Gabapentin (Neurontin, Gralise, Horizant) is a medicine used to treat partial seizures, nerve pain from shingles and restless leg syndrome. It works on the chemical messengers in your brain and nerves.  Gabapentin is from a group of medicines called anticonvulsants. 

Different brands of gabapentin are not interchangeable and they are FDA approved for different conditions. Use only the brand and form of gabapentin your doctor has prescribed. Check your medicine each time you get a refill to make sure you receive the correct form. 

Neurontin (gabapentin) is used to treat pain you may have from shingles (postherpetic nerve pain). It is also used with other seizure medicines for partial onset seizures in patients 3 years and older.

Gralise (gabapentin) is only used for pain after having shingles (postherpetic nerve pain). It should not be used for any other medical condition.

Horizant (gabapentin enacarbil) is an extended release tablet used to treat restless legs syndrome and for the pain from having shingles (postherpetic nerve pain).

Generic brands of gabapentin capsules, USP are used for postherpetic nerve pain and for add on therapy for partial onset seizures in patients 3 years and older

Gabapentin can cause life-threatening breathing problems, especially if you already have a breathing disorder or if you use other medicines that can make you drowsy or slow your breathing. Seek emergency medical attention if you have very slow breathing.

Some people have thoughts about suicide while taking seizure medicine. Stay alert to changes in your mood or symptoms. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide.

Seizures may increase if you stop using gabapentin suddenly. Ask your doctor before stopping the medicine.

Avoid driving or hazardous activity until you know how gabapentin will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Do not stop using gabapentin suddenly, even if you feel fine.

Take gabapentin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Never take gabapentin in larger amounts, or for longer than prescribed.

Your dose needs may change if you switch to a different brand, strength, or form of this medicine. Avoid medication errors by using only the medicine your doctor prescribes.

Both Gralise and Horizant should be taken with food.

Neurontin can be taken with or without food.

If you break a tablet and take only half of it, take the other half at your next dose. Any tablet that has been broken should be used as soon as possible or within a few days.

Swallow the tablets of Gralise and Horizant whole. Do not crush, break, or dissolve them. Swallow the capsule whole and do not crush, chew, break, or open the capsule.

Measure liquid medicine with the supplied measuring device (not a kitchen spoon).

Doses are based on weight in children. Your child's dose may change if the child gains or loses weight.

You should not stop taking gabapentin suddenly. Stopping suddenly may cause increased seizures. Follow your doctor's instructions about tapering your dose.

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using gabapentin.

Your kidney function may need to be checked often and your dose may change based on the results.

Store tablets and capsules at room temperature away from moisture and heat.

Store the liquid medicine in the refrigerator, do not freeze.

Follow all storage instructions provided. Your pharmacist can provide more information about how to store this medicine.

Usual Adult Dose for Epilepsy:

Initial dose: 300 mg orally on day one, 300 mg orally 2 times day on day two, then 300 mg orally 3 times a day on day three
Maintenance dose: 300 to 600 mg orally 3 times a day
Maximum dose: 3600 mg orally daily (in 3 divided doses)
-Maximum time between doses in the 3 times a day schedule should not exceed 12 hours

-The safety and effectiveness of gabapentin available under the trade name Gralise or Horizant in patients with epilepsy has not been studied.

Use: Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization

Usual Adult Dose for Postherpetic Neuralgia:

-Initial dose: 300 mg orally on day one, 300 mg orally 2 times day on day two, then 300 mg orally 3 times a day on day three
-Titrate up as needed for pain relief
-Maximum dose: 1800 mg per day (600 mg orally 3 times a day)
Gabapentin available under the trade name Gralise:
-Maintenance dose: Gralise should be titrated to 1800 mg orally once daily with the evening meal.
-Recommended titration schedule:
Day 1: 300 mg orally with the evening meal
Day 2: 600 mg orally with the evening meal
Days 3 through 6: 900 mg orally with the evening meal
Days 7 through 10: 1200 mg orally with the evening meal
Days 11 through 14: 1500 mg orally with the evening meal
Day 15: 1800 mg orally with the evening meal
COMMENT:
-Gralise is not interchangeable with other gabapentin products because of differing pharmacokinetic profiles that affect the frequency of administration.

Gabapentin enacarbil extended release tablets are available under the trade name Horizant:
-The recommended dosage is 600 mg orally 2 times a day. Therapy should be initiated at a dose of 600 mg orally in the morning for 3 days of therapy, then increased to 600 mg 2 times a day (1200 mg/day) on day four.
COMMENT:
Gabapentin enacarbil extended release tablets available under the trade name Horizant and gabapentin are not interchangeable.

Use: Postherpetic neuralgia

Usual Adult Dose for Restless Legs Syndrome:

Gabapentin enacarbil available under the trade name Horizant:
600 mg orally once daily with food at about 5 PM

Use: For the treatment of moderate-to-severe primary Restless Legs Syndrome (RLS) in adults

Usual Pediatric Dose for Epilepsy:

Less than 3 years: Not recommended

Greater than or equal to 3 and less than 12 years:
Starting Dose: Ranges from 10 to 15 mg/kg/day in 3 divided doses
Effective Dose: Reached by upward titration over a period of approximately 3 days; the effective dose in patients 5 years of age and older is 25 to 35 mg/kg/day in divided doses (3 times a day). The effective dose in pediatric patients ages 3 and 4 years is 40 mg/kg/day and given in divided doses (3 times a day). Gabapentin may be administered as the oral solution, capsule, or tablet, or using combinations of these formulations. 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.

Greater than 12 years:
-Initial dose: 300 mg orally on day one, 300 mg orally 2 times a day on day two, then 300 mg orally 3 times a day on day three
-Maintenance dose: 900 to 1800 mg orally in 3 divided doses; the dose may be increased 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 three times a day schedule should not exceed 12 hours.

Use: Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization in patients 3 years of age and older<

You should not take gabapentin if you are allergic to it.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• breathing problems;

• diabetes;

• depression, a mood disorder, or suicidal thoughts or actions;

• drink alcohol;

• a history of drug addiction;

• a seizure;

• (patients with RLS) if you are a day sleeper or work a night shift; or

• kidney disease (or if you are on dialysis).

Some people have thoughts about suicide while taking seizure medicine. Children taking gabapentin may have behavior changes. Stay alert to changes in your mood or symptoms. Your family or caregivers should also watch for sudden changes in your behavior.

It is not known if gabapentin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Do not start or stop seizure medication during pregnancy without your doctor's advice. Having a seizure during pregnancy could harm both mother and baby. Tell your doctor if you become pregnant.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of gabapentin on the baby.

Ask a doctor if it is safe to breastfeed while using gabapentin.

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

If you take Horizant: skip the missed dose and take your next dose at the regular time. Do not use two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can be fatal.

Overdose symptoms may include slow breathing, double vision, tremor, slurred speech, drowsiness, change in your mental state, dizziness, tiredness, or diarrhea.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets, extended-release tablets, and capsules at room temperature, away from excess heat and moisture (not in the bathroom). Store the oral solution in the refrigerator.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

Unless your doctor tells you otherwise, continue your normal diet.

Avoid driving or hazardous activity until you know how gabapentin will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Avoid taking an antacid within 2 hours before you take gabapentin.

Do not drink alcohol. Dangerous side effects could occur.

Get emergency medical help if you have signs of an allergic reaction to gabapentin: hives, difficult breathing, swelling of your face, lips, tongue, or throat.

Seek medical treatment if you have a serious drug reaction that can affect many parts of your body. Symptoms may include skin rash, fever, swollen glands, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes.

Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.

Gabapentin can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Some side effects are more likely in children taking gabapentin. Call your doctor if the child has any of the following side effects: behavior changes, memory problems, trouble concentrating, or acting restless, hostile, or aggressive.

Gabapentin may cause serious side effects. Call your doctor at once if you have:

• drowsiness, dizziness, weakness;

• problems with balance or muscle movement; or

• increased seizures.

Common gabapentin side effects may include:

• fever, chills, sore throat, body aches, tiredness;

• headache;

• swelling of your legs and feet;

• trouble speaking;

• vision problems, dizziness, drowsiness;

• tremors, problems with balance or muscle movement; or

• nausea, vomiting.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Taking gabapentin with other drugs that make you drowsy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Tell your doctor about all your current medicines. Many drugs can affect gabapentin, especially:

• naproxen;

• opioid medicine - hydrocodone, oxycodone, morphine, buprenorphine;

• zolpidem;

• lorazepam; or

• cimetidine.

This list is not complete and many other drugs may affect gabapentin. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Keep all appointments with your doctor.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking gabapentin.

If you use a dipstick to test your urine for protein, ask your doctor which product you should use while taking this medication.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Gabapentin may be used along with other medicines to treat seizures or pain.

An improvement in the frequency of seizures is usually noticeable within a few weeks.

If you're taking gabapentin for pain, you should see an improvement after one to two weeks, though results can take longer if your doctor prescribed a lower starting dose with plans to increase it later.

If the medicine helps your symptoms, you can continue to take it regularly.

Addiction to gabapentin isn’t likely. However, it’s considered a controlled substance in some states because it’s been reportedly used to boost the effects of opioids.

Watch for and report any symptoms of depression while using gabapentin.

Make sure to tell your doctor before you stop taking this medicine.

It’s important to only use the dosage and brand of gabapentin that your doctor prescribes. You should check your medicine label each time to make sure it’s correct.

Here’s what you should know about the different brands:

• The brand Neurontin is used to treat seizures and nerve pain.
• Gralise is used for managing nerve pain only (not epilepsy).
• Horizant is used for nerve pain and restless legs syndrome.

Your dosage of gabapentin will depend on your age, weight, and medical condition. You may need to start on a lower dose and gradually increase it.

Gabapentin is used “off-label” to help medical conditions that it’s not approved to treat.

Doctors may recommend gabapentin as a therapy for the following:

• Bipolar disorder
• Diabetic neuropathy
• Attention deficit disorder (ADD)
• Trigeminal neuralgia
• Migraines
• Drug and alcohol withdrawal seizures
• Premenstrual syndrome
• Periodic limb movement disorders of sleep
• Complex regional pain syndrome