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Anticonvulsant / Neuropathic Analgesic Pregnancy: Avoid — neonatal abstinence syndrome reported; limited human data. Use only if no alternative.

Gabapentin (Burns — Neuropathic Pain)

Brand names: Neurontin

Adult dose

Dose: Start 300 mg at night; titrate to 300–900 mg three times daily
Route: Oral
Frequency: Three times daily
Max: 3600 mg/day
Used for neuropathic post-burn pain, pruritus (itch) in healing burns, and as opioid-sparing adjunct. Start low (300 mg nocte) and titrate over 1–2 weeks. Also effective for post-burn itch — one of the most distressing symptoms during healing.

Paediatric dose

Dose: 5 mg/day/kg
Route: Oral
Frequency: Three times daily
Max: 50 mg/kg/day
Children ≥6 years: 10–15 mg/kg/day in 3 divided doses (titrate). Children 3–5 years: 40 mg/kg/day in 3 divided doses.

Dose adjustments

Renal

Significant dose reduction required: eGFR 30–59: max 1400 mg/day; eGFR 15–29: max 700 mg/day; eGFR <15: max 300 mg/day.

Hepatic

No dose adjustment required — not hepatically metabolised.

Paediatric weight-based calculator

Children ≥6 years: 10–15 mg/kg/day in 3 divided doses (titrate). Children 3–5 years: 40 mg/kg/day in 3 divided doses.

Clinical pearls

  • MHRA 2017: gabapentinoids + opioids — warning of potentially fatal respiratory depression. Review all concurrent opioid prescriptions before initiating.
  • Post-burn itch: gabapentin is first-line pharmacological treatment for neuropathic pruritus in healing burns — significant symptom relief at 300–900 mg TDS
  • Gabapentin vs. pregabalin: gabapentin has non-linear absorption (saturable transport) — absorption decreases at higher doses. Pregabalin has linear absorption — more predictable. Both are Schedule 3 CDs since 2019.

Contraindications

  • Hypersensitivity to gabapentin

Side effects

  • Dizziness and somnolence (very common)
  • Ataxia
  • Peripheral oedema
  • Weight gain
  • Blurred vision
  • Cognitive impairment
  • Respiratory depression (with opioids — MHRA 2017 warning)

Interactions

  • Opioids (additive respiratory depression — MHRA safety warning)
  • CNS depressants (additive sedation)
  • Antacids (reduce gabapentin absorption by 20% — separate by 2 hours)
  • Morphine (increases gabapentin levels)

Monitoring

  • Pain and itch scores (NRS)
  • Sedation and dizziness
  • Respiratory rate (with opioids)
  • Renal function (dose adjustment)

Reference: BNFc; BNF 90; MHRA Drug Safety Update 2017 (Gabapentinoids); BBA Burns Pain and Itch Guidelines; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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