Top 100: Gabapentin and Pregabalin

Question 1

1) What types of epilepsy are gabapentin and pregabalin used to treat?
2) what types of epilepsy should they be avoided in?

Answer 1

1) Used in focal seizures with or without secondary generalisation (Gaba can be used as monotherapy)
2) They are not recommended in absence and myoclonic seizures

Question 2

What are the main side effects gabapentin and pregabalin? (3)

Answer 2

1) Drowsiness, dizziness and ataxia, which usually improve over the first few weeks of treatment
↳ warn patients about drowsiness and driving/machinery

Question 3

which patients should gabapentin and pregabalin be used in caution in?

Answer 3

Both drugs depend on the kidneys for their elimination, so reduce dose in renal impairment

Question 4

outline some of the important interactions with regards to gabapentin and pregabalin

Answer 4

1) Sedative effects enhanced when combined with other sedating drugs (e.g. benzodiazepines)
2) gabapentin- false positive readings with some urinary protein tests

Question 5

why are gabapentin and pregabalin particularly useful where combination regimens are necessary?

Answer 5

Few drug interactions – in contrast to many other antiepileptic drugs, e.g. carbamazepine, lamotrigine and valproate

Question 6

How should the dose of gabapentin and pregabalin be initiated?

Answer 6

1) Should be started at a low dose to improve tolerability

2) Dose increased over days and weeks the optimal balance between benefits and side effects is reached

Question 7

Outline the important safety/MHRA warning with regards to gabapentin?

Answer 7

1) associated with risk of severe respiratory depression even without concomitant opioid therapy
2) propylene glycol, acesulfame K and saccharin may exceed the recommended WHO daily intake limits with high doses of oral solution

Question 8

Outline the important safety information regarding the use of Thiopental midozolam and lorazepam in status epilepticus

Answer 8

1) only administered by,personnel experienced in its use, with adequate training in anaesthesia and airway management
2) Risk of driving or undertaking skilled tasks- risk extends to at least 24 hours after administration. Avoid alcohol