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Gabapentin

Grade

Neuropathic Pain

Administration

  • Oral: An ideal time to administer Gabapentin is before feeding.

Formulations

  • UK Availability: Gabapentin is administered orally as a capsule, tablet, or compounded liquid, with or without food. 

Therapeutics

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Use

  • Sole Use: As the ability to diagnose and monitor neuropathic pain is unclear, sole use is not yet advised. Use without additional agents with known analgesic benefits may leave the patient in unacceptable pain.

  • Multimodal Use: As neuropathic pain is challenging to diagnose and may accompany other forms of pain, it is common for additional agents to be used alongside Gabapentin in a subjective, case-by-case manner. These include NSAIDs, opiates and additional adjuvant analgesic agents such as amantadine. The evidence for multimodal use is weak/absent.

  • Treatment Goals: Reduction in clinical signs associated with neuropathic pain, reduction of pain, and improved speed of patient recovery.

  • Treatment Endpoints: Undefined.

Efficacy

  • Efficacy Profile: Undefined; No data located compares the benefit of Gabapentin as a combined analgesic to other analgesia agents or a combination of analgesics in canine neuropathic pain.

Adverse Effects and Contraindications

  • Adverse Effects Profile: Adverse effects of Gabapentin can include sedation and ataxia and are more likely when administered at higher dosages or when combined with other drugs that produce similar adverse effects.

Reproduction

  •  Pregnancy: Avoid use as there is evidence of fetotoxicity in Rodents and Rabbits (Prakash et al., 2008), but little evidence of adverse effects in humans  (Fujii et al., 2013). 

  • Lactation: Avoid use. Gabapentin is distributed into milk following oral administration. 

  • Male Fertility: Avoid use as there is evidence of impaired fertility in rats (Daoud et al., 2004).

  • Female Fertility: Assumed to be safe. No evidence suggesting that female fertility is affected by exposure to gabapentin was found (Fujii et al., 2013). 

Alternative Products and Protocols

  1. Alternative Products: NSAIDs, opiates and additional adjuvant analgesic agents such as amantadine.

  2. Alternative Protocols: PK/PD data suggests that eight hourly (8h) dosing is more likely to be effective than 12h or 24h dosing for the relief of persistent neuropathic pain (KuKanich and Cohen, 2011; Radulovic et al., 1995; Vollmer et al., 1986).

Monograph Status

  1. Pilot Monograph:  No editorial review has ocurred. 


Evidence

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  1. Amadei, E., Cantile, C., Gazzano, A., Pierantoni, L., Mariti, C., 2021. The link between neurology and behavior in veterinary medicine: A review. Journal of Veterinary Behavior 46, 40–53. https://doi.org/10.1016/j.jveb.2021.07.003

  2. Cloquell, A., Kaczmarska, A., Gutierrez-Quintana, R., José-López, R., 2021. Magnetic resonance imaging findings and clinical management of suspected intracranial hypovolemia after transfrontal craniotomy in a dog. Veterinary Surgery 50, 1696–1703. https://doi.org/10.1111/vsu.13586

  3. Fox, S.M., 2012. Painful Decisions for Senior Pets. Veterinary Clinics of North America: Small Animal Practice, Geriatrics 42, 727–748. https://doi.org/10.1016/j.cvsm.2012.04.010

  4. Gaynor, J.S., 2008. Control of Cancer Pain in Veterinary Patients. Veterinary Clinics of North America: Small Animal Practice, Update on Pain Management 38, 1429–1448. https://doi.org/10.1016/j.cvsm.2008.06.009

  5. Giudice, E., Crinò, C., Barillaro, G., Crupi, R., Macrì, F., Viganò, F., Di Pietro, S., 2019. Clinical findings in degenerative lumbosacral stenosis in ten dogs—A pilot study on the analgesic activity of tramadol and gabapentin. Journal of Veterinary Behavior 33, 7–15. https://doi.org/10.1016/j.jveb.2019.05.004

  6. Gomes, S.A., Lowrie, M., Targett, M., 2020. Single dose epidural methylprednisolone as a treatment and predictor of outcome following subsequent decompressive surgery in degenerative lumbosacral stenosis with foraminal stenosis. The Veterinary Journal 257, 105451. https://doi.org/10.1016/j.tvjl.2020.105451

  7. Gregor, K.M., Knebel, A., Haverkamp, A.-K., Baumgärtner, W., Volk, H., 2022. Metastatic Canine Phaeochromocytoma with Unusual Manifestation. Journal of Comparative Pathology 192, 33–40. https://doi.org/10.1016/j.jcpa.2022.01.006

  8. Hechler, A.C., Moore, S.A., 2018. Understanding and Treating Chiari-like Malformation and Syringomyelia in Dogs. Topics in Companion Animal Medicine 33, 1–11. https://doi.org/10.1053/j.tcam.2018.03.002

  9. Hellyer, P., Rodan, I., Brunt, J., Downing, R., Hagedorn, J., Robertson, S., 2007. AAHA/AAFP pain management guidelines for dogs and cats. Journal of Feline Medicine & Surgery 9, 466–480. https://doi.org/10.1016/j.jfms.2007.09.001

  10. Lamont, L.A., 2008. Adjunctive Analgesic Therapy in Veterinary Medicine. Veterinary Clinics of North America: Small Animal Practice, Update on Pain Management 38, 1187–1203. https://doi.org/10.1016/j.cvsm.2008.06.002

  11. Loughin, C.A., 2016. Chiari-like Malformation. Veterinary Clinics of North America: Small Animal Practice, Congenital Abnormalities of the Skull, Vertebral Column, and Central Nervous System 46, 231–242. https://doi.org/10.1016/j.cvsm.2015.10.002

  12. Mathews, K., Kronen, P.W., Lascelles, D., Nolan, A., Robertson, S., Steagall, P.V., Wright, B., Yamashita, K., 2014. Guidelines for Recognition, Assessment and Treatment of Pain. Journal of Small Animal Practice 55, E10–E68. https://doi.org/10.1111/jsap.12200

  13. Mathews, K.A., 2008. Neuropathic Pain in Dogs and Cats: If Only They Could Tell Us If They Hurt. Veterinary Clinics of North America: Small Animal Practice, Update on Pain Management 38, 1365–1414. https://doi.org/10.1016/j.cvsm.2008.09.001

  14. Mauler, D.A., De Decker, S., De Risio, L., Volk, H.A., Dennis, R., Gielen, I., Van der Vekens, E., Goethals, K., Van Ham, L., 2017. Spinal Arachnoid Diverticula: Outcome in 96 Medically or Surgically Treated Dogs. J Vet Intern Med 31, 849–853. https://doi.org/10.1111/jvim.14714

  15. Moore, S.A., 2016. Managing Neuropathic Pain in Dogs. Front Vet Sci 3, 12. https://doi.org/10.3389/fvets.2016.00012

  16. Otero, P.E., Portela, D.A., Fuensalida, S.E., Romano, M., Tarragona, L., Cavalcanti, M., Texeira, J.G., Jones, R., Guerrero, J.A., 2022. Pericapsular hip desensitization in dogs: A cadaveric study and case series. Veterinary Anaesthesia and Analgesia. https://doi.org/10.1016/j.vaa.2022.08.001

  17. Plessas, I.N., Rusbridge, C., Driver, C.J., Chandler, K.E., Craig, A., McGonnell, I.M., Brodbelt, D.C., Volk, H.A., 2012. Long-term outcome of Cavalier King Charles spaniel dogs with clinical signs associated with Chiari-like malformation and syringomyelia. Vet Rec 171, 501. https://doi.org/10.1136/vr.100449

  18. Plessas, I.N., Volk, H.A., Rusbridge, C., Vanhaesebrouck, A.E., Jeffery, N.D., 2015. Comparison of gabapentin versus topiramate on clinically affected dogs with Chiari-like malformation and syringomyelia. Veterinary Record 177, 288–288. https://doi.org/10.1136/vr.103234

  19. Reader, R., Olaitan, O., McCobb, E., 2021. Evaluation of prescribing practices for gabapentin as an analgesic among veterinary professionals. Veterinary Anaesthesia and Analgesia 48, 775–781. https://doi.org/10.1016/j.vaa.2021.06.007

  20. Romero‐Fernandez, N., José‐López, R., Durand, A., Gutierrez‐Quintana, R., 2017. Successful medical management of an epidural abscess in a dog. Veterinary Record Case Reports 5, e000448. https://doi.org/10.1136/vetreccr-2017-000448

  21. Ruel, H.L.M., Steagall, P.V., 2019. Adjuvant Analgesics in Acute Pain Management. Veterinary Clinics of North America: Small Animal Practice, Alternatives to Opioid Analgesia in Small Animal Anesthesia 49, 1127–1141. https://doi.org/10.1016/j.cvsm.2019.07.005

  22. Ruel, H.L.M., Watanabe, R., Evangelista, M.C., Beauchamp, G., Auger, J.-P., Segura, M., Steagall, P.V., 2020. Pain burden, sensory profile and inflammatory cytokines of dogs with naturally-occurring neuropathic pain treated with gabapentin alone or with meloxicam. PLoS One 15, e0237121. https://doi.org/10.1371/journal.pone.0237121

  23. Rusbridge, C., Jeffery, N.D., 2008. Pathophysiology and treatment of neuropathic pain associated with syringomyelia. The Veterinary Journal 175, 164–172. https://doi.org/10.1016/j.tvjl.2006.12.007

  24. Sanchis-Mora, S., Chang, Y.M., Abeyesinghe, S.M., Fisher, A., Upton, N., Volk, H.A., Pelligand, L., 2019. Pregabalin for the treatment of syringomyelia-associated neuropathic pain in dogs: A randomised, placebo-controlled, double-masked clinical trial. The Veterinary Journal 250, 55–62. https://doi.org/10.1016/j.tvjl.2019.06.006

  25. Scaglione, J., Diaz, S.F., Bonagura, J.D., Kohnken, R.A., Helms, T.H., Cianciolo, R.E., 2018. Ischemic necrosis of the digits and hyperlipidemia associated with atherosclerosis in a Miniature American Shepherd. J Am Vet Med Assoc 253, 209–214. https://doi.org/10.2460/javma.253.2.209

  26. Sharun, K., Kumar, R., Chandra, V., Saxena, A.C., Pawde, A.M., Kinjavdekar, P., Dhama, K., Amarpal,  null, Sharma, G.T., 2021. Percutaneous transplantation of allogenic bone marrow-derived mesenchymal stem cells for the management of paraplegia secondary to Hansen type I intervertebral disc herniation in a Beagle dog. Iran J Vet Res 22, 161–166. https://doi.org/10.22099/ijvr.2021.38613.5620

  27. Sharun, K., Rawat, T., Kumar, R., Chandra, V., Saxena, A.C., Pawde, A.M., Kinjavdekar, P., Amarpal, Sharma, G.T., 2020. Clinical evaluation following the percutaneous transplantation of allogenic bone marrow-derived mesenchymal stem cells (aBM-MSC) in dogs affected by vertebral compression fracture. Veterinary and Animal Science 10, 100152. https://doi.org/10.1016/j.vas.2020.100152

  28. Shearer, T.S., 2011. A Case Report: Caring for a Golden Retriever with Nasal Cancer. Veterinary Clinics of North America: Small Animal Practice, Palliative Medicine and Hospice Care 41, 689–692. https://doi.org/10.1016/j.cvsm.2011.03.016

  29. Wagner, A.E., Mich, P.M., Uhrig, S.R., Hellyer, P.W., 2010. Clinical evaluation of perioperative administration of gabapentin as an adjunct for postoperative analgesia in dogs undergoing amputation of a forelimb. J Am Vet Med Assoc 236, 751–756. https://doi.org/10.2460/javma.236.7.751

  30. Wolf, J.K., Early, P.J., Pozzi, A., Vigani, A., 2021. Ultrasound-guided paravertebral perineural glucocorticoid injection for signs of refractory cervical pain associated with foraminal intervertebral disk protrusion in four dogs. J Am Vet Med Assoc 258, 999–1006. https://doi.org/10.2460/javma.258.9.999

  31. Wyatt, S., Gonçalves, R., Gutierrez-Quintana, R., De Decker, S., 2018. Outcomes of nonsurgical treatment for congenital thoracic vertebral body malformations in dogs: 13 cases (2009-2016). J Am Vet Med Assoc 253, 768–773. https://doi.org/10.2460/javma.253.6.768

CM/SM | Chiari-like Malformation and Syringomyelia

  1. Hechler, A.C., Moore, S.A., 2018. Understanding and Treating Chiari-like Malformation and Syringomyelia in Dogs. Topics in Companion Animal Medicine 33, 1–11. https://doi.org/10.1053/j.tcam.2018.03.002

  2. Loughin, C.A., 2016. Chiari-like Malformation. Veterinary Clinics of North America: Small Animal Practice, Congenital Abnormalities of the Skull, Vertebral Column, and Central Nervous System 46, 231–242. https://doi.org/10.1016/j.cvsm.2015.10.002

  3. Moore, S.A., 2016. Managing Neuropathic Pain in Dogs. Front Vet Sci 3, 12. https://doi.org/10.3389/fvets.2016.00012

  4. Plessas, I.N., Rusbridge, C., Driver, C.J., Chandler, K.E., Craig, A., McGonnell, I.M., Brodbelt, D.C., Volk, H.A., 2012. Long-term outcome of Cavalier King Charles spaniel dogs with clinical signs associated with Chiari-like malformation and syringomyelia. Vet Rec 171, 501. https://doi.org/10.1136/vr.100449

  5. Plessas, I.N., Volk, H.A., Rusbridge, C., Vanhaesebrouck, A.E., Jeffery, N.D., 2015. Comparison of gabapentin versus topiramate on clinically affected dogs with Chiari-like malformation and syringomyelia. Veterinary Record 177, 288–288. https://doi.org/10.1136/vr.103234

  6. Rusbridge, C., Jeffery, N.D., 2008. Pathophysiology and treatment of neuropathic pain associated with syringomyelia. The Veterinary Journal 175, 164–172. https://doi.org/10.1016/j.tvjl.2006.12.007

  7. Wolfe, K.C., Poma, R., 2010. Syringomyelia in the Cavalier King Charles spaniel (CKCS) dog. Can Vet J 51, 95–102.

Supplementary Information

  1. Gabapentin 300mg Capsules |  SPC | Accessesed 02/01/23: Online Version | https://www.medicines.org.uk/emc/product/4636/smpc Print Version | https://www.medicines.org.uk/emc/product/4636/smpc/print

  2. Gabapentin Glenmark 50 mg/ml Oral Solution | SPC |  Accessesed 02/01/23: Online Version: https://www.medicines.org.uk/emc/product/12121 | Print version: (https://www.medicines.org.uk/emc/product/12121/smpc/print)

Expert Opinion

  1. 1317822 Canine: Extrapolation of pharmacological properties in man and veterinary species. Some material employed in collating the data displayed here was taken from veterinary product datasheets or extrapolated from pharmacology texts.


Monograph Details

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