Gabapentin and kidney disease: What you need to know

In this article:

• Is gabapentin bad for your kidneys? 
• Can you take gabapentin if you have kidney disease?
• Safe gabapentin dosages for people with kidney problems 
• Alternatives to gabapentin
• The bottom line 

In this article

• Is gabapentin bad for your kidneys? 
• Can you take gabapentin if you have kidney disease?
• Safe gabapentin dosages for people with kidney problems 
• Alternatives to gabapentin
• The bottom line 

 Gabapentin is an anticonvulsant medication. Gabapentin can reduce seizure activity in people with epilepsy, decrease postherpetic neuralgia pain associated with shingles, treat restless leg syndrome, and help treat diabetic neuropathy. It is available in capsules, tablets, oral solutions, and extended-release capsules.

If you regularly use gabapentin, you may want to know about gabapentin and kidney disease. Does gabapentin affect the kidneys? Is gabapentin hard on the kidneys? There is no indication that gabapentin on its own can cause renal impairment, renal failure, or kidney disease. However, if you already have kidney disease, it may be more difficult to clear gabapentin from your system, which means that your dose will have to be adjusted accordingly.

Here, we’ll look at gabapentin and kidney disease, including what any potential kidney risks are, how to take gabapentin if you have kidney disease, and some alternative gabapentin medications and treatment options.

Is gabapentin bad for your kidneys? 

It’s common to wonder if gabapentin may cause organ damage, particularly if it can negatively impact the kidneys. Although some case studies have found links between taking gabapentin and resulting liver issues, there are no cases in the literature of gabapentin on its own causing kidney issues or kidney disease.

In general, gabapentin is not considered harmful to the kidneys in people who have normal kidney function, says Soma Mandal, MD, an internist at Summit Health. Gabapentin is primarily excreted through the kidneys, she notes. “So in patients with healthy renal function, the medication is cleared effectively from the body,” she explains.

Not only is gabapentin generally safe for your kidneys, but it’s not known to damage your kidneys or cause kidney disease. “Gabapentin is generally safe for the kidneys when used correctly,” Sean Ormond, MD, anesthesiologist and interventional pain management physician at Atlas Pain Specialists. “It doesn’t directly harm the kidneys or lead to kidney disease in most individuals.”

However, as Dr. Ormond points out, if you already have kidney issues, the drug can build up in your system because you need well-functioning kidneys to clear it out. “This accumulation may increase the risk of side effects, so it’s crucial to use it under the guidance of a doctor,” he says.

Can you take gabapentin if you have kidney disease?

Although gabapentin is generally safe for people without kidney issues, if you have renal impairment or any underlying kidney issues, you need to be aware of the potential risks.

“For patients with kidney disease, gabapentin can accumulate in the body because the kidneys are less effective at excreting the drug,” Dr. Mandal explains. “This accumulation can increase the risk of side effects, such as dizziness, fatigue, and confusion, which are more pronounced in this population.”

As the National Library of Medicine notes, gabapentin toxicity has occurred in people with chronic kidney disease or in people undergoing hemodialysis. Symptoms of this toxicity include tremors, confusion, and respiratory depression (breathing issues) that sometimes require intubation.

Aaron Emmel, PharmD, founder at Pharmacy Tech Scholar points out that gabapentin is not classified as a nephrotoxin (a medication that can damage the kidneys). However, he notes, there are rare reports of gabapentin causing rhabdomyolysis, which is when skeletal muscle becomes damaged and breaks down rapidly.

“A possible consequence of that is damage to the kidneys as they try to filter out the harmful byproducts of muscle breakdown,” Dr. Emmel describes. “Again, this is rare, but this should be monitored for in kidney disease patients especially since they often receive inappropriately high doses of gabapentin.”

All of this is why dosing of gabapentin is of utmost importance for people with kidney disease, says Andrew Youssouf, MD, who is double board-certified in addiction medicine and emergency medicine and is the medical director of Ikon Recovery. “To prevent toxicity and manage these risks, lower doses of gabapentin are typically prescribed for patients with kidney disease,” he says. “The specific dosage depends on the extent of kidney impairment, ensuring that it’s tailored to each patient’s unique needs.”

If you are a kidney disease patient taking gabapentin, your physician will also closely monitor your blood levels to ensure the drug’s safety and effectiveness, says Dr. Youssouf. “This personalized approach helps cater to each patient’s unique health profile, optimizing the benefits of gabapentin while mitigating potential complications,” he explains.

Safe gabapentin dosages for people with kidney problems 

For healthy patients, the dose of gabapentin prescribed depends on your age and which condition the medication is treating. For instance, in adults and children 12 and over, the gabapentin dose for treating seizures is 300-600 mg, taken three times a day. The dosing is similar for postherpetic neuralgia, but with a dosing schedule that builds up over time. It’s usually recommended that people begin with 300 mg on day one, and gradually increase to 300 mg three times a day, and then up to 600 mg three times a day.

There are no appropriate studies or recommendations on what the dosing of gabapentin should be for people with kidney disease or kidney issues. That’s because it generally varies from one individual to another. “The safe dose of gabapentin for someone with kidney disease really depends on how well your kidneys are functioning,” Dr. Ormond explains. “Doctors typically start with a lower dose and make adjustments based on your kidney health.”

Dr. Emmel agrees and says that dosing for gabapentin among kidney patients depends on kidney function. He explains that this is usually measured via creatinine clearance. Creatinine clearance is a blood test physicians use to test the ability kidneys to filter creatine, and is a test that can determine your overall kidney health.

“As an example, a patient with a creatinine clearance of 15 ml/min is at the most advanced stage of kidney disease and possibly close to needing to be placed on dialysis,” Dr. Emmel describes. “The maximum recommended dose for this patient would be 300 mg per day, which is only 1/3rd of the starting dose for a patient without kidney disease.”

Alternatives to gabapentin

If you have underlying kidney issues, you may be looking for an alternative medication that will provide some of the same benefits as gabapentin, without the risks to your kidneys. What to take as an alternative depends on what conditions you are looking to treat, as well as other medical conditions you live with. All decisions about medications should be made in consultation with a healthcare professional.

There are a few alternatives medications that may be better suited for individuals with kidney issues, according to Dr. Ormond. “Medications like certain antidepressants or topical treatments can effectively manage nerve pain without posing as much risk to kidney function,”  he says.

Dr. Emmels suggests that other drugs to consider include other anti-seizure medications than gabapentin. “One example is carbamazepine, which unlike gabapentin, does not need to be adjusted in kidney disease,”he says. At the same time, carbamazepine “has many potential side effects and interactions that need to be considered,” he notes. Some unwanted effects of carbamazepine include cognitive changes, dizziness, fatigue, speech issues, uncontrollable shaking, dry mouth, constipation, and walking and coordination problems.

There are also non-medication options to consider as alternatives to gabapentin. “Non-pharmacological treatments for nerve pain can include physical therapy, acupuncture, and cognitive-behavioral therapy,” says Dr. Mandal.

Some people find relief through lifestyle modifications, she says. These include:

• Regular exercise
• A healthy diet
• Utilizing relaxation techniques to manage pain

“It is essential to discuss these options with a doctor to determine the best and safest approach for each individual,” Dr. Mandal emphasizes.

The bottom line 

For people with normal renal function, gabapentin isn’t hard on the kidneys and is easily cleared out of the body. But if you have renal impairment or kidney disease, it can be more difficult for your body to clear gabapentin, which can lead to issues like gabapentin toxicity. If you have kidney issues, your provider will likely alter your gabapentin dose based on your kidney function. They will also closely monitor you so that your kidneys remain healthy as you take the medication.