Empfehlungen zur behandlung fokaler epilepsien mit gabapentin: Konsensuspapier

A number of controlled trials and various clinical experience have demonstrated the clinical benefit of gabapentin as a first-line treatment for adolescents and adults with partial epilepsies. The recommended target dose is 600 mg t.i.d. (1800 mg per day). An increase to 2400-3600 mg per day and more can be useful. It is recommended to start with 300 - 800 mg per day and to increase the daily dose every 3 days by 30 - 400 mg. If necessary, a more rapid titration with 300 - 400 mg per day is feasible. As a rule, the dosage is given t.i.d. Gabapentin is not metabolized and does neither undergo nor cause any relevant drug interactions. As it is excreted renally by more than 90%, the daily dose has to be reduced in patients with severely impaired glomerular filtration rate. Gabapentin is well tolerated, does not lead to hepatic dysfunction or hematological changes and has not caused any organ damage during exposure of more than six million patient years. Like many other antiepileptic drugs, gabapentin has great clinical benefit in only a small percentage of patients with chronic refractory epilepsy when used for substitution or as add-on treatment. Gabapentin treatment should be considered especially in the elderly and in those with co-morbidity who need to take other medication. Gabapentin is a well tolerated, safe, and effective drug for single or multiple drug treatment of partial epilepsies in adolescents and adults, possibly also in children. Its special merit is that it allows rapid titration, if needed, and its excellent compatibility with other drugs.