Uraemic Pruritus / Neuropathic Pain in CKD Pregnancy: Risk related to antiepileptic medicines in general: the risk of birth defects is increased 2-3 fold in the offspring of mothers treated with an antiepileptic, most frequently cleft lip, cardiovascular malformations and neural tube defects, with multiple antiepileptic therapy carrying a higher risk than monotherapy — monotherapy should be practised whenever possible, specialist advice given to women of childbearing potential, and antiepileptic therapy must NOT be discontinued suddenly. Risk related to gabapentin: gabapentin crosses the human placenta; there is a limited amount of data in pregnant women and animal studies have shown reproductive toxicity, so the potential risk for humans is unknown and 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 — newborns should be monitored carefully. Breast-feeding: gabapentin is excreted in human milk; because the effect on the breast-fed infant is unknown, caution should be exercised and gabapentin should be used in breast-feeding mothers only if the benefits clearly outweigh the risks. Fertility: no effect on fertility in animal studies.

Gabapentin (CKD Dosing)

Brand names: Neurontin

Gabapentin in chronic kidney disease (the renal-dosing context) is a gabapentinoid used for neuropathic pain and as an adjunct in epilepsy; because it is cleared almost entirely by the kidneys, dosing must be reduced as renal function falls.

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: Initial titration for all indications (adults and adolescents aged 12 years and above): Day 1 — 300 mg once a day; Day 2 — 300 mg twice a day; Day 3 — 300 mg three times a day. Effective dosing range 900 to 3600 mg/day

Route: Oral — can be given with or without food, swallowed whole with sufficient fluid intake (e.g. a glass of water)

Frequency: The total daily dose should be divided into three single doses; the maximum time interval between doses should not exceed 12 hours

Max: 3600 mg/day (the stated maximum dose for both epilepsy and peripheral neuropathic pain). Dosages up to 4800 mg/day have been well tolerated in long-term open-label clinical studies. IN RENAL IMPAIRMENT THE TOTAL DAILY DOSE IS CAPPED BY CREATININE CLEARANCE — see renalAdjustment

Source: UK SPC (eMC) for Gabapentin 100 mg hard capsules, section 4.2 (https://www.medicines.org.uk/emc/product/100984/smpc). EPILEPSY (adults and adolescents): typically requires long-term therapy, dosage determined by the treating physician according to individual tolerance and efficacy. In clinical trials the effective dosing range was 900 to 3600 mg/day. Therapy may be initiated using the Table 1 titration OR by administering 300 mg three times a day on Day 1; thereafter, based on individual response and tolerability, the dose can be increased in 300 mg/day increments every 2-3 days up to a maximum of 3600 mg/day. Slower titration may be appropriate for individual patients. The minimum time to reach 1800 mg/day is one week, to reach 2400 mg/day is a total of 2 weeks, and to reach 3600 mg/day is a total of 3 weeks. It is not necessary to monitor gabapentin plasma concentrations, and gabapentin may be used with other antiepileptic medicines without concern for alteration of plasma/serum concentrations of either. PERIPHERAL NEUROPATHIC PAIN (adults): therapy may be initiated with the Table 1 titration, or alternatively the starting dose is 900 mg/day given as three equally divided doses; thereafter increase in 300 mg/day increments every 2-3 days up to a maximum of 3600 mg/day, with the same minimum titration times as above. Efficacy and safety in painful diabetic neuropathy and post-herpetic neuralgia have not been examined for treatment periods longer than 5 months; if a patient requires dosing beyond 5 months, the treating physician should assess clinical status and determine the need for additional therapy. DISCONTINUATION: if gabapentin has to be discontinued this should be done GRADUALLY OVER A MINIMUM OF 1 WEEK, independent of the indication. POOR GENERAL HEALTH (e.g. low body weight, after organ transplantation): the dose should be titrated more slowly, using smaller dosage strengths or longer intervals between dose increases. ELDERLY (over 65 years): may require dosage adjustment because of declining renal function with age (see renalAdjustment); somnolence, peripheral oedema and asthenia may be more frequent. CAPSULE STRENGTH NOTE: the SPC states that gabapentin 100 mg capsules can be used to follow the dosing recommendations for patients with renal insufficiency. SOURCE LIMITATION: eMC section 4.5 was NOT captured in this bundle — the interactions listed below are taken from section 7 of the US label (openFDA/DailyMed) and must be checked against the UK SPC. Sections 4.4 and 4.8 were truncated at the fetch limit.

Paediatric dose

Route: Oral, with or without food

Frequency: The total daily dose should be divided into three single doses; the maximum time interval between doses should not exceed 12 hours

Max: No absolute maximum is stated for children; dosages up to 50 mg/kg/day have been well tolerated in a long-term clinical study

EPILEPSY, children aged 6 years and above (section 4.2). dosePerKg is left null because the SPC states RANGES, not single per-kg values, and all figures are TOTAL DAILY doses. Verbatim: 'The starting dose should range from 10 to 15 mg/kg/day and the effective dose is reached by upward titration over a period of approximately three days. The effective dose of gabapentin in children aged 6 years and older is 25 to 35 mg/kg/day. Dosages up to 50 mg/kg/day have been well tolerated in a long-term clinical study.' Adults and adolescents aged 12 years and above use the adult titration scheme instead. The SPC gives no paediatric dosing for children under 6 years in the retrieved text, and no paediatric renal-impairment table (Table 2 is headed 'Dosage of Gabapentin in Adults Based on Renal Function'). Verify all paediatric dosing against a children's formulary.

Dose adjustments

Renal

DOSAGE ADJUSTMENT IS RECOMMENDED in patients with compromised renal function and/or those undergoing haemodialysis. SPC TABLE 2 — DOSAGE OF GABAPENTIN IN ADULTS BASED ON RENAL FUNCTION (creatinine clearance mL/min: total daily dose mg/day, administered as three divided doses): 80 or above — 900-3600; 50-79 — 600-1800; 30-49 — 300-900; 15-29 — 150 to 600; below 15 — 150 to 300. The 150 mg/day figure is to be administered as 300 mg EVERY OTHER DAY. For patients with creatinine clearance below 15 mL/min, the daily dose should be 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 that a patient with a creatinine clearance of 15 mL/min receives). Reduced dosages apply to all patients with creatinine clearance below 79 mL/min. HAEMODIALYSIS: for ANURIC patients undergoing haemodialysis who have NEVER received gabapentin, a loading dose of 300 to 400 mg is recommended, then 200 to 300 mg of gabapentin following each 4 hours of haemodialysis; on dialysis-free days there should be NO treatment with gabapentin. For renally impaired patients undergoing haemodialysis, the maintenance dose should be based on Table 2 above, and IN ADDITION to the maintenance dose an extra 200 to 300 mg dose following each 4-hour haemodialysis treatment is recommended. ELDERLY (over 65 years): may require dosage adjustment because of declining renal function with age, per Table 2. Gabapentin 100 mg capsules can be used to follow the dosing recommendations for patients with renal insufficiency.

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

Very common: somnolence, dizziness, ataxia; viral infection
Common: convulsions, hyperkinesias, dysarthria, amnesia, tremor, insomnia, headache, paraesthesia, hypaesthesia, abnormal coordination, nystagmus, increased/decreased/absent reflexes; visual disturbances such as amblyopia and diplopia; vertigo
Common: pneumonia, respiratory infection, urinary tract infection, otitis media; leucopenia; anorexia, increased appetite; hostility, confusion and emotional lability, depression, anxiety, nervousness, abnormal thinking; hypertension, vasodilatation; dyspnoea, bronchitis, pharyngitis, cough, rhinitis; vomiting, nausea, dental abnormalities, gingivitis, diarrhoea, abdominal pain, dyspepsia, constipation
Uncommon or rare: hyperglycaemia (most often in patients with diabetes) and rare hypoglycaemia; palpitations; hypokinesia, mental impairment; agitation; rare loss of consciousness; RARE RESPIRATORY DEPRESSION; allergic reactions such as urticaria
Frequency not known: anaphylaxis and hypersensitivity syndrome (a systemic reaction that can include fever, rash, hepatitis, lymphadenopathy and eosinophilia); thrombocytopenia; hyponatraemia; hallucinations, suicidal ideation, drug dependence; other movement disorders (choreoathetosis, dyskinesia, dystonia); tinnitus
NOTE: the section 4.8 list was truncated at the source-fetch limit, so this is not the complete adverse-reaction list

Interactions

US label section 7.1 — opioids: respiratory depression and sedation, sometimes resulting in death, have been reported following co-administration of gabapentin with opioids (e.g. morphine, hydrocodone, oxycodone, buprenorphine). With morphine, observe for signs of CNS depression such as somnolence, sedation and respiratory depression; gabapentin concentrations are increased by morphine and dose adjustment may be needed. Co-administration with hydrocodone decreases hydrocodone exposure — consider the potential for altered hydrocodone exposure and effect when gabapentin is started or stopped
US label section 7.2 — other antiepileptic drugs: gabapentin is not appreciably metabolised and does not interfere with the metabolism of commonly co-administered antiepileptic drugs
US label section 7.3 — antacids containing aluminium and magnesium hydroxides reduced the mean bioavailability of gabapentin by about 20%; it is recommended that gabapentin be taken at least 2 hours following antacid administration
Section 4.6 of the UK SPC also notes that co-exposure to gabapentin and opioids during pregnancy may increase the risk of neonatal withdrawal syndrome
eMC section 4.5 was not captured in the source bundle and must be checked on the SPC

Clinical monograph

How it works

It binds the alpha-2-delta subunit of voltage-gated calcium channels, reducing excitatory neurotransmitter release and modulating neuronal excitability.

Prescribing in practice

Renal clearance means accumulation and toxicity (sedation, confusion, myoclonus) occur readily in CKD, so reduce dose and frequency according to renal function and supplement after dialysis as directed.
Gabapentin is a controlled drug in the UK, and combining it with opioids increases the risk of respiratory depression and death.
Withdraw gradually rather than stopping abruptly to avoid seizures and discontinuation symptoms.

Monitoring

Monitor renal function and watch for signs of accumulation such as drowsiness, ataxia or confusion, particularly in advanced CKD and dialysis patients.

Counselling the patient

Lower doses are needed because your kidneys clear this drug; do not take more than prescribed.
Excessive drowsiness, confusion or muscle twitching may mean the dose is too high for your kidneys.
Do not stop suddenly, and avoid alcohol and other sedatives, especially opioids.

Evidence & guidelines

MHRA reclassified gabapentinoids as controlled drugs and warned of respiratory depression risk, particularly in renal impairment and with concomitant opioids.

Reference: MHRA DSU 2019 (Class C Controlled Drug); MHRA DSU 2017 (CKD Warning); ERA-EDTA Uraemic Pruritus Guidelines; SPC Neurontin; 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

Pathways