Gabapentin and pregabalin are renally excreted drugs; in advanced CKD (e.g., eGFR <30 mL/min), administration without dose adjustment leads to drug accumulation and increased risk of toxicity.
Always calculate CrCl and adjust doses accordingly; do not use standard dosing in advanced CKD.
Monitor for early signs of toxicity like somnolence or confusion, especially in elderly or frail patients.
Gabapentin is dialyzable; pregabalin is not supplement doses post-dialysis for gabapentin if used.
Consider non-renally cleared alternatives for neuropathic pain or seizures in severe CKD.
Both gabapentin and pregabalin are primarily eliminated unchanged by the kidneys through glomerular filtration. In advanced CKD, reduced glomerular filtration rate (GFR) impairs clearance, causing prolonged half-life and accumulation in plasma.
Risk of severe adverse effects including excessive sedation, dizziness, ataxia, myoclonus, confusion, encephalopathy, respiratory depression, and coma; pregabalin may also exacerbate peripheral edema or weight gain in renal impairment.
Dose adjustment is essential: For gabapentin, reduce dose by 50% if CrCl 15-29 mL/min, avoid if <15 mL/min; for pregabalin, adjust to 25-50 mg/day if CrCl <30 mL/min. Monitor for CNS toxicity, consider therapeutic drug monitoring if available, and evaluate need for alternative therapies. Consult nephrology for dialysis patients.
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