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Gabapentin belongs to a class of drugs known as anticonvulsants, used to help control seizures in the treatment of epilepsy. It is also used to control pain associated with shingles and has been evaluated for pain conditions, including migraine, as its pain-modulating properties may regulate the perception of pain. Anticonvulsant drugs, such as gabapentin, are becoming increasingly popular for migraine prevention.

NEWLY DISCOVERED USES (OFF-LABEL)
Alcohol withdrawal, attention deficit hyperactivity disorder (ADHD), chronic neuropathic pain, cocaine addiction, diabetic peripheral neuropathy, generalized anxiety disorder (GAD), fibromyalgia, menopause, migraine prevention, panic disorder, post-traumatic stress disorder (PTSD), social phobia, trigeminal neuralgia.

POTENTIAL SIDE EFFECTS
Drowsiness, dizziness, muscle incoordination, fatigue, fever, emotional lability, nausea, upset stomach, dry mouth, double vision, blurred vision.

CAUTIONS

• Avoid abrupt discontinuation of therapy.
• Use with caution if you have renal impairment, or if you are elderly.
• Use with caution when operating heavy machinery or driving.
• Monitor for possible mood disturbances or psychological changes when using this drug in children.

SPECIAL INFORMATION
International and domestic studies that have evaluated Neurontin for migraine prevention suggest that it is effective. In a study of 63 patients with migraine (with or without aura), gabapentin significantly reduced migraine frequency and intensity among 30 patients who received it. In this study, adverse events were mild to moderate in severity.

Similarly, in a large study, 143 people with migraine received daily doses of gabapentin or placebo for 12 weeks. At the end of 12 weeks, the migraine rate had declined from 4.2 migraines before treatment to 2.7 migraines after treatment in those who received gabapentin. This decrease was significantly greater than the decrease from 4.1 migraines to 3.5 migraines among those who received placebo. Of the 56 gabapentin recipients, 46% had at least a 50% reduction in the four-week migraine rate. Drug-related adverse events (sleepiness and dizziness) led to drug withdrawal in 13% of patients in the gabapentin group compared with 7% in the placebo group. The researchers concluded that Neurontin is an effective and well-tolerated preventive for migraine.

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Neurontin News - Epilepsy Treatment

The American Academy of Neurology and the American Epilepsy Society released new guidelines for the treatment of epilepsy with seven new antiepileptic drugs.

A 23-member committee of neurologists, pediatric neurologists, epileptologists and physicians in pharmacy conducted a literature review of 1,462 articles from 1987 to 2003 that involved epilepsy and at least one of seven new antiepileptic drugs. The drugs included Pfizer Inc.’s Neurontin (gabapentin), GlaxoSmithKline Plc’s Lamictal (lamotrigine), Ortho-McNeil Pharmaceutical Inc.’s Topamax (topiramate), Cephalon Inc.’s Gabitril (tiagabine hydrochloride), Novartis AG’s Trileptal (oxcarbazepine), UCB Pharma Inc.’s Keppra (levetiracetam) and Elan Corp. Plc and Eisai Co. Ltd.'s Zonegran (zonisamide).

The committee members assessed drug efficacy and side effects from double-blind controlled studies that included 20 or more patients.

Overall, they found that Neurontin, Lamictal, Topamax and Trileptal were effective as monotherapy in newly diagnosed adolescents and adults with partial or mixed seizure disorders and were effective for the treatment of refractory partial seizures in children.

The evidence showed that Lamictal was effective for newly diagnosed absence seizures in children. However, there was limited evidence suggesting that Lamictal and Topamax were effective for adjunctive treatment of idiopathic generalized epilepsy and Lennox-Gastaut syndrome among both adults and children.

All of the new drugs were found to be appropriate for adjunctive treatment of refractory partial seizures in adults, while Neurontin could be effective for treating mixed seizure disorders.

However, the committee members said that there is a lack of evidence related to the use of these new drugs in newly diagnosed patients with other generalized epilepsy syndromes.

These study results were published in the April 27 issue of Neurology.

Neurontin Significantly Reduces Chronic Neuropathic Pain

Two studies recently published in The Journal of the American Medical Association, report that Parke-Davis’ Neurontin(R) (gabapentin capsules) significantly reduced chronic neuropathic pain.
One study examined the effects of Neurontin on patients with diabetic peripheral neuropathy (DPN), a chronic, often painful condition that affects approximately half of the estimated 1.5 million diabetes patients in Canada. A companion study examined the use of Neurontin in patients suffering from post-herpetic neuralgia (PHN), the chronic neuropathic pain condition that can follow shingles (herpes zoster).

Results of the national, multi-centre DPN study demonstrated that patients suffering from diabetic peripheral neuropathy experienced a significant reduction in pain after treatment with the drug and that 26 percent of those patients treated with Neurontin were pain-free at the end of the trial compared to 15 percent of patients treated with placebo. This difference was statistically significant.

Findings of the national, multi-centre PHN study showed that patients suffering from the condition experienced a statistically significant reduction in average daily pain after treatment with Neurontin. Importantly, almost twice as many patients treated with Neurontin (16 percent) were pain-free versus those treated with placebo (8.8 percent) at the end of the trial. Both studies also showed that patients receiving Neurontin experienced improvement in sleep and overall quality of life.

“Further, more significant pain reduction was observed in some patients after only two weeks of treatment. All of these findings combined are clinically important."

DPN is characterised by nerve fibre loss that can result in symptoms ranging from diminished pain and temperature perception, paresthesia (pins and needles) and neuropathic (sharp or burning) pain, to loss of light touch and muscle weakness. Other symptoms include insomnia, anxiety, depression, weight loss and a general decline in quality of life.

"In this study, Neurontin reduced pain and sleep interference associated with the condition and also exhibited positive effects on mood and quality of life.

The most common adverse events during clinical trials were somnolence (19.3 percent versus 8.7 percent with placebo); dizziness (17.1 percent versus 6.9 percent with placebo); ataxia (12.5 percent versus 5.6 percent with placebo); fatigue (11 percent versus five percent with placebo) and nystagmus (8.3 percent versus four percent with placebo).

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Epilepsy Medicine Neurontin (Gabapentin)

A Historical Point of View
Epilepsy has afflicted human beings since the dawn of our species and has been recognized since the earliest medical writings. In fact, few medical conditions have attracted so much attention and generated so much controversy as epilepsy.
The Greek physician Hippocrates writes the first book on epilepsy, On the Sacred Disease. Refuting the idea that epilepsy is a curse or a prophetic power, Hippocrates proves the truth: It's a brain disorder. "It is thus with regard to the disease called Sacred: it appears to me to be nowise more divine nor more sacred than other diseases, but has a natural cause like other affections. . ."

There have always been people with epilepsy. Since the dawn of time, epilepsy has affected millions of people, from beggars to kings. It is one of the oldest conditions of the human race with a rich and distinguished history.

A seizure happens when the electrical system of the brain malfunctions. Instead of discharging electrical energy in a controlled manner, the brain cells keep firing. The result may be a surge of energy through the brain, causing unconsciousness and contractions of the muscles. An epilepsy syndrome is defined by a collection of similar factors, such as type of seizure, when they developed in life, and response to treatment.
There is no cure for epilepsy, yet. Medications do not cure epilepsy in the same sense that penicillin can cure an infection. For many people with epilepsy, however, the medication will prevent seizures as long as they are taken regularly; but, successful drug therapy requires the active cooperation of the patient. Antiepileptic drugs successfully prevent seizures in the majority of people who take them regularly and as prescribed. It has been estimated that at least fifty percent of all patients with epilepsy gain complete control of their seizures for substantial periods of time.

Whenever possible, doctors try to prevent seizures with a single medication. This is called monotherapy. However, some people may require polytherapy, the use of more than one medication to achieve seizure control.When selecting a drug, your doctor will consider the type of seizures you have. Not all medications work for all types of seizures.

Like all drugs, epilepsy medicines have side effects. Some are dose-related, and become more likely as the dose increases.
Neurontin was approved in December 1993 a an adjunctive treatment for partial epileptic seizures in adults and children. Neurontin (Gabapentin) is used with other medications to help control seizures in adults and children (3 years of age and older). It is also used to relieve nerve pain associated with shingles (herpes zoster) infection in adults. Gabapentin may also be used to treat other nerve pain conditions (e.g., diabetic neuropathy, peripheral neuropathy, trigeminal neuralgia).

Take this medication by mouth, with or without food, as directed by your doctor. The dosage is based on your medical condition and response to therapy. During the first few days, your doctor may gradually increase your dose so your body can adjust to the medication. To minimize side effects, take the very first dose at bedtime.

SIDE EFFECTS: Common side effects of gabapentin are dizziness, somnolence, ataxia, fatigue, fluid retention, hostility, nausea and vomiting. Other adverse events associated with gabapentin include hypertension, anorexia, bruising, joint pain, motion sickness, and pneumonia.
Antiepileptic medications have been associated with increased risk of suicidal thinking and behavior.

Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

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