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Gabapentin The use of gabapentin for restless legs syndrome (RLS) is off-label. Initial dose: 300 mg if the person is under 65 years old and 100 mg if the person is over 65 years old. Titration: maximum recommended dose for RLS is 2700 mg. CKS did not identify any specific guidance on dose titration for use in RLS. However, for other gabapentin enacarbil (Horizant, Gralise, Neurontin), a drug prescribed for the treating nerve damage from shingles, postherpetic neuralgia, and restless leg syndrome. Dizziness, somnolence, ataxia, fatigue, and drowsiness are the most common side effects. Identify the appropriate indications for gabapentin therapy, including neuropathic pain, partial onset seizures, restless legs syndrome, and other relevant neurological and psychiatric conditions. Detailed Gabapentin dosage information for adults and children. Includes dosages for Restless Legs Syndrome, Epilepsy and Postherpetic Neuralgia; plus renal, liver and dialysis adjustments. A dose of 600 mg/day provides significant improvement to patients with moderate to severe primary RLS, but a dose of 1,200 mg/day may be more effective for patients with severe primary RLS. The most frequent adverse events associated with gabapentin enacarbil are somnolence and dizziness. Pooled Analyses of Three Clinical Trials When discontinuing HORIZANT, patients with RLS receiving 600 mg or less once daily can discontinue the drug without tapering. If the recommended dose is exceeded, the dose should be reduced to 600 mg daily for 1 week prior to discontinuation to minimize the potential of withdrawal seizure. Gabapentin enacarbil has theoretical pharmacokinetic advantages over gabapentin, and as such, could also be considered if a patient fails gabapentin RLS therapy. The dose of gabapentin for the treatment of RLS is 300–1800 mg daily, typically administered in two to three doses throughout the day. In moderate to severe primary restless legs syndrome (RLS), clinicians should consider prescribing a pharmacologic agent to reduce RLS symptoms: Strong Evidence Pramipexole, rotigotine, cabergoline*, and gabapentin enacarbil (Level A). For adults with RLS, the guideline provides a strong recommendation for intravenous ferric carboxymaltose and conditional recommendations for two other formulations of intravenous iron and one formulation of oral iron — ferrous sulfate. Most RLS patients require 1200 to 1800 mg of gabapentin daily, but doses up to 3600 mg daily can be used. Because of nonlinear kinetics and substantial interindividual variability, the gabapentin dose often does not always reflect serum level, especially at single doses above 600 mg. Gabapentin enacarbil may have two distinct therapeutic doses for the treatment of RLS: 600 mg/day or lower doses for the treatment of subjective RLS symptoms and 1,200 mg/day or higher doses for the treatment of both subjective RLS symptoms and associated problems such as severe sleep disturbances. Gabapentin is a prescription drug sold under the brand name Neurontin, Horizant, and others that is used to treat symptoms of restless legs syndrome (RLS) as well as partial seizures and postherpetic neuralgia. Detailed dosage guidelines and administration information for Horizant (gabapentin enacarbil). Includes dose adjustments, warnings and precautions. Horizant ® offers single-step titration and reaches therapeutic dose within 4 days 1. No titration is required. Patients should take once daily at about 5 PM 1. Tablets should be swallowed whole and should not be cut, crushed, or chewed. Tablets should be taken with food. For oral dosage form (extended-release tablets): For restless legs syndrome: Adults—600 milligrams (mg) as a single dose at about 5 PM. Your doctor may adjust your dose as needed and tolerated. Children—Use and dose must be determined by your doctor. For postherpetic neuralgia: When discontinuing HORIZANT, patients with RLS receiving 600 mg or less once daily can discontinue the drug without tapering. If the recommended dose is exceeded, the dose should be reduced to 600 mg daily for 1 week prior to discontinuation to minimize the potential of withdrawal seizure. Most RLS patients require 1200 to 1800 mg of gabapentin daily, but doses up to 3600 mg daily can be used. Because of nonlinear kinetics and substantial interindividual variability, the gabapentin dose often does not always reflect serum level, especially at single doses above 600 mg. The use of gabapentin for restless legs syndrome (RLS) is off-label. Initial dose of 300 mg if the person is under 65 years old and 100 mg if the person is over 65 years old. Maximum recommended dose for RLS is 2700 mg. CKS did not identify any specific guidance on dose titration for use in RLS.
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