Gabapentin patients

La Spina I, Porazzi D et al (2001) Gabapentin in painful HIV-related neuropathy a report of 19 patients, preliminary observations. Eur J Neurol 8(l) 71-75 Lanska MJ, Lanska DJ et al (1988) Syphilitic polyradiculopathy in an HIV-positive man. Neurology 38(8) 1297-1301... 

Gabapentin, a non-benzodiazapine GABA analog, was modestly effective in a 14-week controlled trial in SAD. Most patients were titrated to a maximal dose of 3600 mg/day.58 Pregabalin 600 mg/day was effective for social anxiety, fear, and avoidance behavior in a 10-week controlled trial.63 Pregabalin was well tolerated, and the most common side effects were somnolence and dizziness. 

A number of non-hormonal therapies have been studied for symptomatic management of vasomotor symptoms, including antidepressants [e.g., selective serotonin reuptake inhibitors (SSRIs) and venlafaxine], herbal products (e.g., soy, black cohosh, and dong quai), and a group of miscellaneous agents (e.g., gabapentin, clonidine, and megestrol). The choice of therapy depends on the patient s concomitant disease states, such as depression and hypertension, and the risk for potential adverse effects. 

Overall, non-hormonal therapies are less effective in treating vasomotor symptoms than HRT but do offer an important option for women experiencing menopausal symptoms who cannot or are unwilling to take HRT. The antidepressants gabapentin and clonidine have the best evidence for efficacy of all the non-hormonal options and should be considered first as an alternative to HRT. The most important considerations in choosing an alternative therapy are the patient s comorbidities and the efficacy and safety of the medication. 

Gabapentin inhibits high-voltage activated Ca channels and elevates human brain GABA levels. It is a second-line agent for patients with partial seizures who have failed initial treatment. It may also have a role in patients with less severe seizure disorders, such as new-onset partial epilepsy, especially in elderly patients. 

Ben-Menachem, E., Soderfelt, B., Hamberger, A., Hedner, T., and Persson, L. I. (1995) Seizure frequency and CSF parameters in a double-blind placebo controlled trial of gabapentin in patients with intractable complex partial seizures. Epilepsy Res. 21,231-236. 

Anticonvulsants. Several antiseizure medicines have been studied in the treatment of PTSD, and some results have been encouraging. Open label studies, first with carbamazepine (800-1200 mg/day) and later with valproate (500-2000 mg/ day), demonstrated overall improvement in PTSD patients, though not for intrusive recollections per se. Recent open label studies of gabapentin, lamotrigine, tiagabine, and topiramate have suggested these anticonvulsants might also be helpful for some PTSD symptoms. 

In addition to treating insomnia, gabapentin has been used to treat epilepsy, anxiety disorders, and bipolar disorder. It is generally well tolerated with sedation and headaches being the only prominent side effects. Because gabapentin is excreted unchanged in urine, it does not require metabolism by the liver. It is therefore easily eliminated by elderly patients and those with liver disease, although it should be used with caution in those with poor renal (kidney) function. 

Mood Stabiiizers. First lithium and more recently valproic acid (Depakote, Depakene), carbamazepine (Tegretol), and gabapentin (Neurontin) have been used to treat agitated dementia patients. 

In recent years, some physicians have used gabapentin as an alternative treatment for mild but chronic agitation. There are no studies of its effectiveness, but gabapentin is easily tolerated and may be a reasonable alternative for some patients. 

Use of gabapentin in patients under 12 years of age with compromised renal function has not been studied. 

Neuropsychiatric adverse events (3 to 12 years of age) Gabapentin use in pediatric patients with epilepsy 3 to 12 years of age is associated with the occurrence of CNS-related adverse events. 

Among the gabapentin-treated patients, most of the events were mild to moderate in intensity. 

Status epiiepticus In the placebo controlled studies, the incidence of status epilepticus in patients receiving gabapentin was 0.6% vs 0.5% with placebo. 

Petroff, O. A., Hyder, F., Rothman, D. L., and Mattson, F. H. (2006). Brain homocarnosine and seizure control of patients taking gabapentin or topiramate. Epilepsia 47,495 98. 

Gabapentin acts by increasing GABA activity, although its exact mechanism of action is unclear. It causes dose-related sedation and dizziness. It has been shown in randomised controlled trials to be effective in social anxiety disorder (Pande et al. 1999) and to benefit some patients with panic disorder (Pande et al. 2000). Pregabalin is a related compovmd that has recently demonstrated efficacy in GAD in a phase III study (Pande et al. 2003). 

Gabapentin is recommended as adjunctive therapy in the treatment of partial seizures in adults. When used with other drugs, it appears to be an effective AED it is usually not effective when employed alone for patients with severe seizures. 

Gabapentin is generally well tolerated in adult patients, and adverse effects of the drug are usually mild to moderate in severity (AHFS, 2000). The most frequent adverse effects of gabapentin as adjunctive therapy are somnolence, dizziness, and asthenia (Bruni, 1998). 

The safety and efficacy of gabapentin as adjunctive therapy to CBZ and/or phenytoin has been assessed in adults, adolescents (Bruni, 1998), and children (Khur-ana et ah, 1996) with partial seizures. A decrease of 50% or more in frequency of complex partial -I- secondary generalized seizures was reported in 71% of patients on a mean maintenance dose of gabapentin of 1600 mg/day (Bruni, 1998). It has also been used in the treatment of spasticity in adolescents with multiple sclerosis (Cutter et al., 2000) and in adults and adolescents with neuropathic pain (Rosenberg et al.,... 

Dimond, K.R., Pande, A.C., Lamoreaux, L., and Pierce, M.W. (1996) Effect of gabapentin (Neurontin) [corrected] on mood and wellbeing in patients with epilepsy. Progress in Neuropsychophar-macol Biol Psychiatry 20 407-17. [published erratum appears in Prog Neuropsychopharmacol Biol Psychiatry 1996 20(6) 1081]. 

Knoll, J., Stegman, K., and Suppes, T. (1998) Clinical experience using gabapentin adjunctively in patients with a history of mania or hypomania. Affect Disord 49 229-233. 

Tallian, K.B., Nahata, M.C., Lo, W., and Tsao, C.Y. (1996) Gabapentin associated with aggressive behavior in pediatric patients with seizures. Epilepsia 37 501-502. 

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