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Neurology 2001;56:743-748
© 2001 American Academy of Neurology
Articles

Rapid initiation of gabapentin

A randomized, controlled trial

R.S. Fisher, MD, PhD;, R.C. Sachdeo, MD;, J. Pellock, MD;, P.E. Penovich, MD;, L. Magnus, MD; and P. Bernstein, MS

From the Epilepsy Center (Dr. Fisher), Stanford Medical School, Stanford, CA; Robert Wood Johnson Medical School (Dr. Sachdeo), Rutgers University, Piscataway, NJ; Medical College of Virginia (Dr. Pellock), Virginia Commonwealth University, Richmond, VA; Minnesota Epilepsy Group (Dr. Penovich), St. Paul, MN; and Medical Research (Dr. Magnus) and Biostatistics (Dr. Bernstein) Departments, Parke-Davis Division of Warner-Lambert Company, Summit, NJ.

Address correspondence and reprint requests to Dr. R.S. Fisher, Department of Neurology, Stanford University, 300 Pasteur Dr., Rm. H3113, Stanford, CA 94305-5235; e-mail: rfisher{at}stanford.edu

OBJECTIVE: To compare the tolerability of two different dose-initiation regimens of gabapentin for the adjunctive treatment of partial seizures.

BACKGROUND: Patient compliance is a key feature of successful outpatient pharmacologic therapy for epilepsy, and one aspect of compliance is simplicity of initiation. By using a rapid titration rate, leading to a rapid therapeutic gabapentin dose, perhaps there could be an improvement with compliance.

METHODS: Male or female patients, at least 12 years old, with a recent history of partial seizures with or without secondary generalization, were randomized to receive gabapentin (following a blinded placebo period of an undisclosed number of days) as either a Slow initiation (300 mg day 1, 600 mg day 2, then 900 mg/day) or a Rapid initiation (900 mg/day immediately following the placebo lead-in).

RESULTS: Starting gabapentin therapy at an initial therapeutic dosage of 900 mg/day is well tolerated by patients with epilepsy and is as safe as initiating with a titration schedule over 3 days. Of the four most common adverse events (somnolence, dizziness, ataxia, fatigue), only one, dizziness, occurred more often in the nontitrated (Rapid initiation) group than in the titrated (Slow initiation) group.

CONCLUSION: Initiation of gabapentin at 900 mg/day is as well tolerated as is a 3-day titration, except for a higher incidence of dizziness.




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