Gabapentin Nursing Implications
Gabapentin Nursing Pharmacology
Gabapentin is a drug used to help control seizures among patients with epilepsy. It is under the classification of anticonvulsant medications. Gabapentin can be used to treat restless legs syndrome and some forms of nerve pain.
Gabapentin works by changing the electrical activity in the brain and altering the actions of chemicals called neurotransmitters. Neurotransmitters send signals between nerve cells (neurons) and the brain.
Gabapentin is available in different formulations, it comes as a capsule, tablet, an extended-release tablet and liquid to be taken by mouth.
Take the medicine as directed by the physician, read the prescription carefully, and do not take less of it or more than what is prescribed.
The extended-release tablets cannot be replaced by another type of product. So be sure that the patient gets only the formulation that was prescribed by the doctor. For the extended-release tablets, swallow them whole. Do not cut, chew or crush.
Indications of Gabapentin
- Partial Seizure . Patients suffering from a partial (focal) seizure, both adults and young children age 3 and older. Gabapentin is given together with other medications to work in controlling specific types of seizures among people with epilepsy. During a seizure attack, the brain cells are enforced to function more rapidly than the normal thing. Gabapentin aids in preventing the brain cell from moving as fast as the seizure dictates, and decreasing the unusual excitement in the brain intending to stop the seizure activity. Safety and effectiveness of gabapentin have not been manifested in children 3 years old and below. The effect of gabapentin in reducing the frequency of seizures usually manifests within a week.
- Nerve Pain. Postherpetic neuralgia (PHN) is a kind of nerve pain that occurs after shingles or herpes zoster in adults. This kind of pain is described as burning or stabbing nerve pain. The virus lies in the dorsal root ganglion, a portion in our spinal nerve root. For some reason, it gets reactivated and causes shingles rash. A painful rash that appears after being infected by herpes zoster In some cases, gabapentin is also used to lessen the pain caused by diabetic neuropathy, a condition in which there is numbness or tingling sensation due to nerve damage in patients who have diabetes. It takes 2 to 3 hours for the peak concentration of gabapentin, it helps to improve sleeping problems because of nerve pain within one week, but it may require up to two weeks for relief from nerve pain to be felt.
- Restless legs syndrome based on clinical studies and trials. Gabapentin is an effective treatment for mild to moderate primary restless leg syndrome (RLS). Gabapentin extended-release tablet is prescribed to patients suffering from restless legs syndrome, a condition that involves leg discomfort and unpleasant leg sensation, and a strong urge to move the legs, especially during inactivity like prolonged sitting, or lying down. Symptoms are relieved by movement like stretching or walking.
- Hot flashes. In some situations, gabapentin is given to prevent hot flashes among women treated for breast cancer or who experiencing menopause.
Mechanism of Action of Gabapentin
Gabapentin is a prescription drug under the classification of anticonvulsant and known as GABA analog. Gamma-aminobutyric acid (GABA) is a type of amino acid in our nervous system that maintains the balance between nerve cell excitation and inhibition.
It plays like a brake in a car by decelerating the nerve cells that are hyper excited. It lowers the excitability of neurons that are involved in seizure attacks and transmitting pain signals. Gabapentin and other GABA analogs mirror the effect of GABA by calming nerve cell excitation.
Countless studies have been done, but experts are still not sure how gabapentin exactly works. But based on research and clinical trials, in the situation of seizure, gabapentin is tied strongly to the alpha2-delta site on voltage-gated calcium channel, which alters the calcium effects, a low level of calcium may lead to a seizure.
This action decreases the possibility of having a seizure attack. For postherpetic neuralgia, it appears that it prevents the elevation of sensitivity to pain. Gabapentin is once taken by mouth, and will be absorbed into the blood and systemic circulation.
It will undergo the process of metabolism wherein the medicine will be absorbed and eliminated from the body. Metabolism is done through the kidneys.
Pharmacokinetics of Gabapentin
Absorption: About 50 to 60% of gabapentin are absorbed from the gastrointestinal tract.
Peak: The peak level is 1 to 3 hours. The peak effect is 2 to 3 weeks.
Distribution: Compared to other anticonvulsant agents, gabapentin crosses the blood-brain barrier. It immediately passes into the cerebrospinal fluid.
Gabapentin is not confined to plasma proteins. In animal studies, its highest concentration is found in the pancreas and kidneys.
Metabolism: Gabapentin is not metabolized in humans.
Elimination: 76 to 81% excretion continuing in 96 hours. 10-23% found in feces.
Half-life: Gabapentin’s half-life is 5 to 6 hours.
Side Effects of Gabapentin
Most of the common side effects of gabapentin are mild and expected to disappear within a few days. If the condition worsens and prolongs, consult the doctor immediately.
- Swelling of the hands, ankles, arms, lower legs, and feet
- Difficulty walking
- Dry mouth
- Dry mouth
- Uncontrollable shaking of body parts
- Double vision
- Blurring of vision
- Swelling of the eyes
- Lazy eye or amblyopia
- Uncontrolled eye movement
- Memory and thinking problems
- Spike in appetite
- Weight gain
- Back and joint pain
- Flu-like symptoms (sneezing, cough, colds, throat pain)
- Mood change
- Back pain
- Mouth ulcers
- Problems with movement and coordination
Some side effects that are more common in children:
- Behavioral change
- Trouble concentrating and focusing
- Memory problems
- Changes in emotion
Serious side effects: If the patient has any of these serious side effects, call the doctor immediately.
- Skin rashes
- Swollen lymph nodes
- Difficulty breathing and swallowing
- Severe Dizziness
- Swelling of the face, eyes, tongue, and throat
- Hoarseness of voice
- Bluish discoloration of skin, lips, and fingernails
- Suicidal thoughts
- Worsening depression and anxiety
- Panic attacks
- Impulsive behavior
- Aggressiveness or violent behavior.
- Hyperverbal speech
- Dark-colored urine
- Blood in urine
- Difficulty urinating
- Recurrent infection
Adverse Reactions of Gabapentin
- Neurologic and Psychiatric conditions such as status epilepticus, short or long seizures, convulsion, dizziness, asthenia, behavioral problems, restlessness, somnolence, ataxia, hyperactivity, hostility, suicidal ideation, behavior, and mood change. Clinical trials have been conducted and it appears that dizziness and somnolence were at a great rate.
- Nephrological disorders include Renal allograft dysfunction, Kidney failure.
- Multi-organ hypersensitivity or DRESS (Drug Reaction with Eosinophilia and systemic symptoms) usually resembles an acute viral infection, presented with fever, rashes, and swollen lymph nodes (lymphadenopathy). It also involves other organ systems like the liver (hepatitis), kidney (nephritis), blood (hematological abnormalities), heart (myocarditis), and eosinophilia is also presented. Most of these conditions can be fatal.
- Anaphylaxis and angioedema: These can happen after the first dose or even at any time during the regimen. Symptoms include difficulty breathing, swelling of lips, throat, and tongue, and decreased blood pressure. If any of these occur, discontinue taking gabapentin and seek medical care immediately.
- Neuromuscular disorder: Myasthenia gravis, tremors.
- Gastrointestinal: Nausea, vomiting, gastric upset
- Endocrine: Weight gain
- Pulmonary: Chronic obstructive pulmonary disease (COPD); respiratory depression. If the patient has an underlying respiratory condition and is prescribed gabapentin along with a CNS depressant, close monitoring for symptoms of respiratory depression and sedation should be implemented. Consider starting gabapentin therapy at a low dose if possible and supportive measures are also added.
- Hepatic: Altered liver function test
- Hematology: Leucopenia
- Skin: Steven-Johnson syndrome, rashes, eczema.
- Eyes: Involuntary eye movement, double vision
Drug Interactions with Gabapentin
Some medication interacts with gabapentin, taking it with other drugs can cause possible side effects and worse death. Scan the labels on all the medicine to check if any of them contains products that may interact with gabapentin. It is important to tell the doctor about the prescription and non-prescription drugs the patient is taking. Including nutritional supplements, vitamins, and even herbal medicine. Make sure to inform the physician if the patient is taking or planning to take any of the following:
- Antiseizure medicine
- Antihypertensive drugs
- Muscle relaxants
- Cold and flu medications
- Psychiatric medicine
- Sleeping pills
- Pain medication
If the patient is currently on gabapentin therapy, always consult the physician first before taking any medicines, especially over-the-counter medications.
Contraindications of Gabapentin
Gabapentin should not be given in patients with absence and myoclonic seizures for it may worsen the condition. Also, people who are known to be hypersensitive to gabapentin or any of its ingredients should not receive gabapentin anymore.
Gabapentin overdose symptoms include:
- Difficulty breathing
- Difficulty speaking
- Loss of balance
- Extreme Dizziness
- Double vision
- Slurred speech
Discuss the importance of taking the correct dosage of gabapentin carefully and accurately with the patient to prevent the accident of taking too much of it.
Minor patients must be supervised and monitored by an older guardian for proper guidance. If any concerns arise, inform them to talk to the healthcare provider immediately. Hemodialysis is an effective option to remove gabapentin from plasma.
The patient/carer is advised to call the emergency hotline or poison control center if the patient has overdosed or experienced serious side effects
Nursing Considerations for Gabapentin
- Assess the patient’s medical and family history. Take note of the type of allergies both food and medicine, all medicine, supplements, vitamins are currently taken, past and present health history, and alcohol and drug abuse.
- If the patient is pregnant or planning to get pregnant, advise the patient to inform their physician before starting taking gabapentin. Clinical studies reveal that gabapentin crosses the placenta and increases developmental toxicity in the fetus.
- Gabapentin is given to children aged 3 years and above.
- Incidence of edema of feet and/or hands and ataxia increase in elderly patients taking gabapentin. Precaution for fall risk must be considered. Put away any fall hazards object at home and assist elderly patients when ascending or descending stairs.
- Educate the patient that gabapentin shouldn’t be abruptly discontinued, without a doctor’s order because of the risk of frequent seizure activity and may cause withdrawal symptoms such as anxiety, difficulty sleeping, nausea, pain, and sweating. Consult the physician first before discontinuing or changing the dose of gabapentin.
- Gabapentin should not be taken at the same time as an antacid. Allow at least 2 hours apart before taking gabapentin. Antacid makes absorption of gabapentin difficult.
- Advise the patient to avoid drinking alcohol if taking gabapentin. It may increase dizziness and sleepiness. Also, it may worsen if the patient has trouble concentrating. Offer counseling services that may help the patient to stop Alcoholism.
- Some patients experience gastrointestinal upset when taking gabapentin, give the drug with food and eat small frequent meals to avoid GI upset.
- Advise the patient to avoid driving and doing hazardous activities such as operating heavy machinery after taking gabapentin. It may cause dizziness or drowsiness that may result in accidents. Also, inform the assigned doctor if the patient is working in a night shift setup.
- Taking gabapentin may increase the risk of suicidal ideation and behavioral changes, mostly in patients who are young adults, under the age of 24. Patients treated with gabapentin or any anticonvulsant agents must be monitored for any emergency or worsening symptoms of depression, suicidal thoughts, and changes in mood, thoughts, feelings, and behavior. If the patient experiences symptoms or notices any change in their behavior, notify the doctor immediately. Family members must be instructed to take precautions, be alert and report any symptoms they will observe. Support and understanding coming from patients’ loved ones and family members is highly important.
- Attend all follow-up visits with the attending physician as scheduled.
- Major breathing problems, the risk of sleepiness, and even death can be experienced if gabapentin is taken with other pain relievers. Take precautions and consult the doctor first.
- If the patient is taking gabapentin for the first time, give the initial dose at bedtime. This is to decrease dizziness and drowsiness.
- Monitor the patient for symptoms of worsening depression, increase suicidal ideation, and behavioral and mood changes.
- Observe therapeutic effectivity. It may take several weeks after the first dose was given.
- Evaluate the seizure frequency. In limited cases, gabapentin increases the incidence of frequent seizures.
- For pediatric patients, instruct the parents to carefully measure the liquid medicine. Use the dosing cup provided. Do not use a kitchen spoon or kitchen measuring cup because these may be not accurate.
- Provide safety. Since concentration, body coordination, and vision may be impaired, safety measures are highly important. When giving gabapentin to children, their mental capacity may change while they are on medication. Children may have difficulty paying attention, may have sudden changes in mood, not focus and difficulty in concentrating, can be sleepy or clumsy. Avoid any dangerous activities like riding bicycles, climbing, running, or jumping.
- For breastfeeding patients, consult the doctor first before giving gabapentin. Gabapentin may pass into breast milk and can cause potentially serious side effects in the child.
- If the patient demonstrates hypersensitivity to gabapentin or any of its ingredients, discontinue the therapy and notify the doctor immediately.
- Inform the doctor if any of these happen: severe headache, rash, vomiting, chills, and difficulty breathing. Also, instruct family members or companions about symptoms of hypersensitivity and they should report it immediately to the healthcare provider.
- If the patient missed a dose, advise them to take it as soon as they remember. Take only one dose if the patient remembers it just a few hours from the scheduled time. Do not catch up by taking two capsules at once.
- Gabapentin is metabolized through the kidneys, therefore extra consideration should be observed if the patient taking gabapentin has kidney problems. Monitor the patient’s kidney function while on this regimen. If while on treatment the kidney function decreases, the doctor may adjust the dosage of this drug. Observe any signs of kidney abnormalities, which include difficulty urinating, changes in the amount of urine output, blood in the urine, weight gain, and swelling of the legs and feet because of water retention.
- Monitor for any signs of liver abnormalities, such as jaundice or yellowish discoloration of skin and sclera, dark colored urine, vomiting, light-colored stool, unexplainable bleeding, and bruising
- Instruct the patient that if they will be having any surgery, including dental surgery, inform the doctor about the gabapentin therapy that is currently ongoing.
- Observe any mental health and behavioral problems that may appear. It can be a new mental health and behavioral problem, or it could worsen the existing medical condition.
- Monitor the patient carefully for signs of central nervous system depression, including sedation and somnolence.
- If the patient will undergo a blood test, it is important to inform the doctor and laboratory technician about taking gabapentin. For it can affect the results of certain medical tests.
- For dipstick type of urinalysis, in testing urine for protein, ask the doctor first which product to use while under gabapentin therapy.
- Instruct the patient to store gabapentin at room temperature, away from direct light, and keep away out of reach of children.
Gabapentin Nursing DIagnosis
- Possible Nursing Gabapentin Diagnoses
- Impaired Sleep Pattern related to the side effect of gabapentin
- Nausea/ Vomiting related to the side effect of gabapentin
- Risk for Diarrhea related to the side effect of gabapentin
- Risk for Disturbed Sensory Perception (Visual) related to the side effect of gabapentin
- Deficient Knowledge related to gabapentin
|Gabapentin Nursing Interventions||Rationale|
|Assess the patient for signs and symptoms of epilepsy or nerve pain.||To confirm the indication for administering gabapentin.|
|Assess if the patient has absence or myoclonic seizures.||Gabapentin is generally contraindicated in patients with absence or myoclonic seizures.|
|Check the patient’s allergy status.||Previous allergic reactions to gabapentin may render the patient unable to take them. Alternatives to gabapentin should therefore be considered in case of allergy.|
|Assess if the patient is pregnant or lactating.||Gabapentin is not recommended to be given to a pregnant woman as this drug is unassigned in terms of pregnancy category as per the U.S. FDA. For lactating mothers, gabapentin may be given with close monitoring by the healthcare provider as small amounts of gabapentin may be passed into breast milk. .|
|Perform a focused neurological assessment of the patient.||To confirm the indication for administering gabapentin.|
|Assess the patient’s mucous membranes and his/her ability to swallow.||To check for any potential problems with administration, hydration, and absorption.|
To ensure that the right form of gabapentin is given.
|Assess the patient’s vital signs, particularly the blood pressure and heart rate.||Gabapentin may cause lower blood pressure levels and heart rate.|
Nursing Planning and Intervention
|Gabapentin Nursing Interventions||Rationale|
|Administer gabapentin with or without food at the same time everyday.||To ensure optimal absorption and therapeutic action by gabapentin, as well as reduce possible side effects.|
|Ask the patient to swallow a gabapentin tablet whole, as prescribed. Do not crush or chew the capsule.||This will ensure adequate absorption of the drug being administered. Crushing or chewing may cause all of the drug to be released at once, which may increase the likelihood of side effects.|
|Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking gabapentin. Instruct the patient on how to self-administer gabapentin.||To inform the patient on the basics of gabapentin, as well as to empower him/her to safely self-administer the medication.|
|Monitor the patient’s input and output and commence stool charts.||Gabapentin may cause diarrhea. Early detection of either side effect can help institute a bowel program and relieve them effectively.|
|Discourage alcohol intake or the consumption of recreational drugs such as heroin and cannabis when on gabapentin.||Alcohol and recreational drugs can increase the nervous system side effects of gabapentin, such as irritability, dizziness, and drowsiness.|
|Help the patient with activities of daily living as needed.||Gabapentin may cause fatigue, dizziness, and drowsiness which may put the patient at risk for injury. Therefore, patients on gabapentin require close supervision when doing ADLs.|
|Inform the patient that gabapentin may cause mood swings and this should be reported to any healthcare professional once noticed.||To inform the patient of the possible side effect of the drug on his or her behavior and emotional state.|
|Gabapentin Nursing Interventions||Rationale|
|Ask the patient to repeat the information about gabapentin.||To evaluate the effectiveness of health teaching on gabapentin.|
|Monitor the patient’s heart rate and blood pressure at least every 4 hours.||To ensure that the gabapentin did not cause hypotension or bradycardia.|
|Commence a seizure and/or pain chart.||To check for the effectiveness of gabapentin on the patient’s seizure activity and/or nerve pain.|
|Monitor the patient’s emotional and behavioral status using a behavioral chart. Check the patient’s sleep pattern as well.||Gabapentin may cause changes in mood, irritability, and other psychological effects. These should be monitored closely to ensure the patient’s safety and to check if the dose needs to be reduced or the drug must be discontinued.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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