Rapid initiation of gabapentin - A randomized, controlled trial

Objective: To compare the tolerability of two different dose-initiation reg imens of gabapentin for the adjunctive treatment of partial seizures. Backg round: Patient compliance is a key feature of successful outpatient pharmac ologic therapy for epilepsy, and one aspect of compliance is simplicity of initiation. By using a rapid titration rate, leading to a rapid therapeutic gabapentin dose, perhaps there could be an improvement with compliance. Me thods: Male or female patients, at least 12 years old, with a recent histor y of partial seizures with or without secondary generalization, were random ized to receive gabapentin (following a blinded placebo period of an undisc losed number of days) as either a Slow initiation (300 mg day 1, 600 mg day 2, then 900 mg/day) or a Rapid initiation (900 mg/day immediately followin g the placebo lead-in). Results: Starting gabapentin therapy at an initial therapeutic dosage of 900 mg/day is well tolerated by patients with epileps y and is as safe as initiating with a titration schedule over 3 days. Of th e four most common adverse events (somnolence, dizziness, ataxia, fatigue), only one, dizziness, occurred more often in the nontitrated (Rapid initiat ion) group than in the titrated (Slow initiation) group. Conclusion: Initia tion of gabapentin at 900 mg/day is as well tolerated as is a S-day titrati on, except for a higher incidence of dizziness.