Indications and Mechanism of Action
Gabapentin is a generic name of neurontin, a medication in the form of capsules and tablets which are used as a part of adjunctive therapy for patients with partial onset seizures. With the help of the chosen drug, adult patients, as well as patients older than 3 years, may control seizures of different types and avoid epilepsy in case it is regularly taken. Another important indication of gabapentin is to manage postherpetic neuralgia (Markley, Dunteman, Kareht, & Sweeney, 2015). This condition is characterized by pain persistence for more than three months and associated with sleep disturbance and low back pain. Gabapentin is also used orally to relieve painful restless leg syndrome and decrease the possibility of complications because of amyotrophic lateral sclerosis (Carrasco, Rao, Bearer, & Sundarrajan, 2015; Chiò, Mora, & Lauria, 2017). Tremors and nystagmus are the health problems that may be solved or, at least, controlled by taking gabapentin 3 times daily.
The mechanism of action of gabapentin is based on analgesic and antiepileptic qualities of the drug. However, not many current studies can be found on this topic. Fornasari (2017) compares the mechanisms of action of gabapentin and pregabalin, focusing on alpha-2/delta-1 expression. Though the chosen drug has no direct connection to the work of the neurotransmitter y-aminobutyric acid known as GABA, it has a property to strengthen the qualities of GABA. In addition, gabapentin is able to inhibit calcium channels by opening ionizing channels. Finally, the recent discovery proves the possibility of gabapentin to determine the work of certain voltage-dependent calcium channels as the main inhibitor of the alpha-2/delta-1 subunit (Offord & Isom, 2016). Still, it is recommended to continue researching gabapentin mechanism of action and its role in GABA synthesis.
Precautions and Contraindications
Special attention is paid to the section of precautions and contradictions of gabapentin due to associated depression and possible suicidal thoughts. First of all, it is recommended to check the level of sensitivity to this drug and avoid using gabapentin in patients who demonstrate hypersensitivity to any of its components. Then, the analysis of the emotional well-being cannot be neglected as it is a chance to understand what kind of reactions may be observed and what interventions should be offered. Anticonvulsants like gabapentin can promote the emergence of depression, as well as the thoughts about self-harm and suicide. Unusual changes in mood and behavior have to be reported.
Another significant precaution touches upon the patients who have renal problems or are on dialysis. This drug can considerably reduce renal function and develop serious renal impairment. Finally, it is recommended for pregnant women to avoid taking gabapentin because of the year limitations that exclude neonates (Markley et al., 2015). Still, other authors support the idea of using gabapentin to avoid the complications of restless leg syndrome among pregnant women (Carrasco et al., 2015). This contradiction is a serious background to continue investigating the characteristics of gabapentin.
Even one dose of gabapentin can cause a number of side effects and change the health conditions of a patient. Among the most frequent adverse reactions, it is possible to identify the following: diarrhea, dizziness, dry mouth, drowsiness, and the loss of coordination. Some patients may report that they start observing unpredictable tremor or eye movement. Abuse and addiction are the outcomes that hard to be predicted because much depends on the patient’s history. All these reactions and outcomes have to be discussed with a doctor. Sleepiness is a side effect that prevents drivers from taking this drug unless they are hospitalized or stay at home for a while. Finally, as it has already been mentioned, gabapentin may increase suicidal thoughts and behaviors. Therefore, depression and behavioral changes should be defined as the possible human reactions to this drug. Another adverse reaction like the development of adenocarcinoma (or cancer) cells is not approved by human studies but remains a serious research topic in the studies with rats.
Patient education plays an important role in taking drugs and avoiding serious complications. It is not enough to inform a patient about the required doses and schedules. However, one should admit that overdosing is a problem some patients still face. As soon as adverse reactions are observed, or the patient suffers from breathing troubles and unpredictable changes, people should call 911 or address to the nearest hospital. It is also necessary to discuss the worth of gabapentin and evaluate the expectations that have to be achieved. Patients have to be prepared for such conditions as depression, suicidal thoughts, and mood changes. If possible, family members or caregivers should observe the patient during the first day of taking the drug.
Education must include the explanation the possible outcomes of interactions between gabapentin and opioids, including the changes in the work of the central nervous system. Gabapentin may cause dependence, and patients have to learn how to control their treatment and avoid abuse complications. Communication with a psychologist is one of the possible solutions. To conclude, a number of treating properties of gabapentin cover its possible negative sides and adverse reactions making this drug one of the best treatment options for patients with seizures and postherpetic neuralgia.
Carrasco, M., Rao, S. C., Bearer, C. F., & Sundararajan, S. (2015). Neonatal gabapentin withdrawal syndrome. Pediatric Neurology, 53(5), 445-447. Web.
Chiò, A., Mora, G., & Lauria, G. (2017). Pain in amyotrophic lateral sclerosis. The Lancet Neurology, 16(2), 144-157. Web.
Markley, H. G., Dunteman, E. D., Kareht, S., & Sweeney, M. (2015). Real-world experience with once-daily gabapentin for the treatment of postherpetic neuralgia (PHN). The Clinical Journal of Pain, 31(1), 58-65. Web.
Offord, J., & Isom, L. L. (2016). Drugging the undruggable: Gabapentin, pregabalin and the calcium channel α2δ subunit. Critical Reviews in Biochemistry and Molecular Biology, 51(4), 246-256. Web.