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Uraemic Pruritus / Neuropathic Pain in CKD

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.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

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. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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