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Gabapentin Overdose Dialysis Patient — ESENeph MCQ

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EasyHaemodialysisGabapentin Overdose Dialysis PatientESENeph

A 70-year-old man with CKD G5D on haemodialysis has been experiencing vivid dreams and confusion. His medications include Gabapentin 300 mg TDS (prescribed for neuropathic pain), Omeprazole 20 mg, Amlodipine 10 mg, and Calcichew-D3. Which medication requires urgent dose adjustment?

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Correct answer: E — Gabapentin – it accumulates in ESKD and causes neurotoxicity (confusion, sedation, myoclonus)

Gabapentin is almost entirely renally cleared and accumulates in dialysis patients. The recommended dose in haemodialysis patients is 100-300 mg AFTER each dialysis session only (approximately 3 times per week), not 300 mg TDS. This represents a dramatic dose reduction. Neuropsychiatric toxicity (confusion, vivid dreams, myoclonus, sedation, coma) is a common presentation of Gabapentin accumulation in CKD/ESKD. The dose should be reduced immediately and symptoms monitored.

Reference: BNF 2024 – Gabapentin Renal Dosing; KDIGO 2024 – CKD (Drug Stewardship)