Neuronstad

Rx

Indications

• Adjunctive therapy in the treatment of partial seizures.
• Treatment of peripheral neuropathic pain, pain after zoster.

Dosage

Antiepileptic

• Adults and children older than 12 years of age:
  300 mg, once on the first day, twice on the second day, three times on the third day.Thereafter, the dose can be further increased in 300 mg daily increments until reaching the effective dose, usually 900 – 1800 mg daily, given in three divided doses; the maximum dose is 2400 mg daily. The total daily dose should be taken in equally divided doses and the maximum dosage interval should not exceed 12 hours. Higher doses can be divided into 4 times daily.
• Patients with renal impairment and undergoing hemodialysis:
  Clcr = 50 – 70 ml/min: 600 – 1200 mg daily, in 3 divided doses;
  Clcr = 30 – 49 ml/min: 300 – 600 mg daily, in 3 divided doses;
  Clcr = 15 – 29 ml/min: 300 mg daily, in 3 divided doses;
  Clcr < 15 ml/min: 300 mg on alternate days, in 3 divided doses;
  The loading dose is 300 – 400 mg for patients first use gabapentin, then 200 – 300 mg following each 4 hours of hemodialysis.
• Children aged 6 to 12 years, weighing 30 – 36 kg:
  The three first days: 300 mg once daily; the normal dose and the maintenance dose: 300 mg, 3 times daily. Some children cannot tolerate add to daily, prolonged period of increase (up to weekly) may be more appropriate.

The treatment of peripheral neuropathic pain, pain after zoster

• Adults:
  Maximum dose is 1800 mg daily, given in three divided doses. Or administered as 300 mg, once on the first day, twice on the second day, three times on the third day. Thereafter, the dose can be further increased in 300 mg daily, until dose increased up to a maximum of 1800 mg daily, given in three divided doses.
• Elderly patients:
  Require dosage adjustment.

Usage

• Neuronstad is administered orally, the drug may be administered without regard to meals.
• Neuronstad is used as an adjunctive therapy in combination with other antiepilepsies. Gabapentin monotherapy may not be effective.

• Hypersensitivity to gabapentin or to any of the ingredients.

Common

• Ataxia, nystagmus, fatigue, dizziness, edema, drowsiness, amnesia;
• Dyspepsia, dry mouth, constipation, abdominal pain, and diarrhea;
• Peripheral edema;
• Rhinitis, pharyngitis, cough, pneumonia;
• Diplopia, amblyopia;
• Myalgia, arthralgia;
• Pruritus, rash;
• Leucopenia;
• Erectile dysfunction, viral infections.
• Children aged 3 to 12 years: Mental problems as anxiety, behavior changes (crying, feelings of euphoria or depression, agitation, hostility…)

• Gabapentin should be used with caution in patients with a history of mental disorders, renal impairment and undergoing hemodialysis, driving vehicles or operating machines.
• False positive readings have been reported with some urinary protein tests in patients taking gabapentin.
• Adverse effects usually mild or moderate and tend to decrease within 2 weeks of continued therapy.
• Ataxia is often related to dosage. If the symptom does not subside after reducing dose, the drug administration should be discontinued.
• If Stevens-Johnson syndrome is suspected, the drug administration should be discontinued.
• Neuronstad should not be discontinued abruptly because of the possibility of increasing seizure frequency. Before gabapentin is discontinued or an alternative anticonvulsant is added to the regimen, such changes should be done gradually over a period of at least 7 days.
• Neuronstad should be used during pregnancy only if the potential benefits justify the risk to the fetus. Gabapentin should be administered to nursing women only if the potential benefits justify the risk to the infant.
• Neuronstad acts on the central nervous system and may cause drowsiness, dizziness or other related symptoms. This is especially true at the beginning of the treatment and after increase in dose. Patients should avoid dangerous activities like driving or operating machines.