Gabapentin (Burns — Neuropathic Pain)

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.