Article written and medically reviewed by Dr. Alexander R. Chen, MD, FAAN – Board-Certified Neurologist, Fellow of the American Academy of Neurology. Last updated: November 17, 2025
What is Neurontin (Gabapentin) Used For?
FDA-approved indications:
- Adjunctive therapy for partial seizures (adults & children ≥3 years)
- Postherpetic neuralgia (PHN) in adults
Common evidence-based off-label uses (2025):
- Diabetic peripheral neuropathy
- Fibromyalgia
- Restless legs syndrome (Horizant ER)
- Neuropathic pain from spinal cord injury
- Migraine prophylaxis
- Alcohol withdrawal & anxiety disorders (limited evidence)
Dosage and Titration Schedules (2025 AAN/AANEM Guidelines)
Postherpetic Neuralgia & Most Neuropathic Pain
| Day | Morning | Afternoon | Bedtime | Total Daily |
|---|---|---|---|---|
| 1–3 | — | — | 300 mg | 300 mg |
| 4–6 | 300 mg | — | 300 mg | 600 mg |
| 7–10 | 300 mg | 300 mg | 300 mg | 900 mg |
| 11–14 | 300 mg | 300 mg | 600 mg | 1,200 mg |
| Week 3+ | 600 mg | 600 mg | 600–1,200 mg | 1,800–3,600 mg |
Partial Seizures (Adults)
| Age | Initial | Target | Maximum |
|---|---|---|---|
| ≥12 years | 900 mg/day (300 mg TID) | 900–1,800 mg/day | 3,600 mg/day |
| 3–11 years | 10–15 mg/kg/day | 25–35 mg/kg/day | 50 mg/kg/day |
Comparative Table: Gabapentin vs Pregabalin vs Alternatives (2025)
| Drug | Bioavailability | Dosing Frequency | Renal Adjustment | Abuse Potential | Cost (generic) |
|---|---|---|---|---|---|
| Gabapentin (Neurontin) | 30–60 % (dose-dependent) | TID | Yes (CrCl-based) | Low–Moderate | Very low |
| Pregabalin (Lyrica) | >90 % | BID | Yes | Higher (Schedule V) | Moderate |
| Duloxetine (Cymbalta) | ~50 % | QD–BID | Mild | None | Low |
| Amitriptyline | Variable | QD (night) | No | None | Very low |
Mechanism of Action
Gabapentin binds to the α2δ-1 subunit of voltage-gated calcium channels, reducing excitatory neurotransmitter release (glutamate, norepinephrine, substance P) in the CNS and spinal cord.
Safety Profile & Warnings (2025 FDA)
Class warnings: increased suicidal ideation, respiratory depression when combined with opioids/CNS depressants, potential for misuse/abuse (especially in opioid-use-disorder patients).
Official Sources
- FDA Label – Neurontin (2024): FDA Neurontin Prescribing Information
- EMA SmPC – Gabapentin: EMA Gabapentin SmPC
- PubMed – Gabapentin for neuropathic pain (Cochrane 2023): PubMed 37042629
Real Patient Reviews (2024–2025)
“1,800 mg/day completely controls my diabetic nerve pain. Life-changing.”
“After shingles, 2,400 mg/day took away the burning pain in 2 weeks.”
“Helps fibromyalgia, but I had to titrate slowly to avoid dizziness.”
“Best for restless legs – 600 mg at night and I finally sleep.”
“Seizures reduced 80 % when added to lamotrigine.”
Frequently Asked Questions (FAQ)
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