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Patients with chronic kidney disease often receive inappropriately high gabapentin dosage for their kidney function, occasioning overt toxicity; advanced age and comorbidity predispose these patients for toxicity. Materials and methods: A retrospective analysis of adult CKD and end-stage kidney disease (ESKD) patients hospitalized from 2014 to 2020 and receiving GPs was conducted. Patients were grouped based on whether the average daily dose prescribed was higher than recommended (inappropriately dosed, (ID)) or as recommended (appropriately dosed (AD The short answer is: yes, gabapentin can be problematic for individuals with kidney failure and chronic kidney disease (CKD). While gabapentin is often prescribed for pain management, particularly nerve pain, and sometimes for seizures, its primary elimination pathway is through the kidneys. We found that patients with chronic kidney disease had elevated serum gabapentin concentrations, in some cases leading to gabapentin toxicity; those with advanced age and multiple comorbidities were more prone to the toxicity, and the toxicity tended to be underrecognized. The straightforward answer is yes, you can potentially take gabapentin if you have stage 3 kidney disease, but with significant caveats. It’s crucial to understand that gabapentin is primarily eliminated by the kidneys, meaning that impaired kidney function can lead to a buildup of the drug in your system. With a growing chronic kidney disease epidemic,22, 23 an increasing number of patients with chronic kidney disease will be exposed to gabapentin. This study demonstrates that gabapentin dosage for patients with chronic kidney disease has been insufficiently adjusted and that the risk of gabapentin toxicity has been underrecognized. Gabapentin’s apparent total clearance is 100 mL/min in adults with normal renal function, which is essentially equivalent to CrCl and does not suggest the involvement of tubular reabsorption. 1 Some evidence suggest that active tubular secretion mediated by organic cation transporter-1 (OCT-1) may play a role in gabapentin’s renal clearance. .table_layout tbody td{ font-size:0.95em;} Usual Gabapentin Dosing (Adults) Usual initial gabapentin dose: 300mg q8h. Usual maintenance dose: 300-600mg q8h. Maximum dosage/day: 3600 mg Gabapentin Renal Dosing [>60 ml/min]: Give usual dosage : Dosage range: 400-1400mg/day (divided doses - Usually bid) : Dosage range: 200-700mg/day. : 100-300 mg/day. Use lower end of this range for CRCL Myoclonus in renal failure: two cases of gabapentin toxicity. Kaufman KR, Parikh A, Chan L, Bridgeman M, Shah M. Epilepsy Behav Case Rep. 2014;2:8–10. doi: 10.1016/j.ebcr.2013.12.002. [PMC free article] [Google Scholar] 2. Rational dosing of gabapentin and pregabalin in chronic kidney disease. Although gabapentin is well known for its favorable pharmacokinetics, it is exclusively eliminated renally, and patients with chronic kidney disease are at risk for toxicity. Existing literature on such risk is lacking. Pain is one of the most common and distressing symptoms among patients with chronic kidney disease (CKD) . The prevalence of pain has been associated with substantially lower health-related quality of life and greater psychosocial distress, insomnia, and depressive symptoms [ 2-9 ]. This case report outlines a significant type of morbidity due to continued use of gabapentin during an episode of acute renal failure. Setting. University teaching hospital. Discussion. Gabapentin is widely used in the management of pain. Gabapentin isn’t known to cause liver or kidney problems. However, it can cause an allergic reaction called DRESS syndrome, which can lead to liver or kidney damage. But this is extremely rare. If you have existing kidney problems, your healthcare provider may start you at a lower gabapentin dose. Gabapentin is not absolutely contraindicated in kidney disease, but it demands meticulous management. The key to its safe use is careful dose adjustments, rigorous monitoring for toxicity, and an open dialogue with your healthcare provider. Here’s a scenario of using gabapentin in chronic kidney disease. A 42 year old African American man with a history of coronary artery disease and decompensated heart failure s/p heart transplant and chronic kidney disease presented to a hospital on 9/29/16 complaining of shortness of breath, dyspnea upon exertion and LE edema. Gabapentinoids are opioid substitutes whose elimination by the kidneys is reduced as kidney function declines. To inform their safe prescribing in older adults with chronic kidney disease (CKD), we examined the 30-day risk of serious adverse events according to the prescribed starting dose. Patients with chronic kidney disease often receive dangerously high gabapentin dosage for their kidney function, which can lead to all sorts of problems. An alternative we recommend instead of Gabapentin is Alpha Lipoic Acid. Chronic kidney disease has become a global epidemic, and frequently its significance has been underestimated. 22, 23 The present study revealed several deficiencies in our current state of care for patients with chronic kidney disease who are receiving long-term gabapentin. First, the gabapentin dosage adjustment for these patients was Some of its most common side effects include the following: ataxia, nystagmus, drowsiness, headaches, diplopia, fatigue and myoclonic twitches. 1 All of these effects appear quite often in patients with chronic kidney disease, especially if they are undergoing dialysis and their doses are not adjusted to their glomerular filtration rates. 2 We
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