Gabapentin and pregabalin are excreted almost entirely unchanged by the kidneys. In older adults, whose kidney function is often lower than the serum creatinine suggests, standard doses accumulate and cause sedation, dizziness, ataxia and falls. Labelled dosing for both drugs is reduced stepwise as creatinine clearance falls.
Combined with opioids, gabapentinoids add to respiratory depression. Stopping them suddenly after long use can cause withdrawal symptoms, so reduce gradually.
- Check eGFR or creatinine clearance before starting or increasing a gabapentinoid.
- Start low and titrate slowly in older adults.
- Ask specifically about falls, unsteadiness and daytime drowsiness at review.
- Take extra care when combining with opioids or other sedatives.
- Taper rather than stop abruptly after prolonged use.
Why it matters
Unadjusted gabapentinoid doses are a common, avoidable cause of falls and confusion on medical wards.
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