Gabapentin Toxicity CKD — ESENeph MCQ

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EasyChronic Kidney DiseaseGabapentin Toxicity CKDESENeph

A 70-year-old man with CKD G4 (eGFR 20 mL/min/1.73m2) takes Gabapentin 300 mg TDS for neuropathic pain. He develops increasing drowsiness and ataxia. What is the most likely cause?

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Correct answer: E — Gabapentin toxicity due to accumulation in CKD

Gabapentin is renally excreted and accumulates in CKD, causing dose-dependent toxicity (drowsiness, ataxia, confusion). At eGFR 20, the maximum recommended dose is approximately 300 mg daily (not TDS). BNF recommends significant dose reduction in renal impairment. The dose should be reduced immediately and monitored. Pregabalin similarly requires renal dose adjustment. This is a common prescribing error in CKD patients.

Reference: BNF 2024 – Gabapentin Renal Dosing; NICE CG173 – Neuropathic Pain