Monday Pharmaceutical Mystery: What Medication May Be Causing Neurological Symptoms?

She has been in the hospital for 5 days and during that time the doctors did all the expensive tests looking for blood clots, ischemia,inflammation, infection, and malignancies in the brain andnervoussystem. But they find nothing. The doctor says he is at a loss to what is causing JKs symptoms.

As the pharmacist for the team, you review JKs medications, and the dosages according to her weight of 86 kg and renal function of eCrCl of 45 ml/min.

Mystery: Which is the medication dose you want to lower and why?

Solution: Gabapentin. JK had a decline in renal function, as verified by changes in SrCr, and that caused gabapentin to accumulate to toxic levels. JK will need a new lower dose to stay symptom-free.Renal disease for gabapentin are as follows: eCrCl 30-59ml/min 700mg bid, eCrCl 15-29 ml/min 700mg qd, eCrCl <15 ml/min 300mg/day.1

Drug levels for gabapentin can easily accumulate and reach toxic levels when renal function declines or when the recommended dosage is exceeded. I believe this is an under recognized problem that can be easily addressed by pharmacists.2

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Monday Pharmaceutical Mystery: What Medication May Be Causing Neurological Symptoms? - Pharmacy Times