Gabapentin, an anticonvulsant and a drug used to alleviate neuropathic pain, has become widely accepted for the treatment of many health conditions. It is given, per symptoms, from as low as 100mg to as high as 800mg as in the case of nerve pain, seizures, or even off label use such as for anxiety or restless leg syndrome, which has quite a tendency to be addictive drugs. With such a vast range of dosages available, it is understandable that people really ask: “Is 100mg or 800mg of Gabapentin suitable for me?”
Gabapentin 100mg is routinely used to treat and avert seizures in patients with epilepsy and to relieve nerve pain (post-herpetic neuralgia) that occurs after a viral illness such as shingles. Furthermore, it is used in the treatment of restless legs syndrome (RLS). The action of Gabapentin is through capsules, tablets, oral suspension, and has to be taken as prescribed by a doctor. Decreases the stimulation of the brain that is abnormal, and changes the perception of pain in the body.
In this article, we will understand the mechanisms of action of Gabapentin, the rationale behind the need for prescribing varying strengths, the common adverse effects associated with the medication, and how to navigate working with your doctor to ascertain the dose that is specific for you.
Understanding Gabapentin: What Is It and How Does It Work?
Initially, gabapentin (also called Neurontin) was approved for use in the management of seizure disorders. Nevertheless, the range of indications for this drug has increased, and it is now often used for the treatment of neuropathic, mostly diabetic nerve-related pain, as well as pain caused by shingles, sciatica, and others.
Although the specific pharmacology of gabapentin remains unknown, it is thought that it works by attaching to certain calcium channels in the brain where it inhibits the exocytotic release of excitatory neurotransmitters responsible for pain and seizure. Its ability to suppress the functions of already hyperactive nerve cells makes it applicable in a number of conditions which involve nerve irritation or over-activity as a complication.
It is safe to say that Gabapentin works for a lot of patients, but due to many factors that include the medical condition of the patient, his or her general health and the way his or her body responds to the drug, finding the right dose is very challenging. It comes in various dosages – usually available as 100mg, 300mg, 600mg and 800mg tablets – which facilitates the design of flexible treatment regimens.
The Role of Dosage in Gabapentin Therapy
As Gabapentin has many indications the dosages may greatly vary. The dosage prescribed may also be dependent on the condition being treated, its severity, age of the patient, kidney activity and comorbidities.
Gabapentin Use in Treatment of Diseases Synonymous with Neuropathy
Neuropathic Pain: The drug gabapentin is often recommended for patients suffering from chronic pains that are nerve-related due to diabetic neuropathies, post-herpetic neuralgia and pains associated with sciatica, among other issues.
Seizures: Gabapentin, being an antiepileptic, is also included among the medications for complex focal seizures.
Restless Leg Syndrome (RLS): Even though this is an unapproved indication, Gabapentin has been shown to reduce the symptoms of discomfort related to RLS.
Anxiety and Insomnia: Some physicians off label prescribe. Gabapentin for anxiety and insomnia treatment because it has a soothing effect on the nervous system.
Fibromyalgia: Many fibromyalgia patients get relief from Gabapentin, a medication used to treat nerve pain, which is a widespread pain and fatigue illness.
Migraine Prevention: In some instances, it is prescribed, however this use is not approved by the FDA, for the reduction of the frequency of migraine attacks.
Dosage Guidelines by Condition
According to condition: Neuropathic pain is generally managed by starting with 100 mg to 300 mg of this medication which is taken a few times a day, with variations adjusted as per the patient tolerance. It is worth noting that this can be increased to a maximum of 3600 mg per day and usually in three separate doses.
Seizures: Gabapentin dosage’s for seizures tend to be higher. Patients may start with 300 mg every day in three divided doses with subsequent titration of the dose and some may tolerate as much as 2400 mg a day.
RLS, Restless leg syndrome: The requirement is usually lower for RLS. Some patients will even commence with as little as 100 mg dose ingested in the evening before going to sleep.
Also called anxiety related insomnia and anxiety: For doses intended for the treatment of anxiolysis or sleep measures, the medication is usually prescribed at lower doses of 100 mg to 600 mg daily although more may be used in very bad cases.
Choosing Between 100mg and 800mg Gabapentin
The major factor in deciding whether to use a lower dose (say 100mg) as compared to a higher dose (such as 800mg) is the extent of the condition and the way the patient responds to the medication. Let us now consider the differences presented in these two dosages:
100mg Gabapentin: When a Lower Dose is Preferable
A 100mg dose is usually the reasonable minimum that one can begin with when using Gabapentin. This dosage is appropriate for patients who:
Are alcohol naive: A stepwise titration is often preferred so as to reduce the likelihood of adverse effects like sedation and dizziness while at the same time allow for acceptance of the drug over time.
Present with mild injury or disease: Conditions such as mild neuropathic pain or restlessness leg syndrome, would not require a hefty amount of dosage and thus do not subject the body to excessive pharmacotherapy.
Are elderly or have pre-existing renal conditions: Since the active principle Gabapentin is renally cleared, patients with renal impairment, especially the aging population, are usually commenced on lower doses to minimize risk of toxicity.
At 100mg, such patients also tend to tolerate the drug much better and hence the side effects associated with this dose are minimal; however, the analgesic effect may also be lesser than that obtained with higher doses. This is the rationale as to why many patients are commenced on 100mg and titrated upwards as necessary.
800mg Gabapentin: When a Higher Dose is Necessary
An 800 mg dose of Gabapentin is considered excessive and is generally administered to patients with more advanced conditions or those that have not responded to lower doses of the drug. Due to the following reasons, this dosage is more likely to be recommended:
Escalating pain: Individuals experiencing extreme levels of discomfort such as in cases of postherpetic neuralgia or sciatica pain are likely going to achieve relief only at higher doses of the drug.
Management of epilepsy: Higher doses are generally needed to achieve effective control of seizure in patients with epilepsy.
Common chronic conditions such as fibromyalgia: A good number of patients with a history of chronic incapacitating widespread pain conditions usually require a higher, effective dosage of gabapentin.
The presence of physical dependence or established tolerance. In patients who have been exposed to gabapentin for a significant period of time, it is possible that higher than normal maintenance doses will be needed due to the reduced potency of the drug caused by its prolonged use.
Although increasing amounts of doses generally improves pain relief, it also entails contributing factors such as side effects which include dizziness, drowsiness, unsteadiness among others which are worst at higher doses.
Side Effects of Gabapentin: What to Expect at Different Dosages
Like all medicinal products, Gabapentin may produce adverse effects. This is especially true for the fact that the incidence and the severity of side effects usually vary with the amount that is taken such that the higher the dosage taken, the greater the chances of developing the adverse effects.
Common Side Effects
Drowsiness and fatigue: One of the side effects of gabapentin is sedation, which is dose-dependent and worse when the dose is higher.
Dizziness: Many individuals experience a sensation of unsteadiness, particularly upon rising quickly.
Unsteadiness: Coordination can be impaired due to excessive dosing, making one more liable to falls.
Weight gain: Some people may experience weight gain while on Gabapentin, particularly if taken in higher doses.
Swelling in the extremities (edema): There is a higher likelihood of the occurrence of swelling of the legs, feet, or hands with the use of higher doses.
Serious Side Effects
While it is uncommon, certain adverse effects may occur of a more serious nature, including:
Alterations in emotional state: Patients report feelings of depression, anxiety, even suicidal thoughts, especially at more elevated doses.
Life-threatening allergic reactions: Trouble breathing, a swollen face or throat, hives, and other signs of an allergic reaction.
Issues with respiration: At larger doses, especially in conjunction with drugs like opioids, Gabapentin can lead to respiratory depression, which is when the breathing rate reduces or stops altogether, a dangerous side effect.
Patients should not hesitate to reach out to their doctor without delay upon noticing any disturbing or extreme symptoms.
Determining the Right Dosage: The Role of Your Healthcare Provider
Determining the appropriate Gabapentin dosage is dependent on the individual’s unique medical needs and circumstances. The health professional will evaluate various aspects in order to ascertain the appropriate starting dose for the patient – whether 100mg, 800mg or an amount in between. Such aspects are:
Past medical history – For example, patients with renal or hepatic impairment will likely have a lower dose prescribed by their physician.
Concomitant medications – Gabapentin can be used together with other medications, barring those with sedative properties or affecting the kidneys. The physician will consider your medications during his prescribing of the dose.
Severity of the ailment – The greater the ailments, the higher the dose likely to be prescribed.
Your ability to withstand adverse effects – If your side effects are too severe at the higher doses, the physician will maintain you at lower doses or change the entire medication.
Your treatment history – In such cases, the medication outweighs the dose increment. If you find that 100mg works there is no point in taking a higher dosage. Still, if the symptoms do not go away, then the dosage may be increased.
How to Take Gabapentin Safely
Whatever the dosage, Gabapentin medication should be taken as prescribed by the doctor. To facilitate safe and effective medication use, the following instructions may be helpful:
The medication should be taken each day at the same time: This ensures that there is a level of the drug in the body which is steady over time.
Don’t suddenly stop taking Gabapentin: Abruptly halting Gabapentin treatment can trigger withdrawal symptoms such as anxiety, insomnia, nausea, or even seizure attacks. If withdrawal becomes necessary, your physician will assist you in gradually reducing the amount of the drug.
Limit intake of alcohol: It is not recommended to take alcoholic drinks during Gabapentin treatment as this may aggravate the side effects such as dizziness and drowsiness.
Track your symptoms: Keep a diary of when you experience any symptoms or side effects, and how severe they are. This will enable your doctor to alter your medication accordingly.
Conclusion
The choice of whether to go for the 100mg or 800mg dose of Gabapentin- or one in the middle of the side effects and body response to the treatment – is also influenced by several factors including the health condition that you are suffering from, how bad the symptoms are and how you tolerate the treatment. This is because lower doses are usually adequate in case of mild cases or as a starting dose, however, more severe conditions may require advanced doses.
It is as well important to talk to your physician to help you figure the dosage that shall be effective for you. The aim is to seek for the extent which alleviates pain with minimal side effects, thus ensuring that there is no loss in quality of life while using Gabapentin.