Gabapentin Dosing in Renal Insufficiency

Introduction to Dosing Adjustments

The American Academy of Family Physicians and other guideline societies recommend that elderly patients require particular attention to renal dosing adjustments, with apparent oral clearance decreasing from approximately 225 mL/min in patients <30 years to 125 mL/min in patients >70 years, primarily due to decreased renal function 2

For patients with CrCl 30-59 mL/min, the recommended dosing frequency is twice daily (BID), and for those with CrCl 15-29 mL/min or CrCl <15 mL/min, the recommended dosing frequency is once daily (QD), according to the Mayo Clinic Proceedings 1

The National Kidney Foundation suggests that hemodialysis patients require both maintenance dosing based on residual renal function and supplemental post-dialysis doses, with the maintenance dose based on CrCl and the supplemental post-hemodialysis dose administered after each 4-hour hemodialysis session 1
The American Geriatrics Society recommends that elderly patients should always have their CrCl calculated rather than relying on serum creatinine alone, as normal serum creatinine can mask significant renal impairment due to decreased muscle mass 2