Gabapentin Enacarbil (Horizant®)

Usual Dosing (Adults)

INDICATIONS AND USAGE
HORIZANT is indicated for:

-treatment of moderate-to-severe primary Restless Legs Syndrome (RLS) in adults.
-management of postherpetic neuralgia (PHN) in adults.

DOSAGE AND ADMINISTRATION
Instruct patients to swallow tablets whole and not to cut, crush, or chew tablets. Take with food.

RLS: 600 mg once daily taken at about 5 PM.

-A dose of 1,200 mg once daily provided no additional benefit compared with the 600-mg dose, but caused an increase in adverse reactions.
-If the dose is not taken at the recommended time, the next dose should be taken the following day as prescribed.

PHN: The starting dose is 600 mg in the morning for 3 days, then increase to 600 mg twice daily beginning on day 4.

-A daily dose greater than 1,200 mg provided no additional benefit.
-If the dose is not taken at the recommended time, skip this dose, and the next dose should be taken at the time of next scheduled dose.

Patients with renal impairment: Doses of HORIZANT must be adjusted in accordance with renal function.

DOSAGE FORMS AND STRENGTHS
Extended-Release Tablets: 300 mg and 600 mg. (3)

Renal Dosing

Dosage of HORIZANT for Patients With Restless Legs Syndrome in Accordance With Creatinine Clearance

Creatinine Clearance (mL/min)	Target Dose Regimen
≥60	600 mg per day
30 - 59	Start at 300 mg per day and increase to 600 mg as needed
15 - 29	300 mg per day
<15	300 mg every other day
<15 on hemodialysis	Not recommended

Dosage of HORIZANT for Patients With Postherpetic Neuralgia in Accordance With Creatinine Clearance

Creatinine Clearance (mL/min)	Titration	Maintenance	Tapering
≥60	600 mg in AM for 3 days	600 mg twice daily	600 mg in AM for 1 week
30 - 59	300 mg in AM for 3 days	300 mg twice daily. Increase to 600 mg twice daily as neededa	Reduce current maintenance dose to once daily in AM for 1 week
15 - 29	300 mg in AM on Day 1 and Day 3	300 mg in AM. Increase to 300 mg twice daily if neededa	If taking 300 mg twice daily, reduce to 300 mg once daily in AM for 1 week. If taking 300 mg once daily, no taper needed.
<15	None	300 mg every other day in AM. Increase to 300 mg once daily in AM if neededa	None
<15 on hemodialysis	None	300 mg following every dialysis. Increase to 600 mg following every dialysis if neededa	None

Creatinine clearance can be estimated from serum creatinine using the Cockcroft-Gault formula.

Creatinine clearance for males =	[140-age (years)]× [body wt (kg)] 72 × [serum creatinine (mg/dL)]
Creatinine clearance for females =	[140-age (years)]× [body wt (kg)]× 0.85 72 × [serum creatinine (mg/dL)]

Hemodialysis

Not recommended.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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