Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. Swallow whole; do not chew, crush, or split.Capsules and tablets: Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Initiate buprenorphine at lower doses in patients already receiving CNS depressants.Cannabidiol: May enhance the CNS depressant effect of CNS Depressants.Cannabis: May enhance the CNS depressant effect of CNS Depressants.Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Inhibitory neurotransmitters like GABA slow the activity of other neurons, allowing for different types of control and communication between neurons in the brain and spinal cord.Opiate drugs are significant drugs of abuse and have received much attention in the media as drugs of abuse. Monitor all patients for notable changes in behavior that might indicate suicidal thoughts or depression; notify healthcare provider immediately if symptoms occur.• Myasthenia gravis: Use with caution in patients with myasthenia gravis; may exacerbate condition (Mehrizi 2012).• Renal impairment: Use with caution in patients with renal impairment; dose adjustment required.• Respiratory disease: Gabapentin may cause respiratory depression; use caution and initiate with the lowest recommended dose in patients with respiratory compromise (FDA 2019).• Seizure disorder: The safety and efficacy of the ER formulation has not been studied in patients with epilepsy.• Substance abuse: Use with caution in patients with a history of substance abuse, including alcohol, benzodiazepines, cannabis, cocaine, and opioids; potential for drug dependency exists.

The most significant include emotional lability, hostility (eg, aggressive behaviors), changes in behavior and thinking (eg, concentration problems and changes in school performance), and hyperkinesia (primarily restlessness and hyperactivity).• Respiratory effects: Serious, life-threatening, and fatal respiratory depression may occur in patients using gabapentin; risk may be increased with conditions such as chronic obstructive pulmonary disease, in the elderly, and with the concomitant use of opioids and other CNS depressants. Gabapentin, and its brand-name formulation Neurontin, are used as anticonvulsants as well as to treat certain types of neuropathic pain. Capsules may be opened and sprinkled on food (eg, applesauce, orange juice, pudding) for patients unable to swallow capsules (Gidal 1998).Extended release: Administer with evening meal. Discontinue therapy and seek immediate medical care if signs or symptoms of anaphylaxis or angioedema occur.• CNS depression: May cause CNS depression, including somnolence and dizziness, that may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).• Multiorgan hypersensitivity: Potentially serious, sometimes fatal, multiorgan hypersensitivity (also known as drug reaction with eosinophilia and systemic symptoms) has been reported with some antiepileptic drugs, including gabapentin.

Participants with central sensitization of the cough reflex exhibited a greater response to gabapentin treatment compared to participants without central sensitization Data from a randomized, double-blind, placebo-controlled study support the use of gabapentin in the treatment of pain and sleep disturbances associated with fibromyalgia Data from a limited number of patients in case reports/series and a retrospective chart review suggest that gabapentin (monotherapy or as an adjunct to other agents such as baclofen, cisapride, omeprazole, haloperidol, and metoclopramide) may decrease the frequency and severity of persistent or intractable hiccups In a meta-analysis of trials evaluating the treatment of neuropathic pain, including painful polyneuropathy and spinal cord injury pain, gabapentin was shown to be safe and effective Based on guidelines from the International Association for the Study of Pain (IASP), European Federation of Neurological Societies (EFNS), and Society of Critical Care Medicine (SCCM), gabapentin is effective and recommended for the management of peripheral neuropathy Data from 3 meta-analyses support the use of preemptive doses of gabapentin to decrease postoperative pain and opioid use Data from a limited number of patients studied suggest that gabapentin may be beneficial for the treatment of chronic pruritus, including brachioradial pruritus Based on European Dermatology Forum (EDF) and European Academy of Dermatology and Venerology (EADV) guidelines for the treatment of chronic pruritus, gabapentin is recommended for chronic pruritus of neuropathic origin.

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