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Author: Admin | 2025-04-28
Gabapentin has promising results for this antipsychotic side effect, as evidenced in open-label trials at doses of 300–3600 mg/day.Gabapentin is often used as a hypnotic, and this is supported by small controlled and open-label trials where it improved sleep duration and quality (eg, increased slow-wave sleep) at 200–900 mg/day (Furey SA et al, J Clin Sleep Med 2014;10(10):1101–1109). In practice, this means gabapentin may not help your patients fall asleep faster, but it can deepen their sleep and reduce nocturnal awakenings. Women with post-menopausal vasomotor symptoms are good candidates for this hypnotic use, as gabapentin reduced hot flashes in several controlled trials (Saadati N et al, Glob J Health Sci 2013;5(6):126–130).RisksGabapentin has no serious warnings, but common adverse effects include sedation, fatigue, dizziness, imbalance, tremor, and visual changes from nystagmus.Dosing tipsGabapentin is one of the rare psychiatric meds with “nonlinear pharmacokinetics.” That means serum levels start to plateau after a certain dose and rise sluggishly from there. For gabapentin, that dose is 900 mg. At 900 mg, 540 mg of the drug is absorbed; at 1200 mg, only 564 mg is absorbed; and at 2400 mg, a measly 816 mg makes it into the bloodstream. This slowdown occurs because the transporters that absorb gabapentin are easily saturated at higher doses (the prodrug Horizant was developed to overcome this limitation, but it does so at a cost).Gabapentin is excreted entirely by the kidneys, which means it avoids hepatic drug interactions, but the dose needs to be lowered as creatinine clearance (CC) declines, a common problem in older patients. The usual dose range of 900–3600 mg/day is lowered to 400–1400 mg/day for a CC of 30–59 mL/min, 200–700 mg/day for a CC of 15–29 mL/min, and 100–300 mg/day for a CC below 15 mL/min (such patients usually require dialysis).With a six-hour half-life, gabapentin can be divided three times daily for anxiety disorders and dosed at bedtime for sleep disorders. When stopping the medication, taper gradually to avoid withdrawal symptoms, which are rare and include tremor, sweating, restlessness, insomnia, and a lower threshold for seizures (Mersfelder TL and Nichols WH, Ann Pharmacother 2016;50(3):229–233).
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