Comment
Author: Admin | 2025-04-28
Adjunctive therapy. It augmented lithium in acute mania and had mild preventive effects over a year when added to various mood stabilizers. As encouraging as these results are, both came from small trials with a total n of 85 (Astaneh AN and Rezaei O, Int J Psychiatry Med 2012;43(3):261–271; Vieta E et al, J Clin Psychiatry 2006;67(3):473–477). In practice, gabapentin is best reserved for treating bipolar disorder in patients with comorbidities like anxiety and alcohol or cannabis use disorders.Table: Off-Label Dosing of Gabapentin(Click to view full-size PDF.)Restless legs syndrome and painGabapentin has only three FDA indications: partial seizures, post-herpetic neuralgia, and restless legs syndrome (RLS). Although used widely in pain disorders, it only has clear benefits in post-herpetic neuralgia and diabetic peripheral neuropathy, and is not considered effective for low back pain, sciatica, spinal stenosis, or migraines (Mathieson S et al, BMJ 2020;369:m1315).Gabapentin’s RLS approval is reserved for gabapentin enacarbil (Horizant), a prodrug that delays absorption by attaching the medication to an enacarbil molecule. However, there are three reasons to prefer the original gabapentin when treating RLS besides the higher cost of the patented Horizant: Convenience. Horizant must be taken with a meal at 5:00 p.m. Gabapentin can be taken before bed regardless of food. Driving. The PDR warns of “significant driving impairment” for two hours after taking Horizant, a problem that is compounded by alcohol, which quickens Horizant’s release. This is an issue for patients who dine out, while gabapentin can be taken right before bed without affecting driving the next morning. Toxicity. The enacarbil in Horizant breaks down into acetaldehyde, the same byproduct responsible for the carcinogenic and hangover effects of alcohol. The FDA originally rejected the drug over this issue, and Horizant still carries a warning about “chromosomal aberrations” in human lymphocytes “attributed to acetaldehyde.”Although lacking in FDA approval, the original gabapentin was effective for RLS in half a dozen small studies. The usual dose is 300 mg before bed (which is equivalent to 600 mg of Horizant), but studies have gone as high as 2400 mg.Akathisia, sleep, and hot flashesTreatments for RLS often reduce akathisia, and
Add Comment