Anticonvulsant / Neuropathic Analgesic Pregnancy: Gabapentin crosses the human placenta; there is a limited amount of data in pregnant women and animal studies have shown reproductive toxicity. Gabapentin should not be used during pregnancy unless the potential benefit to the mother clearly outweighs the potential risk to the foetus. Neonatal withdrawal syndrome has been reported in newborns exposed in utero, and co-exposure to gabapentin and opioids during pregnancy may increase that risk — monitor newborns carefully. Gabapentin is excreted in human milk; use in breast-feeding mothers only if the benefits clearly outweigh the risks. Fertility: no effect in animal studies.

Gabapentin (Burns — Neuropathic Pain)

Brand names: Neurontin

Gabapentin is a gabapentinoid anticonvulsant used as an adjunct for neuropathic and itch-related pain in burns, where injured skin and nerves generate persistent dysaesthesia and pruritus.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Peripheral neuropathic pain: starting dose 900 mg/day given as three equally divided doses; alternatively initiate by titration — Day 1: 300 mg once a day, Day 2: 300 mg two times a day, Day 3: 300 mg three times a day

Route: Oral (with or without food; swallow whole with sufficient fluid)

Frequency: Three divided doses daily; the maximum time interval between doses should not exceed 12 hours

Max: 3600 mg/day

Fetched UK SPC is Gabapentin 100 mg hard capsules (https://www.medicines.org.uk/emc/product/100984/smpc). Titration: based on individual patient response and tolerability, the dose can be increased in 300 mg/day increments every 2-3 days up to the maximum of 3600 mg/day; slower titration may be appropriate for individual patients. Minimum time to reach 1800 mg/day is one week, to reach 2400 mg/day a total of 2 weeks, and to reach 3600 mg/day a total of 3 weeks. In peripheral neuropathic pain (painful diabetic neuropathy, post-herpetic neuralgia) efficacy and safety have not been examined in clinical studies for treatment periods longer than 5 months; if dosing beyond 5 months is required, the treating physician should assess clinical status and the need for additional therapy. In patients with poor general health (low body weight, after organ transplantation, etc.) titrate more slowly, using smaller dosage strengths or longer intervals between increases. Discontinuation: if gabapentin has to be stopped, do so gradually over a minimum of 1 week, independent of the indication. Elderly (over 65 years): may require dosage adjustment because of declining renal function with age; somnolence, peripheral oedema and asthenia may be more frequent. Concomitant CNS depressants and opioids: observe carefully for CNS depression, somnolence, sedation and respiratory depression (§4.4). For reference, the SPC's other indication — EPILEPSY in adults and adolescents — uses an effective dosing range of 900 to 3600 mg/day, three times daily. PAEDIATRIC: the SPC gives NO paediatric dose for neuropathic pain. The only per-kg paediatric figures in §4.2 are for EPILEPSY in children aged 6 years and above (starting dose 10 to 15 mg/kg/day titrated upward over about three days, effective dose 25 to 35 mg/kg/day, dosages up to 50 mg/kg/day well tolerated in a long-term study, total daily dose divided into three single doses with no more than 12 hours between doses) — those are for epilepsy only and must not be carried onto this neuropathic-pain page. Verify any under-18 dosing against a children's formulary.

Dose adjustments

Renal

Dosage adjustment is recommended in compromised renal function (total daily dose, given as three divided doses): creatinine clearance 80 ml/min or above — 900-3600 mg/day; 50-79 ml/min — 600-1800 mg/day; 30-49 ml/min — 300-900 mg/day; 15-29 ml/min — 150 mg every other day to 600 mg/day; below 15 ml/min — 150 mg every other day to 300 mg/day, with the daily dose reduced in proportion to creatinine clearance (e.g. a patient with a creatinine clearance of 7.5 ml/min should receive one-half the daily dose given at 15 ml/min). Haemodialysis: for anuric patients on haemodialysis who have never received gabapentin, a loading dose of 300 to 400 mg then 200 to 300 mg following each 4 hours of haemodialysis, with no treatment on dialysis-free days; for renally impaired patients on haemodialysis, base the maintenance dose on the table above plus an additional 200 to 300 mg after each 4-hour haemodialysis treatment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Somnolence, dizziness and ataxia (very common)
Headache, insomnia, tremor, amnesia, dysarthria, paraesthesia, nystagmus, convulsions (common)
Nausea, vomiting, diarrhoea, abdominal pain, dyspepsia, constipation, dry mouth or throat (common)
Peripheral/facial oedema, rash, pruritus, purpura, fatigue, hypertension, vasodilatation (common)
Viral infection (very common); pneumonia, respiratory infection, urinary tract infection, otitis media, leucopenia (common)
Rare but serious: respiratory depression, anaphylaxis and hypersensitivity syndrome, Stevens-Johnson syndrome / toxic epidermal necrolysis, pancreatitis, hepatitis and jaundice, suicidal ideation (frequency not known)

Interactions

Opioids (e.g. morphine, hydrocodone, oxycodone, buprenorphine) — respiratory depression and sedation, sometimes resulting in death, have been reported with coadministration; observe closely for CNS depression (eMC §4.4; US label §7.1)
Other CNS depressants — carefully observe for somnolence, sedation and respiratory depression (eMC §4.4)
Morphine — gabapentin concentrations increased; dose adjustment may be needed (US label §7.1)
Hydrocodone — coadministration decreases hydrocodone exposure; consider the effect when gabapentin is started or stopped (US label §7.1)
Antacids containing aluminium and magnesium hydroxides — gabapentin bioavailability reduced by about 20%; take gabapentin at least 2 hours after the antacid (US label §7.3)
Other antiepileptic drugs — gabapentin is not appreciably metabolised and does not interfere with their metabolism (US label §7.2). The eMC §4.5 was not captured in this fetch; verify against the UK SPC

Clinical monograph

How it works

It binds the alpha-2-delta subunit of voltage-gated calcium channels, reducing excitatory neurotransmitter release and dampening central sensitisation in damaged sensory pathways.

Prescribing in practice

Combined with opioids it potentiates central nervous system and respiratory depression — a recognised cause of fatal overdose — so titrate cautiously and review concurrent sedatives in burns patients.
Doses must be reduced in renal impairment, as gabapentin is cleared unchanged by the kidneys and accumulates if function is reduced.
Withdraw gradually rather than stopping abruptly to avoid rebound symptoms, and titrate up slowly to limit sedation and dizziness.

Monitoring

Monitor pain and itch scores, sedation and respiratory status (especially alongside opioids), and renal function when dosing in impairment.

Counselling the patient

Drowsiness and dizziness are common, particularly when starting or increasing the dose — take care with tasks needing alertness.
Do not stop suddenly, and tell the team about any breathing problems or excessive sleepiness.

Evidence & guidelines

Gabapentin is a controlled drug in the UK following MHRA warnings about respiratory depression and misuse risk, particularly when combined with opioids or other CNS depressants.

Reference: MHRA Drug Safety Update 2017 (Gabapentinoids); BBA Burns Pain and Itch Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs