neurontin
| Product dosage: 100mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | $4.01 | $40.14 (0%) | 🛒 Add to cart |
| 20 | $2.51 | $80.27 $50.17 (37%) | 🛒 Add to cart |
| 30 | $2.01 | $120.41 $60.20 (50%) | 🛒 Add to cart |
| 60 | $1.17 | $240.82 $70.24 (71%) | 🛒 Add to cart |
| 90 | $1.00 | $361.23 $90.31 (75%) | 🛒 Add to cart |
| 120 | $0.92 | $481.64 $110.38 (77%) | 🛒 Add to cart |
| 180 | $0.78 | $722.46 $140.48 (81%) | 🛒 Add to cart |
| 270 | $0.63 | $1083.68 $170.58 (84%) | 🛒 Add to cart |
| 360 | $0.54
Best per pill | $1444.91 $195.66 (86%) | 🛒 Add to cart |
| Product dosage: 300mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | $5.02 | $50.17 (0%) | 🛒 Add to cart |
| 20 | $4.01 | $100.34 $80.27 (20%) | 🛒 Add to cart |
| 30 | $3.34 | $150.51 $100.34 (33%) | 🛒 Add to cart |
| 60 | $2.34 | $301.02 $140.48 (53%) | 🛒 Add to cart |
| 90 | $2.12 | $451.53 $190.65 (58%) | 🛒 Add to cart |
| 120 | $1.84 | $602.05 $220.75 (63%) | 🛒 Add to cart |
| 180 | $1.67 | $903.07 $301.02 (67%) | 🛒 Add to cart |
| 270 | $1.26 | $1354.60 $341.16 (75%) | 🛒 Add to cart |
| 360 | $1.11
Best per pill | $1806.14 $401.36 (78%) | 🛒 Add to cart |
| Product dosage: 400mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | $6.02 | $60.20 (0%) | 🛒 Add to cart |
| 20 | $4.52 | $120.41 $90.31 (25%) | 🛒 Add to cart |
| 30 | $3.68 | $180.61 $110.38 (39%) | 🛒 Add to cart |
| 60 | $2.68 | $361.23 $160.55 (56%) | 🛒 Add to cart |
| 90 | $2.56 | $541.84 $230.78 (57%) | 🛒 Add to cart |
| 120 | $2.34 | $722.46 $280.95 (61%) | 🛒 Add to cart |
| 180 | $2.03 | $1083.68 $366.24 (66%) | 🛒 Add to cart |
| 270 | $1.56 | $1625.52 $421.43 (74%) | 🛒 Add to cart |
| 360 | $1.39
Best per pill | $2167.37 $501.70 (77%) | 🛒 Add to cart |
| Product dosage: 600mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | $7.02 | $70.24 (0%) | 🛒 Add to cart |
| 20 | $5.02 | $140.48 $100.34 (29%) | 🛒 Add to cart |
| 30 | $4.01 | $210.72 $120.41 (43%) | 🛒 Add to cart |
| 60 | $3.34 | $421.43 $200.68 (52%) | 🛒 Add to cart |
| 90 | $2.79 | $632.15 $250.85 (60%) | 🛒 Add to cart |
| 120 | $2.68 | $842.86 $321.09 (62%) | 🛒 Add to cart |
| 180 | $2.37 | $1264.30 $426.45 (66%) | 🛒 Add to cart |
| 270 | $2.04 | $1896.44 $551.88 (71%) | 🛒 Add to cart |
| 360 | $1.67
Best per pill | $2528.59 $602.05 (76%) | 🛒 Add to cart |
Neurontin, known generically as gabapentin, is an anticonvulsant and neuropathic pain agent originally developed as a structural analog of GABA. It’s one of those foundational drugs in neurology and pain management that every clinician ends up using, but its full profile is more nuanced than many realize. I remember first prescribing it in the late 90s, skeptical about yet another “GABAergic” drug, but over two decades, I’ve seen it help—and occasionally puzzle—countless patients.
Neurontin: Effective Neuropathic Pain and Seizure Control - Evidence-Based Review
1. Introduction: What is Neurontin? Its Role in Modern Medicine
Neurontin, or gabapentin, is a prescription medication belonging to the anticonvulsant class. Initially approved for partial seizures, its application has broadened significantly, particularly for neuropathic pain conditions like diabetic neuropathy and postherpetic neuralgia. Many patients and even some younger clinicians don’t realize it was originally designed as a GABA mimetic—though it doesn’t actually work directly on GABA receptors, which is one of those interesting twists in pharmacology. In clinical practice, Neurontin has become a first-line option for various neuropathic pain syndromes, and off-label, it’s used for everything from restless legs syndrome to certain anxiety disorders. Its value lies in its generally favorable side effect profile compared to older anticonvulsants.
2. Key Components and Bioavailability of Neurontin
The active pharmaceutical ingredient is gabapentin, chemically known as 1-(aminomethyl)cyclohexaneacetic acid. It’s formulated as immediate-release tablets, capsules, and an oral solution. The bioavailability isn’t linear—it decreases as the dose increases, which is crucial for dosing. At 300mg, bioavailability is about 60%, but at 3600mg daily, it drops to around 27%. This is why we typically dose it three times daily rather than once; splitting the dose helps maintain more consistent plasma levels. It’s not significantly metabolized in the liver, which is a plus for patients with hepatic impairment, and it’s eliminated renally, so dose adjustment in renal dysfunction is essential. I’ve had to explain this nonlinear pharmacokinetics to many patients who wonder why we can’t just give one large dose at bedtime.
3. Mechanism of Action of Neurontin: Scientific Substantiation
The exact mechanism isn’t fully understood, which we should be honest about—medicine always has its gray areas. Unlike benzodiazepines, it doesn’t act directly on GABA-A or GABA-B receptors. Instead, it binds to the α2δ subunit of voltage-gated calcium channels in the central nervous system. This binding reduces the release of several excitatory neurotransmitters, including glutamate, substance P, and calcitonin gene-related peptide. Think of it as calming down overexcited nerves rather than putting a brake on the entire system. This selective action is why it’s useful for neuropathic pain without causing the same degree of sedation as some alternatives. The effect on calcium channels also explains its anticonvulsant properties, as it stabilizes neuronal membranes and reduces aberrant electrical activity.
4. Indications for Use: What is Neurontin Effective For?
Neurontin for Partial Seizures
As adjunctive therapy for partial seizures with or without secondary generalization in patients over 12 years. In younger children, it’s also used, but dosing must be carefully weight-based.
Neurontin for Postherpetic Neuralgia
Approved for the management of postherpetic neuralgia, with numerous studies showing significant pain reduction compared to placebo. The typical effective dose is 1800-3600mg daily in divided doses.
Neurontin for Diabetic Neuropathy
Though not FDA-approved for this indication specifically, it’s widely used off-label based on strong clinical evidence. Many patients with burning foot pain or allodynia respond well.
Other Neuropathic Pain Conditions
Including phantom limb pain, complex regional pain syndrome, and neuropathic components of low back pain. I’ve found it particularly helpful in chemotherapy-induced peripheral neuropathy.
Off-Label Uses
Restless legs syndrome, migraine prophylaxis, fibromyalgia, and certain anxiety disorders. The evidence varies—strong for RLS, more mixed for fibromyalgia.
5. Instructions for Use: Dosage and Course of Administration
Dosing must be individualized based on indication and patient response. For neuropathic pain, we typically start low and titrate up:
| Indication | Initial Dose | Titration | Maintenance | Maximum |
|---|---|---|---|---|
| Postherpetic Neuralgia | 300mg day 1 | Increase to 300mg BID day 2, 300mg TID day 3 | 300-600mg TID | 1800mg daily |
| Partial Seizures | 300mg TID | May increase by 300mg/day every 2-3 days | 900-1800mg daily | 3600mg daily |
| Renal Impairment (CrCl <60) | Reduce dose | Slower titration | Lower maintenance | Consult dosing guidelines |
Should be taken with food to improve absorption and minimize GI upset. Abrupt discontinuation can cause withdrawal symptoms, so we taper over at least one week.
6. Contraindications and Drug Interactions with Neurontin
Contraindications include known hypersensitivity to gabapentin. Use with caution in elderly patients due to increased risk of dizziness and falls, and in those with renal impairment—dose adjustment is mandatory. Significant drug interactions are relatively few, which is one of its advantages. Antacids containing aluminum/magnesium can reduce absorption by up to 20%, so we recommend separating administration by at least 2 hours. CNS depressants like opioids and benzodiazepines can potentiate sedation and respiratory depression—this combination requires careful monitoring. I had a patient, Mr. Henderson, 72, who developed significant ataxia when we added Neurontin to his existing lorazepam; reducing the lorazepam dose resolved it.
7. Clinical Studies and Evidence Base for Neurontin
The evidence for neuropathic pain is robust. A 2017 Cochrane review of 37 studies concluded that gabapentin at doses of 1200mg or more daily is effective for chronic neuropathic pain, with NNT of 7.2 for substantial benefit. For postherpetic neuralgia specifically, multiple RCTs show 30-40% pain reduction versus 15-20% with placebo. The pivotal trial by Backonja et al. demonstrated that 67% of patients on gabapentin (1800-2400mg/day) had significant pain reduction versus 39% on placebo. For epilepsy, as adjunctive therapy, it reduces seizure frequency by 50% in approximately 25-30% of treatment-resistant patients. However, some recent meta-analyses have questioned the magnitude of effect, suggesting publication bias may have inflated early estimates—this is the kind of scientific honesty we need in medicine.
8. Comparing Neurontin with Similar Products and Choosing Quality
Versus pregabalin (Lyrica): Pregabalin has higher bioavailability and more linear pharmacokinetics, allowing for twice-daily dosing, but is more expensive and has similar efficacy. Some patients respond better to one than the other—I’ve had several who failed on gabapentin but did well on pregabalin, and vice versa.
Versus older anticonvulsants (carbamazepine, phenytoin): Fewer drug interactions and generally better tolerated, though possibly less potent for certain seizure types.
Versus antidepressants (duloxetine, amitriptyline): Different side effect profiles; antidepressants may be better for pain with comorbid depression, while Neurontin causes less weight gain than amitriptyline and fewer sexual side effects than duloxetine.
Generic gabapentin is bioequivalent to brand-name Neurontin and typically preferred for cost reasons. All manufacturers must meet FDA standards for quality.
9. Frequently Asked Questions (FAQ) about Neurontin
What is the typical timeline for Neurontin to work for neuropathic pain?
Most patients notice some effect within 1-2 weeks, but full benefit may take 4-8 weeks at optimal dose.
Can Neurontin be taken with opioid medications?
Yes, but with caution due to additive CNS depression. Requires close monitoring, especially when initiating or increasing doses.
Does Neurontin cause weight gain?
Weight gain occurs in about 2-3% of patients, less commonly than with pregabalin.
Is Neurontin safe during pregnancy?
Pregnancy Category C—should only be used if potential benefit justifies potential risk to fetus. Registry data suggest possible increased risk of teratogenicity.
Can Neurontin be stopped abruptly?
No—should be tapered over at least one week to avoid withdrawal symptoms like anxiety, insomnia, and pain flare-ups.
10. Conclusion: Validity of Neurontin Use in Clinical Practice
Neurontin remains a valuable tool in our therapeutic arsenal, particularly for neuropathic pain conditions where it offers favorable efficacy with generally manageable side effects. The evidence supports its use as first-line therapy for several indications, though individual patient response varies. Its relatively safe profile and few drug interactions make it suitable for many patients, including those on multiple medications.
I remember particularly well a patient named Sarah, early 40s, with debilitating postherpetic neuralgia after shingles—she’d been on multiple medications with limited effect and significant side effects. We started gabapentin cautiously, titrated to 600mg TID, and over six weeks, her pain score dropped from 8/10 to 3/10. She regained the ability to sleep through the night and wear normal clothing without discomfort. But it wasn’t straightforward—we had to manage initial dizziness and fatigue, and she needed reassurance during the titration period. Five years later, she remains on a maintenance dose with good effect and minimal side effects. Another case, David with diabetic neuropathy, didn’t respond as well—we maxed out at 3600mg daily with only modest benefit before switching to duloxetine. That’s the reality of clinical practice: not every patient fits the textbook response. The development team originally thought it would primarily be an antiepileptic, but the pain indications emerged later through clinical observation—one of those fortunate discoveries that happen in medicine. These longitudinal experiences, both successes and partial responses, reinforce that while Neurontin isn’t a panacea, it’s an important option that has genuinely improved quality of life for many of my patients over the years.