Linda asked
How long should a patient go between doses on Neurontin? I receive 600 mg tablet at 8 a.m. and by mid afternoon it has worn off. I don't get another one until 8 p.m. Is there any information that shows how long that medicine lasts before you need to up the dose?
Answer
Neurontin (gabapentin) is an anti-epileptic (seizure) medication that is also used for pain and restless leg syndrome. Gabapentin comes as an immediate tablet or capsule and is typically doses 2-3 times a day. This translates to dosing of every 8 to 12 hours. Gabapentin also comes in an extended release formulation in the name of Gralise or Horizant. Both extended release formulations are dosed once daily.
The exact mechanism of action of gabapentin in unknown but it is effective in treating neuropathic pain (i.e. nerve type pain), its most common use. It is often the drug of choice for diabetic nerve pain that causes tingling and numbness as well as postherpetic neuralgia (nerve pain caused by herpes or shingles virus).
Gabapentin has a short half life of 5-7 hours and as mentioned, the immediate release formulations are typically dosed three times a day in people with healthy kidney function. The extended release Gralise or Horizant may provide patients with longer steady pain coverage, however they often come with a hefty price tag
When starting gabapentin, it is usually titrated up to an effective dose to avoid side effects. Gabapentin commonly causes sedation and drowsiness and increasing your dose slowly helps to mitigate these adverse reactions.Typically, prescribers start patients with 300 mg once daily on day one, then 300 mg twice daily on day two, and then 300 mg three times daily on day 3. Maximum maintenance doses typically range from 900 mg daily to 3,600 mg daily.
If you are taking your gabapentin twice daily, the assumption is you are on the immediate release form. It may be a good idea to speak with your doctor about adding the recommended third dose, especially since you are finding pain relief is wearing off mid-afternoon. The doctor may have a good reason for having only dosed you twice daily. They may be concerned about your level of drowsiness and mental functioning in the afternoon, and that is why they skipped the dose. Let them know your concerns about this and see if they can get you on a regimen for you that works better in your situation.
