NDT Advance Access originally published online on April 19, 2005
Nephrology Dialysis Transplantation 2005 20(6):1278-1279; doi:10.1093/ndt/gfh757
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Gabapentin for uraemic pruritus
Sir,Gunal et al. [1] reported that gabapentin is effective in the treatment of uraemic pruritus. In previous years, we used gabapentin therapy in haemodialysis (HD) patients for restless leg syndrome, chronic pain and peripheral diabetic neuropathy. In our clinical experience, diverse patients suffered from drowsiness when treated with gabapentin 300 mg after each HD session, thus the dose had to be consistently reduced or the drug had to be stopped. Accordingly, previous studies [2,3] have reported the appearance of somnolence/lethargy in some HD patients receiving gabapentin at the same dosage, and there are a number of case reports highlighting the risk of gabapentin-induced neurotoxicity and coma due to its narrow therapeutic window [4–6].
Similarly to the study of Gunal et al., after having observed the spontaneous remission of uraemic itch in a HD patient receiving gabapentin therapy for peripheral diabetic neuropathy, we started a pilot evaluation aimed at testing the effectiveness and safety of low doses of gabapentin in HD patients with uraemic pruritus [7]. We began this evaluation by cautiously administering gabapentin 100 mg after every HD session and observed no side effects. In addition, the clinical response was as impressive as in the work of Gunal et al. in all of the five treated patients [7]. Importantly, we administered gabapentin under nurse surveillance after HD in order to avoid erroneous extra doses of this medication.
In conclusion, we agree with Gunal et al. that gabapentin is an effective therapy for uraemic pruritus, but we would suggest that administering a lower gabapentin dose (i.e. 100 mg thrice weekly, after each HD session) under nurse surveillance and slowly titrating it up- or downward may lessen the risk of neurotoxicity and gabapentin-induced coma in HD patients.
Conflict of interest statement. None declared.
1 Azienda Ospedaliera Desenzano d/Garda Dialysis Unit Desenzano d/G, Brescia2 University of Parma Nephrology Parma Italy Email: lucio.manenti{at}aod.it
References
- Gunal AI, Ozalp G, Yoldas TK, Gunal SY, Kirciman E, Celiker H. Gabapentin therapy for pruritus in haemodialysis patients: a randomized, placebo-controlled, double-blind trial. Nephrol Dial Transplant 2004; 19: 3137–3139
[Abstract/Free Full Text] - Comstock TJ, Sica DA, Bockbrader HN, Underwood BA, Sedman AJ. Gabapentin pharmacokinetics in patients with various degrees of renal function. J Clin Pharmacol 1990; 30: 862
- Thorp ML, Morris CD, Bagby SP. A crossover study of gabapentin in treatment of restless legs syndrome among hemodialysis patients. Am J Kidney Dis 2001; 38: 104–108[Web of Science][Medline]
- Bassilios N, Vacher VL, Khoury N, Rondeau E, Deray G, Sraer JD. Gabapentin neurotoxicity in a chronic haemodialysis patient. Nephrol Dial Transplant 2001; 16: 2112
[Free Full Text] - Jones H, Aguila E, Farber HW. Gabapentin toxicity requiring intubation in a patient receiving long-term hemodialysis. Ann Intern Med 2002; 137: E75
- Butler TC, Rosen RM, Wallace AL, Amsden GW. Flumazenil and dialysis for gabapentin-induced coma. Ann Pharmacother 2003; 37: 74–76
[Abstract/Free Full Text] - Manenti L, Vaglio A, Costantino E et al. Gabapentin in the treatment of uremic itch: index case and pilot evaluation. J Nephrol 2005; 18: 86–91[Web of Science][Medline]
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