Anticonvulsant / Neuropathic Pain Pregnancy: C — teratogenic risk (neural tube defects in some studies)

Gabapentin

Brand names: Neurontin

Adult dose

Dose: 300mg at night initially, titrating to 900–3600mg/day in divided doses

Route: Oral

Frequency: Three times daily

Neuropathic pain: start 300mg OD night 1, 300mg BD night 2, 300mg TDS night 3, then titrate. Renal impairment: dose reduce based on CrCl.

Clinical pearls

Class C controlled drug in UK since 2019 — enhanced prescribing requirements and addiction risk
CAUTION with opioids: RCT evidence of increased respiratory depression and death
Perioperative use (multimodal analgesia): controversial, especially in opioid-dependent patients
Must taper off slowly — abrupt cessation causes withdrawal (anxiety, insomnia, pain)
First-line for: diabetic neuropathy, PHN, central sensitisation pain syndromes

Contraindications

Class C Controlled Drug in UK — assess abuse potential before prescribing

Side effects

Drowsiness
Dizziness
Ataxia
Peripheral oedema
Weight gain
Respiratory depression (high doses or with opioids)

Interactions

Opioids — synergistic CNS/respiratory depression (INCREASED RISK OF DEATH)
Alcohol — additive CNS depression
Antacids — reduce absorption (separate by 2h)

Monitoring

Renal function (dose adjustment required)
Respiratory rate (if co-prescribed opioids)
Weight
Signs of misuse/dependency

Reference: NICE NG193 (Neuropathic Pain); MHRA Class C Reclassification 2019. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pregabalin · Anticonvulsant / Neuropathic Pain

Pathways