Prescription Drug Information: Gabapentin (Page 7 of 8)

Postherpetic Neuralgia

In adults with postherpetic neuralgia, gabapentin therapy may be initiated as a single 300-mg dose on Day 1, 600 mg/day on Day 2 (divided BID), and 900 mg/day on Day 3 (divided TID). The dose can subsequently be titrated up as needed for pain relief to a daily dose of 1800 mg (divided TID). In clinical studies, efficacy was demonstrated over a range of doses from 1800 mg/day to 3600 mg/day with comparable effects across the dose range. Additional benefit of using doses greater than 1800 mg/day was not demonstrated.

Epilepsy

Gabapentin oral solution is recommended for add-on therapy in patients 3 years of age and older. Effectiveness in pediatric patients below the age of 3 years has not been established.

Patients >12 years of age: The effective dose of gabapentin is 900 to 1800 mg/day and given in divided doses (three times a day). The starting dose is 300 mg three times a day. If necessary, the dose may be increased three times a day up to 1800 mg/day. Dosages up to 2400 mg/day have been well tolerated in long-term clinical studies. Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated. The maximum time between doses in the TID schedule should not exceed 12 hours.

Pediatric Patients Age 3-12 years: The starting dose should range from 10-15 mg/kg/day in 3 divided doses, and the effective dose reached by upward titration over a period of approximately 3 days. The effective dose of gabapentin in patients 5 years of age and older is 25-35 mg/kg/day and given in divided doses (three times a day). The effective dose in pediatric patients ages 3 and 4 years is 40 mg/kg/day and given in divided doses (three times a day) (see CLINICAL PHARMACOLOGY, Pediatrics.) Dosages up to 50 mg/kg/day have been well-tolerated in a long-term clinical study. The maximum time interval between doses should not exceed 12 hours.

It is not necessary to monitor gabapentin plasma concentrations to optimize gabapentin therapy. Further, because there are no significant pharmacokinetic interactions among gabapentin and other commonly used antiepileptic drugs, the addition of gabapentin does not alter the plasma levels of these drugs appreciably.

If gabapentin oral solution is discontinued and/or an alternate anticonvulsant medication is added to the therapy, this should be done gradually over a minimum of 1 week.

Dosage in Renal Impairment

Creatinine clearance is difficult to measure in outpatients. In patients with stable renal function, creatinine clearance (CCr ) can be reasonably well estimated using the equation of Cockcroft and Gault:

for females CCr =(0.85)(140-age)(weight)/[(72)(SCr )] for males CCr =(140-age)(weight)/[(72)(SCr )]

where age is in years, weight is in kilograms and SCr is serum creatinine in mg/dL.

Dosage adjustment in patients ≥12 years of age with compromised renal function or undergoing hemodialysis is recommended as follows (see dosing recommendations above for effective doses in each indication).

TABLE 6. Gabapentin Dosage Based on Renal Function
a For patients with creatinine clearance <15 mL/min, reduce daily dose in proportion to creatinine clearance (e.g. patients with a creatinine clearance of 7.5 mL/min should receive one-half the daily dose that patients with a creatinine clearance of 15 mL/min receive).b Patients on hemodialysis should receive maintenance doses based on estimates of creatinine clearance as indicated in the upper portion of the table and a supplemental post-hemodialysis dose administered after each 4 hours of hemodialysis as indicated in the lower portion of the table.
Renal FunctionCreatinine Clearance(mL/min) Total DailyDose Range(mg/day) Dose Regimen(mg)
≥60 900 — 3600 300 TID 400 TID 600 TID 800 TID 1200 TID
>30 — 59 400 — 1400 200 BID 300 BID 400 BID 500 BID 700 BID
>15 — 29 200 — 700 200 QD 300 QD 400 QD 500 QD 700 QD
15a 100 — 300 100 QD 125 QD 150 QD 200 QD 300 QD
Post-Hemodialysis Supplemental Dose (mg)b
Hemodialysis 125b 150b 200b 250b 350b

The use of gabapentin in patients <12 years of age with compromised renal function has not been studied.

Dosage in Elderly

Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and dose should be adjusted based on creatinine clearance values in these patients.

HOW SUPPLIED

Gabapentin Oral Solution is supplied as follows:

250 mg/5 mL oral solution; clear colorless to slightly yellow solution; each 5 mL of oral solution contains 250 mg of gabapentin; available in: Bottles containing 470 mL (NDC 59063-127-47).

Storage

Store refrigerated, 2°-8°C (36°-46°F)

Rx only

PHARMACIST: Dispense in tight, light-resistant containers as defined in the USP/NF, with a child-resistant closure.

KEEP THIS AND ALL DRUGS OUT OF THE REACH OF CHILDREN.

Made in Germany


Manufactured For:
KIEL LABORATORIES®
2225 Centennial Dr.
Gainesville, GA 30504

Trademarks are the property of their respective owners.

Rev:04/2012

MEDICATION GUIDE

Gabapentin Oral Solution 250 mg / 5 mL


Read the Medication Guide before you start taking Gabapentin Oral Solution and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment.


What is the most important information I should know about Gabapentin Oral Solution?

Do not stop taking Gabapentin Oral Solution without first talking to your healthcare provider.

Stopping Gabapentin Oral Solution suddenly can cause serious problems.

Gabapentin Oral Solution can cause serious side effects including:

1. Like other antiepileptic drugs, Gabapentin Oral Solution may cause suicidal thoughts or actions in a very small number of people, about 1 in 500.

Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:

  • thoughts about suicide or dying
  • attempts to commit suicide
  • new or worse depression
  • new or worse anxiety
  • feeling agitated or restless
  • panic attacks
  • trouble sleeping (insomnia)
  • new or worse irritability
  • acting aggressive, being angry, or violent
  • acting on dangerous impulses
  • an extreme increase in activity and talking (mania)
  • other unusual changes in behavior or mood


How can I watch for early symptoms of suicidal thoughts and actions?

  • Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings.
  • Keep all follow-up visits with your healthcare provider as scheduled.

Call your healthcare provider between visits as needed, especially if you are worried about symptoms.

Do not stop taking Gabapentin Oral Solution without first talking to a healthcare provider.

  • Stopping Gabapentin Oral Solution suddenly can cause serious problems. Stopping a seizure medicine suddenly in a patient who has epilepsy can cause seizures that will not stop (status epilepticus).

Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal thoughts or actions, your healthcare provider may check for other causes.

2. Changes in behavior and thinking – Using Gabapentin Oral Solution in children 3 to 12 years of age can cause emotional changes, aggressive behavior, problems with concentration, restlessness, changes in school performance, and hyperactivity.

3. Gabapentin Oral Solution may cause a serious or life-threatening allergic reaction that may affect your skin or other parts of your body such as your liver or blood cells. You may or may not have rash when you get this type of reaction. It may cause you to be hospitalized or to stop Gabapentin Oral Solution. Call a healthcare provider right away if you have any of the following symptoms:

  • skin rash
  • hives
  • fever
  • swollen glands that do not go away
  • swelling of your lip and tongue
  • yellowing of your skin or of the whites of the eyes
  • unusual bruising or bleeding
  • severe fatigue or weakness
  • unexpected muscle pain
  • frequent infections

These symptoms may be the first signs of a serious reaction. A healthcare provider should examine you to decide if you should continue taking Gabapentin Oral Solution.


What is Gabapentin Oral Solution?

Gabapentin Oral Solution is a prescription medicine used to treat:

  • Pain from damaged nerves (postherpetic pain) that follows healing of shingles (a painful rash that comes after a herpes zoster infection) in adults.
  • Partial seizures when taken together with other medicines in adults and children 3 years of age and older.


Who should not take Gabapentin Oral Solution?

Do not take Gabapentin Oral Solution if you are allergic to gabapentin or any of the other ingredients in Gabapentin Oral Solution. See the end of this Medication Guide for a complete list of ingredients in Gabapentin Oral Solution.


What should I tell my healthcare provider before taking Gabapentin Oral Solution?

Before taking Gabapentin Oral Solution, tell your healthcare provider if you:

  • have or have had kidney problems or are on hemodialysis
  • have or have had depression, mood problems, or suicidal thoughts or behavior
  • are pregnant or plan to become pregnant. It is not known if Gabapentin Oral Solution can harm your unborn baby. Tell your healthcare provider right away if you become pregnant while taking Gabapentin Oral Solution. You and your healthcare provider will decide if you should take Gabapentin Oral Solution while you are pregnant.
    • If you become pregnant while taking Gabapentin Oral Solution, talk to your healthcare provider about registering with the North American Antiepileptic Drug (NAAED) Pregnancy Registry. The purpose of this registry is to collect information about the safety of antiepileptic drugs during pregnancy. You can enroll in this registry by calling 1-888-233-2334.
  • are breast-feeding or plan to breast-feed. Gabapentin Oral Solution can pass into breast milk. You and your healthcare provider should decide how you will feed your baby while you take Gabapentin Oral Solution.

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Taking Gabapentin Oral Solution with certain other medicines can cause side effects or affect how well they work. Do not start or stop other medicines without talking to your healthcare provider.

Know the medicines you take. Keep a list of them and show it to your healthcare provider and pharmacist when you get a new medicine.


How should I take Gabapentin Oral Solution?

  • Take Gabapentin Oral Solution exactly as prescribed. Your healthcare provider will tell you how much Gabapentin Oral Solution to take.
    • Do not change your dose of Gabapentin Oral Solution without talking to your healthcare provider.
  • Gabapentin Oral Solution can be taken with or without food. If you take an antacid containing aluminum and magnesium, such as Maalox® , Mylanta® , Gelusil® , Gaviscon® , or Di-Gel® , you should wait at least 2 hours before taking your next dose of Gabapentin Oral Solution.
  • If you take too much Gabapentin Oral Solution, call your healthcare provider or your local Poison Control Center right away.


What should I avoid while taking Gabapentin Oral Solution?

  • Do not drink alcohol or take other medicines that make you sleepy or dizzy while taking Gabapentin Oral Solution without first talking with your healthcare provider. Taking Gabapentin Oral Solution with alcohol or drugs that cause sleepiness or dizziness may make your sleepiness or dizziness worse.
  • Do not drive, operate heavy machinery, or do other dangerous activities until you know how Gabapentin Oral Solution affects you. Gabapentin Oral Solution can slow your thinking and motor skills.


What are the possible side effects of Gabapentin Oral Solution?

  • See “What is the most important information I should know about Gabapentin Oral Solution?
  • The most common side effects of Gabapentin Oral Solution include:
    • dizziness
    • lack of coordination
    • viral infection
    • feeling drowsy
    • feeling tired
    • fever
    • jerky movements
    • difficulty with speaking
    • temporary loss of memory (amnesia)
    • tremor
    • difficulty with coordination
    • double vision
    • unusual eye movement

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Gabapentin Oral Solution. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


How should I store Gabapentin Oral Solution?

  • Store Gabapentin Oral Solution in the refrigerator between 36°F to 46°F (2°C to 8°C).

Keep Gabapentin Oral Solution and all medicines out of the reach of children.


General information about the safe and effective use of Gabapentin Oral Solution

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Gabapentin Oral Solution for a condition for which it was not prescribed. Do not give Gabapentin Oral Solution to other people, even if they have the same symptoms that you have. It may harm them.

This Medication Guide summarizes the most important information about Gabapentin Oral Solution. If you would like more information, talk with your healthcare provider.

You can ask your healthcare provider or pharmacist for information about Gabapentin Oral Solution that was written for healthcare professionals.

For more information about Gabapentin Oral Solution, medical inquiries, or to report side effects regarding Gabapentin Oral Solution, please call 1-800-541-4802.


What are the ingredients in Gabapentin Oral Solution?

Active ingredient: gabapentin 250 mg/5 mL

The inactive ingredients for the oral solution are anise flavor, artificial strawberry flavor, glycerin, hydrochloric acid, purified water, sodium hydroxide and xylitol.

This Medication Guide has been approved by the U.S. Food and Drug Administration.

Made in Germany.
Manufactured for Kiel Laboratories.


KIEL LABORATORIES®
2225 Centennial Drive,
Gainesville, GA 30504

Trademarks are the property of their respective owners.

Rev: 04/2012

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