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Gabapentin dose in CKD — GPhC CRA MCQ

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ModerateRenal Dose AdjustmentGabapentin dose in CKDGPhC CRA

A 60-year-old woman with an eGFR of 25 mL/min/1.73m2 presents with a prescription for gabapentin 300 mg three times daily for neuropathic pain. She has not previously taken gabapentin. What is the most appropriate action?

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Correct answer: A — Contact the prescriber as the gabapentin dose should be reduced in severe renal impairment to prevent accumulation and toxicity

Gabapentin is almost entirely renally excreted and requires dose reduction in renal impairment. For an eGFR of 15-29 mL/min, the BNF recommends a maximum dose of 300 mg once daily (not three times daily). Dispensing the prescribed dose without adjustment could lead to accumulation, causing excessive sedation, dizziness, and respiratory depression. Pregabalin also requires renal dose adjustment, so switching does not resolve the issue.

Reference: BNF