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Anticonvulsant / Perioperative Analgesic Adjunct Pregnancy: Avoid in pregnancy — teratogenicity signal

Gabapentin (Perioperative)

Brand names: Neurontin

Adult dose

Dose: 300-600 mg orally 1-2 hours pre-operatively; 300 mg three times daily post-operatively
Route: Oral
Frequency: Pre-operative single dose; post-operative three times daily for 2-5 days
Max: 1800 mg/day (perioperative analgesic context)
Pre-emptive analgesia: single dose 1-2 hours before surgery reduces post-operative opioid requirements. Post-operative: continue for 2-5 days as part of multimodal analgesia

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: Oral
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion — limited evidence in paediatric perioperative use

Dose adjustments

Renal

Significant dose reduction required: eGFR 30-59: max 900 mg/day; eGFR under 30: max 300 mg/day

Hepatic

No adjustment required

Paediatric weight-based calculator

Seek specialist opinion — limited evidence in paediatric perioperative use

Clinical pearls

  • MHRA 2017: Gabapentin with opioids associated with fatal respiratory depression — perioperative monitoring essential when combining; titrate carefully
  • UK Schedule 3 Controlled Drug since 2019 — prescription and dispensing requirements apply
  • Meta-analyses (Tiippana 2007, Doleman 2015): pre-operative gabapentin reduces post-operative opioid consumption by 20-35% and pain scores — beneficial as part of enhanced recovery programmes
  • Sedation and dizziness: dose-dependent; elderly patients at higher fall risk post-operatively — use 300 mg and monitor carefully
  • Pre-emptive vs preventive analgesia: debate exists about timing; most evidence supports 300-600 mg given 1-2 hours before surgery for opioid-sparing effect

Contraindications

  • Hypersensitivity to gabapentin

Side effects

  • Sedation and dizziness (dose-dependent — increased fall risk post-operatively)
  • Respiratory depression (MHRA 2017 — especially with opioids)
  • Nausea
  • Visual disturbances

Interactions

  • Opioids (additive CNS and respiratory depression — MHRA 2017 alert)
  • Antacids containing aluminium/magnesium (reduce absorption)
  • Alcohol (additive CNS depression)

Monitoring

  • Sedation score post-operatively
  • Respiratory rate and SpO2 (if on concurrent opioids)
  • Pain scores
  • Fall risk assessment

Reference: BNFc; BNF 90; MHRA Drug Safety Update 2017; Tiippana et al. (2007) meta-analysis; PROSPECT Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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