in multiple sclerosis

Muscular symptoms in MND

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2
Q

What is the pharmacodynamic of gabapentin?

A

A GABA analogue

Inhibits the release of excitatory neurotransmitters

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3
Q

What is the pharmacokinetic of gabapentin?

A

Oral bioavailability = 27(at 4800mg/day)-60(900mg/day)% (dose dependent)

Protein binding = <3%

Half-life = 5-7 hours (in patients with normal renal function)

Metabolism = not appreciably metabolized

Excretion = 100% in urine as unchanged drug (kidney)

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4
Q

What are the cautions for gabapentin?

A

Diabetes

Elderly

High doses of oral solution in adolescents and adults with LBW

Hx of substance abuse

Respiratory depression

Seizures (may be exacerbated)

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5
Q

In which group of patients may gabapentin exacerbate seizures?

A

Absence or myoclonic seizures (including juvenile myoclonic epilepsy)

Tonic/atonic seizures

Dravet syndrome

Lennox-Gastaut syndrome

Myoclonic-atonic seizures

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6
Q

What are the different strengths of gabapentin capsules?

A

100mg

300mg

400mg

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7
Q

What are the different strengths of gabapentin tablets?

A

600mg

800mg

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8
Q

What is the liquid gabapentin equivalent to?

A

100mg tablet or capsule

Usually 2ml

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9
Q

What is the usual dose of gabapentin for epilepsy in adults/older children (aged 12-17 years) and neuropathic pain in adults?

A

900-3600mg

given in 3 divided doses

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10
Q

What is the usual dose of gabapentin for epilepsy in younger children (aged 6-12 years)?

A

Usually 25-35mg/kg given in 3 divided doses

Max 70mg/kg given in 3 divided doses

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11
Q

How would you advice patients to take gabapentin?

A

Swallow capsules and tablets whole with a drink of water or juice - do not chew them

Gabapentin can be taken with/without food

Space dose evenly throughout the day (e.g., first thing in the morning, early afternoon and at bedtime)

For liquid form, use the provided plastic syringe or spoon to measure the dose (ask pharmacist for one if they do not have it?

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12
Q

What should patients do if they forget to take a dose of gabapentin?

A

Take it as soon as they remember

If its within 2 hours of the next dose, they should skip the missed dose and take the next dose as normal

Never take 2 doses at the same time

Never take an extra dose to make up for a missed one

If they forget regularly, set an alarm to help remind them. They could also ask their pharmacists for advice on ways to help them remember

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12
Q

What should patients do if they forget to take a dose of gabapentin?

A

Take it as soon as they remember

If its within 2 hours of the next dose, they should skip the missed dose and take the next dose as normal

Never take 2 doses at the same time

Never take an extra dose to make up for a missed one

If they forget regularly, set an alarm to help remind them. They could also ask their pharmacists for advice on ways to help them remember

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13
Q

Can patients stop taking gabapentin even if they feel fine?

A

Important that they do not stop taking gabapentin suddenly even if they feel fine

For those with epilepsy, stopping gabapentin suddenly can cause status epilepticus

They may have severe withdrawal syndrome if stopped suddenly

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14
Q

What are the symptoms in severe withdrawal syndrome after sudden withdrawal of gabapentin?

A

Anxiety

Difficulty sleeping

Feeling sick

Pain

Sweating

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15
Q

How can withdrawal syndrome/seizures be prevented?

A

By gradually reducing the dose of gabapentin

16
Q

What are the common side effects of gabapentin?

A

Feeling sleepy, tired or dizzy

N+V

Diarrhoea

Mood changes

Swollen arms and legs

Blurred vision

Dry mouth

Difficulty getting an erection

Weight gain

Memory problems

Headaches

Leucopenia (increased susceptibility to infections)

Vertigo

Tremor

Dyspnoea/cough

17
Q

What are the serious side effects of gabapentin? What should patients do if they experience them?

A

Self-harm/suicidal thoughts

High temperature, lymphadenopathy that does not go away, jaundice, unusual bruises/bleeding, severe tiredness/weakness, unexpected muscle pain or weakness with or without a rash - could be symptoms of a serious reaction

Long-lasting stomach pain, N/V - pancreatitis

Muscle pain/weakness and having dialysis for renal failure

Hallucinations

Advice patient to call a doctor or 111 immediately

18
Q

What is the advice around taking gabapentin in pregnancy and breastfeeding?

A

Pregnancy = avoid unless benefits outweigh risks

Breastfeeding = can continue taking gabapentin if baby is healthy

If woman is on gabapentin whilst breastfeeding and notices that their baby is not feeding well as usual, seems unusually sleepy, has a stomach upset of if they have any other concerns they should talk to their doctor, pharmacists, health visitor or midwife

19
Q

TRUE OR FALSE

Gabapentin negatively affects fertility

A

FALSE

No evidence to suggests gabapentin reduces fertility in either men or women

20
Q

What are the dose adjustments for those that have renal impairment?

A

600‒1800 mg daily in 3 divided doses if creatinine clearance 50‒79 mL/minute.

300‒900 mg daily in 3 divided doses if creatinine clearance 30‒49 mL/minute.

150‒600 mg daily in 3 divided doses if creatinine clearance 15‒29 mL/minute (150 mg daily dose to be given as 300 mg in 3 divided doses on alternate days).

150‒300 mg daily in 3 divided doses if creatinine clearance is less than 15 mL/minute (150 mg daily dose to be given as 300 mg in 3 divided doses on alternate days)

21
Q

What are the interactions for gabapentin?

A

No significant drug interaction but:

Antacids + gabapentin = reduced amount of gabapentin in the body - to prevent this take the antacid at least 2 hours before of after gabapentin dose

Strong analgesics (e.g., morphine) + gabapentin = increased tiredness and dizzy

Antidepressants (e.g., amitriptyline, fluoxetine) + gabapentin = increased risk of hyponatraemia

Antipsychotics (e.g., clozapine, quetiapine, risperidone) + gabapentin = CNS depressant effects - can impair ability to perform skilled tasks e.g., driving

22
Q

What effect can gabapentin have on lab tests?

A

False +ve readings for some urinary protein tests

23
Q

Sources

A

https://bnf.nice.org.uk/drugs/gabapentin/

https://go.drugbank.com/drugs/DB00996

https://www.nhs.uk/medicines/gabapentin/taking-gabapentin-with-other-medicines-and-herbal-supplements/

Neurology (12 decks)

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