Gabapentin

Gabapentin

Gabapentin
Systematic (IUPAC) name
1-(Aminomethyl)cyclohexaneacetic acid
Clinical data
Trade names Gralise, Neurontin, Gabarone
AHFS/Drugs.com
MedlinePlus
Licence data US Daily Med:
Pregnancy
category
  • AU: B1
  • US: C (Risk not ruled out)
Legal status
Routes of
administration
Oral
Pharmacokinetic data
Bioavailability 27-60% (inversely proportional to dose; a high fat meal also increases bioavailability)[1][2]
Protein binding Less than 3%[1][2]
Metabolism Not significantly metabolised[1][2]
Biological half-life 5 to 7 hours[1][2]
Excretion Renal[1][2]
Identifiers
CAS Registry Number  Y
ATC code N03
PubChem CID:
DrugBank  Y
ChemSpider  Y
UNII  Y
KEGG  Y
ChEBI  Y
ChEMBL  Y
PDB ligand ID GBN (, )
Chemical data
Formula C9H17NO2
Molecular mass 171.237 g/mol
 Y   

Gabapentin, marketed under the brand name Neurontin among others, is a medication used to treat epilepsy, neuropathic pain, and hot flashes.[3] It is also used for restless leg syndrome.[4] It is recommended as a first line agent for the treatment of neuropathic pain arising from diabetic neuropathy, post-herpetic neuralgia, and central neuropathic pain.[5]

It is a lipophilic structural analogue of the inhibitory neurotransmitter γ-aminobutyric acid (GABA). Gabapentin was initially developed in 1993.[6] In the United States it is available as a generic medication and costs about 0.64 USD per day.[3]

Contents

  • Medical uses 1
    • Seizures 1.1
    • Pain 1.2
    • Anxiety disorders 1.3
    • Other uses 1.4
  • Adverse effects 2
    • Suicide 2.1
    • Overdose 2.2
  • Pharmacology 3
  • Mechanism of action 4
  • Society and culture 5
    • Sales 5.1
    • FDA approval 5.2
    • Off-label promotion 5.3
      • Franklin v. Pfizer case 5.3.1
    • Brand names 5.4
    • Forms 5.5
    • Related drugs 5.6
  • Veterinary use 6
  • See also 7
  • References 8
  • External links 9

Medical uses

Gabapentin is used primarily to treat seizures and neuropathic pain.[7] It is also commonly prescribed for many off-label uses, such as treatment of anxiety disorders,[8][9] insomnia, and bipolar disorder.[8] There are, however, concerns regarding the quality of the trials conducted and evidence for some such uses, especially in the case of its use as a mood stabilizer in bipolar disorder.[10]

Seizures

Gabapentin is approved for treatment of focal seizures,[11] partial seizures and mixed seizures. There is insufficient evidence for its use in generalized epilepsy.[12]

Pain

There is weak evidence that gabapentin provides pain relief for around 10% of people who take it for fibromyalgia, and for chronic neuropathic pain.[5][13] The evidence is stronger for effectiveness in postherpetic neuralgia and diabetic neuropathy.[13] It may reduce opioid use following surgery,[14] and may be helpful in neuropathic pain due to cancer.[15]

Gabapentin does not ameliorate chronic pain after surgery.[14] It is not effective in HIV-associated sensory neuropathy.[16] When used for neuropathic pain it does not appear superior to carbamazepine.[17] It appears to be as effective as pregabalin and costs less[18] It does not appear to provide benefit for complex regional pain syndrome[19]

There is no evidence that it is useful for migraine prevention.[20]

Anxiety disorders

Gabapentin is effective in social anxiety disorder, panic disorder[21][22] and generalized anxiety disorder.[8][9]

Other uses

Gabapentin may be useful in the treatment of comorbid anxiety in bipolar patients, (however not the bipolar state itself).[10][23][24] Gabapentin may be effective in acquired pendular nystagmus and infantile nystagmus, (but not periodic alternating nystagmus).[25][26] It is effective in hot flashes.[27][28][29] It may be effective in reducing pain and spasticity in multiple sclerosis.[30] Gabapentin may reduce symptoms of alcohol withdrawal (but it does not prevent the associated seizures).[31] Use for smoking cessation has had mixed results.[32][33] Gabapentin is effective in alleviating itching in renal failure (uremic pruritus)[34] and itching of other etiologies.[35] It is well-established in the treatment of restless leg syndrome. (A prodrug form, gabapentin enacarbil, is also effective.)[36] Gabapentin is effective in insomnia.[37][38]

Gabapentin is not effective alone as a mood-stabilizing treatment for bipolar disorder.[8] There is insufficient evidence to support its use in obsessive-compulsive disorder and treatment-resistant depression. Gabapentin does not appear effective for the treatment of tinnitus.[39]

Adverse effects

The most common erectile dysfunction.[41][42] Gabapentin should be used carefully in patients with renal impairment due to possible accumulation and toxicity.[43]

An increase in formation of adenocarcinomas was observed in rats during preclinical trials; however, the clinical significance of these results remains undetermined. Gabapentin is also known to induce pancreatic acinar cell carcinomas in rats through an unknown mechanism, perhaps by stimulation of DNA synthesis; these tumors did not affect the lifespan of the rats and did not metastasize.[44]

Suicide

In 2009 the U.S. Food and Drug Administration issued a warning of an increased risk of depression and suicidal thoughts and behaviors in patients taking gabapentin, along with other anticonvulsant drugs[45] modifying the packaging insert to reflect this.[40] A 2010 meta analysis confirmed the increased risk of suicide associated with gabapentin use.[46]

Overdose

Persons who accidentally or intentionally ingested overdoses may have drowsiness, sedation, blurred vision, slurred speech, somnolence and possibly death, if a very high amount was taken, particularly if combined with alcohol. Serum gabapentin concentrations may be measured to confirm diagnosis.[47]

Pharmacology

Gabapentin was initially synthesized to mimic the chemical structure of the neurotransmitter gamma-aminobutyric acid (GABA), but is believed to act on different brain receptors.

Some of its activity may involve interaction with voltage-gated calcium channels. Gabapentin binds to the α2δ subunit (1 and 2) and has been found to reduce calcium currents after chronic but not acute application via an effect on trafficking[48] of voltage-dependent calcium channels in the central nervous system.[49] Another possible mechanism of action is that gabapentin halts the formation of new synapses.[50]

Mechanism of action

The mechanism of the anticonvulsant action of gabapentin has not been fully described. Though similar in structure to the endogenous neurotransmitter GABA, gabapentin has not been shown to bind to GABA receptors at concentrations at or below 1 mM.[51] Gabapentin modulates the action of glutamate decarboxylase (GAD) and branched chain aminotransferase (BCAT), two enzymes involved in GABA biosynthesis. In human and rat studies, gabapentin was found to increase GABA biosynthesis, and to increase non-synaptic GABA neurotransmission in vitro.[52]

Gabapentin (0.01-100 µM) has not been shown to interact with the sodium or L-type calcium ion channels targeted by the conventional anticonvulsant drugs phenytoin, carbamazepine and sodium valproate. Other neurophysiological findings indicate that gabapentin does not interact with glutamate, glycine, or NMDA receptors, further distinguishing its anticonvulsant mechanism from that of common antiepileptic medications.[51]

Society and culture

Sales

Gabapentin is best known under the brand name Neurontin manufactured by Pfizer subsidiary Parke-Davis. A Pfizer subsidiary named Greenstone markets generic gabapentin.

In December 2004 the FDA granted final approval to a generic equivalent to Neurontin made by the Israeli firm Teva.

Neurontin began as one of Pfizer's best selling drugs; however, Pfizer has been criticized and under litigation for its marketing of the drug. They face allegations that Parke-Davis marketed the drug for at least a dozen supposed uses that the FDA had not approved.[53][54] Today it is a mainstay drug for migraines, even though it was not approved for such use in 2004.[55]

FDA approval

Gabapentin was originally approved by the U.S. Food and Drug Administration (FDA) in December 1993, for use as an adjuvant (effective when added to other antiseizure drugs) medication to control partial seizures in adults; that indication was extended to children in 2000.[56] In 2004, its use for treating postherpetic neuralgia (neuropathic pain following shingles) was approved.[56][57]

Off-label promotion

Although some small, non-controlled studies in the 1990s—mostly sponsored by gabapentin's manufacturer—suggested that treatment for bipolar disorder with gabapentin may be promising,[30] the preponderance of evidence suggests that it is not effective.[58] Subsequent to the corporate acquisition of the original patent holder, the pharmaceutical company Pfizer admitted that there had been violations of FDA guidelines regarding the promotion of unproven off-label uses for gabapentin in the Franklin v. Pfizer case.

Reuters reported on March 25, 2010, that "Pfizer Inc violated federal racketeering law by improperly promoting the epilepsy drug Neurontin ... Under federal RICO law the penalty is automatically tripled, so the finding will cost Pfizer $141 million."[59] The case stems from a claim from Kaiser Foundation Health Plan Inc. that "it was misled into believing Neurontin was effective for off-label treatment of migraines, bipolar disorder and other conditions. Pfizer argued that Kaiser physicians still recommend the drug for those uses."[60]

Bloomberg News (3/26/10, Van Voris, Lawrence) added that "during the trial, Pfizer argued that Kaiser doctors continued to prescribe the drug even after the health insurer sued Pfizer in 2005. The insurer's website also still lists Neurontin as a drug for neuropathic pain, Pfizer lawyers said in closing argument."[61]

The Wall Street Journal (3/26/10, Kamp) noted that Pfizer spokesman Christopher Loder said, "We are disappointed with the verdict and will pursue post-trial motions and an appeal."[62] He would later add that "the verdict and the judge's rulings are not consistent with the facts and the law."[59]

Franklin v. Pfizer case

By some estimates, off-label prescriptions account for roughly 90 percent of Neurontin sales.[63]

While off-label prescriptions are common for a number of drugs and are legal, marketing of off-label uses of a drug is illegal.[53] In 2004, Warner-Lambert (which subsequently was acquired by Pfizer) agreed to plead guilty for activities of its Parke-Davis subsidiary, and to pay $430 million in fines to settle civil and criminal charges regarding the illegal marketing of Neurontin for off-label purposes. The 2004 settlement was one of the largest in U.S. history, and the first off-label promotion case brought successfully under the False Claims Act.

The University of California, San Francisco (UCSF) has archived[64] and studied[65] the documents made public by this case, which opens a window into the illegal promotion and marketing of pharmaceuticals. However, Pfizer maintains that the illegal activity originated in 1996, well before it acquired Warner-Lambert in 2000. Several lawsuits are underway after people who had been prescribed gabapentin for off-label treatment of bipolar disorder later attempted or committed suicide.

Brand names

Various suppliers of gabapentin market it under a number of brand names, including Neurostil, Neurontin, Fanatrex, Gabarone, Gralise, Nupentin, Gabrion,[66] Penral, Gabapin.

Forms

A capsule of gabapentin

Gabapentin comes as:

  • 100 mg, 300 mg, and 400 mg capsules
  • 300 mg, 600 mg, and 800 mg tablets
  • a 250 mg/5 mL oral (by mouth) solution.

Inactive ingredients in the capsules include lactose, cornstarch, and talc.

  • The 100-mg capsule shell also contains: gelatin and titanium dioxide.
  • The 300-mg capsule shell also contains: gelatin, titanium dioxide, and yellow iron oxide.
  • The 400-mg capsule shell also contains: gelatin, red iron oxide, titanium dioxide, and yellow iron oxide. The imprinting ink contains FD&C Blue No. 2 and titanium dioxide.

Inactive ingredients in the tablets include poloxamer 407, copolyvidonum, cornstarch, magnesium stearate, hydroxypropyl cellulose, talc, candelilla wax, and purified water.

Inactive ingredients in the oral solution include glycerin, xylitol, purified water, and artificial flavor.[67]

Related drugs

Parke-Davis developed a drug called pregabalin as a successor to gabapentin.[68] Pregabalin was brought to market by Pfizer as Lyrica after the company acquired Warner-Lambert. Pregabalin is related in structure to gabapentin.[69] Another new drug atagabalin has been trialed by Pfizer as a treatment for insomnia.[70]

A prodrug form (gabapentin enacarbil)[71] was approved in 2011 for the treatment of moderate-to-severe restless legs syndrome.[72] and in 2012 for postherpetic neuralgia in adults.[73] It was designed for increased oral bioavailability over gabapentin.[74][75]

Veterinary use

Gabapentin is also used for some animal treatments, but some formulations (especially liquid forms) for human use contains the sweetener xylitol, which is toxic to dogs.[76]

See also

References

  1. ^ a b c d e "Neurontin, Gralise (gabapentin) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 6 April 2014. 
  2. ^ a b c d e Goa, KL; Sorkin, EM (September 1993). "Gabapentin. A review of its pharmacological properties and clinical potential in epilepsy.". Drugs 46 (3): 409–27.  
  3. ^ a b "Gabapentin". The American Society of Health-System Pharmacists. Retrieved Oct 23, 2015. 
  4. ^ "Restless Legs Syndrome: Clinical Presentation, Diagnosis and Treatment".  
  5. ^ a b Attal N, Cruccu G, Baron R, et al. (September 2010). "EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision". Eur. J. Neurol. 17 (9): 1113–e88.  
  6. ^ Pitkänen, Asla; Schwartzkroin, Philip A.; Moshé, Solomon L. (2005). Models of Seizures and Epilepsy. Burlington: Elsevier. p. 539.  
  7. ^ "Gabapentin". The American Society of Health-System Pharmacists. Retrieved 3 April 2011. 
  8. ^ a b c d Stephen V. Sobel (5 November 2012). Successful Psychopharmacology: Evidence-Based Treatment Solutions for Achieving Remission. W. W. Norton. p. 124.  
  9. ^ a b D. John Reynolds; Jamie Coleman; Jeffrey Aronson (10 November 2011). Oxford Handbook of Practical Drug Therapy. Oxford University Press. p. 765.  
  10. ^ a b Vedula, SS; Bero L; Scherer RW; Dickersin K (November 2009). "Outcome reporting in industry-sponsored trials of gabapentin for off-label use".  
  11. ^ Johannessen, SI; Ben-Menachem E (2006). "Management of focal-onset seizures: an update on drug treatment". Drugs 66 (13): 1701–25.  
  12. ^ French, JA; Kanner AM; Bautista J; Abou-Khalil B; Browne T; Harden CL; Theodore WH; Bazil C; Stern J; Schachter SC; Bergen D; Hirtz D; Montouris GD; Nespeca M; Gidal B; Marks WJ; Turk WR; Fischer JH; Bourgeois B; Wilner A; Faught RE; Sachdeo RC; Beydoun A; Glauser TA (May 2004). "Efficacy and tolerability of the new antiepileptic drugs, I: Treatment of new-onset epilepsy: report of the TTA and QSS Subcommittees of the American Academy of Neurology and the American Epilepsy Society". Epilepsia 45 (5): 401–9.  
  13. ^ a b Moore, RA; Wiffen, PJ; Derry, S; McQuay, HJ (Mar 16, 2011). "Gabapentin for chronic neuropathic pain and fibromyalgia in adults.". The Cochrane database of systematic reviews (3): CD007938.  
  14. ^ a b Dauri, M; Faria, S; Gatti, A; Celidonio, L; Carpenedo, R; Sabato, AF (Aug 2009). "Gabapentin and pregabalin for the acute post-operative pain management. A systematic-narrative review of the recent clinical evidences.". Current drug targets 10 (8): 716–33.  
  15. ^ Bar Ad, V (September 2010). "Gabapentin for the treatment of cancer-related pain syndromes". Reviews on Recent Clinical Trials 5 (3): 174–8.  
  16. ^ Phillips, TJ; Cherry CL; Cox S; Marshall SJ; Rice AS (2010-12-28). Pai, Nitika Pant, ed. "Pharmacological treatment of painful HIV-associated sensory neuropathy: a systematic review and meta-analysis of randomised controlled trials".  
  17. ^ Wiffen, P; Collins S; McQuay H; Carroll D; Jadad A; Moore A (2005-07-20). Wiffen, Philip J, ed. "Anticonvulsant drugs for acute and chronic pain". Cochrane database of systematic reviews (Online) (3): CD001133.  
  18. ^ Finnerup, NB; Sindrup SH; Jensen TS (September 2010). "The evidence for pharmacological treatment of neuropathic pain". Pain 150 (3): 573–81.  
  19. ^ Tran de, QH; Duong S; Bertini P; Finlayson RJ (February 2010). "Treatment of complex regional pain syndrome: a review of the evidence". Can J Anaesth 57 (57(2)): 149–66.  
  20. ^ Linde, M; Mulleners, WM; Chronicle, EP; McCrory, DC (Jun 24, 2013). "Gabapentin or pregabalin for the prophylaxis of episodic migraine in adults.". The Cochrane database of systematic reviews 6: CD010609.  
  21. ^ Mula M, Pini S, Cassano GB (June 2007). "The role of anticonvulsant drugs in anxiety disorders: a critical review of the evidence". J Clin Psychopharmacol 27 (3): 263–72.  
  22. ^ Alan F. Schatzberg; Jonathan O. Cole; Charles DeBattista (2010). Manual of Clinical Psychopharmacology. American Psychiatric Pub. pp. 344–345.  
  23. ^ Joseph F. Goldberg; Martin Harrow (1999). Bipolar Disorders: Clinical Course and Outcome. American Psychiatric Pub. p. 98.  
  24. ^ Freeman MP, Freeman SA, McElroy SL (February 2002). "The comorbidity of bipolar and anxiety disorders: prevalence, psychobiology, and treatment issues". J Affect Disord 68 (1): 1–23.  
  25. ^ McLean, RJ; Gottlob I (August 2009). "The pharmacological treatment of nystagmus: a review". Expert opinion on pharmacotherapy 10 (11): 1805–16.  
  26. ^ Strupp, M; Brandt T (July 2009). "Current treatment of vestibular, ocular motor disorders and nystagmus". Therapeutic Advances in Neurological Disorders 2 (4): 223–39.  
  27. ^ Toulis, KA; Tzellos T; Kouvelas D; Goulis DG (February 2009). "Gabapentin for the treatment of hot flashes in women with natural or tamoxifen-induced menopause: a systematic review and meta-analysis". Clinical therapeutics 31 (2): 221–35.  
  28. ^ Cheema, D; Coomarasamy A; El-Toukhy T (November 2007). "Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review". Archives of Gynecology and Obstetrics 276 (5): 463–9.  
  29. ^ Rada, G; Capurro, D; Pantoja, T; Corbalán, J; Moreno, G; Letelier, LM; Vera, C (Sep 8, 2010). "Non-hormonal interventions for hot flushes in women with a history of breast cancer.". The Cochrane database of systematic reviews (9): CD004923.  
  30. ^ a b Mack, Alicia (2003). "Examination of the evidence for off-label use of gabapentin" (PDF). Journal of Managed Care Pharmacy 9 (6): 559–68.  
  31. ^ Muncie HL, Jr; Yasinian, Y; Oge', L (Nov 1, 2013). "Outpatient management of alcohol withdrawal syndrome.". American family physician 88 (9): 589–95.  
  32. ^ Sood, A; Ebbert JO; Schroeder DR; Croghan IT; Sood R; Vander Weg MW; Wong GY; Hays JT (February 2007). "Gabapentin for smoking cessation: a preliminary investigation of efficacy". Nicotine & Tobacco Research 9 (2): 291–8.  
  33. ^ Sood, A; Ebbert JO; Wyatt KD; Croghan IT; Schroeder DR; Sood R; Hays JT (March 2010). "Gabapentin for smoking cessation". Nicotine & Tobacco Research 12 (3): 300–4.  
  34. ^ Berger, TG; Steinhoff, M (June 2011). "Pruritus and renal failure.". Seminars in cutaneous medicine and surgery 30 (2): 99–100.  
  35. ^ Anand S (March 2013). "Gabapentin for pruritus in palliative care". American Journal of Hospice and Palliative Medicine 30 (2): 192–196.  
  36. ^ Scott LJ (December 2012). "Gabapentin enacarbil: in patients with restless legs syndrome". CNS Drugs 26 (12): 1073–83.  
  37. ^ Jack D. Edinger (2013). Insomnia, an Issue of Sleep Medicine Clinics. Elsevier Health Sciences. p. 339.  
  38. ^ Charles M. Morin; Colin A. Espie (2 February 2012). The Oxford Handbook of Sleep and Sleep Disorders. Oxford University Press. p. 544.  
  39. ^ Aazh, H; El Refaie, A; Humphriss, R (December 2011). "Gabapentin for tinnitus: a systematic review.". American journal of audiology 20 (2): 151–8.  
  40. ^ a b "Neurontin packaging insert" (pdf).  
  41. ^ Jeffrey K Aronson (4 March 2014). Side Effects of Drugs Annual: A worldwide yearly survey of new data in adverse drug reactions. Newnes. p. 137.  
  42. ^ American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.: DSM 5. bookpointUS. p. 482. GGKEY:LXJWL7ZHDAH. 
  43. ^ "www.accessdata.fda.gov" (PDF). 
  44. ^ Gabapentin Official FDA information, side effects and uses
  45. ^ "Suicidal Behavior and Ideation and Antiepileptic Drugs".  
  46. ^ Patorno E, Bohn RL, Wahl PM, et al. (April 2010). "Anticonvulsant medications and the risk of suicide, attempted suicide, or violent death". JAMA 303 (14): 1401–9.  
  47. ^ R.C. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 8th edition, Biomedical Publications, Foster City, CA, 2008, pp. 677–8. ISBN 978-0-9626523-7-0.
  48. ^ Hendrich, J; Van Minh, AT; Heblich, F; Nieto-Rostro, M; Watschinger, K; Striessnig, J; Wratten, J; Davies, A; Dolphin, AC (March 2008). "Pharmacological disruption of calcium channel trafficking by the alpha2delta ligand gabapentin" (PDF). Proceedings of the National Academy of Sciences of the United States of America 105 (9): 3628–33.  
  49. ^ Davies, A; Hendrich, J; Van Minh, AT; Wratten, J; Douglas, L; Dolphin, AC (May 2007). "Functional biology of the alpha(2)delta subunits of voltage-gated calcium channels". Trends Pharmacol Sci 28 (5): 220–8.  
  50. ^ Eroglu, Ç; Allen, NJ; Susman, MW; O'Rourke, NA; Park, CY; Özkan, E; Chakraborty, C; Mulinyawe, SB; et al. (October 2009). "The Gabapentin Receptor α2δ-1 is the Neuronal Thrombospondin Receptor Responsible for Excitatory CNS Synaptogenesis".  
  51. ^ a b "Product Monograph". http://www.pfizer.ca. Pfizer. Retrieved 28 September 2014. 
  52. ^ Taylor, CP. "Mechanisms of action of gabapentin". http://www.ncbi.nlm.nih.gov/pubmed/. PubMed. Retrieved 28 September 2014. 
  53. ^ a b Henney JE (August 2006). "Safeguarding patient welfare: who's in charge?" (PDF).  
  54. ^ "Warner–Lambert to pay $430 million to resolve criminal & civil health care liability relating to off-label promotion" (Press release).  
  55. ^ Mathew, NT; Rapoport, A; Saper, J; Magnus, L; Klapper, J; Ramadan, N; Stacey, B; Tepper, S (February 2001). "Efficacy of Gabapentin in Migraine Prophylaxis".  
  56. ^ a b Mack A (2003). "Examination of the evidence for off-label use of gabapentin" (PDF). J Manag Care Pharm 9 (6): 559–68.  
  57. ^ Pfizer Neurontin Label, Revised: 5/2013 Retrieved 9 August 2014
  58. ^ Reinares M, Rosa AR, Franco C, et al. (March 2013). "A systematic review on the role of anticonvulsants in the treatment of acute bipolar depression". Int. J. Neuropsychopharmacol. 16 (2): 485–96.  
  59. ^ a b Berkrot, Bill (2010-03-25). "US jury's Neurontin ruling to cost Pfizer $141 mln". Reuters. 
  60. ^ "Pfizer faces $142M in damages for drug fraud". Business Week. 2010-03-25. Retrieved 13 January 2012. 
  61. ^ Bob Van Voris; Janelle Lawrence (2010-03-26). "Pfizer Told to Pay $142.1 Million for Neurontin Marketing Fraud". Bloomberg News. Retrieved 13 January 2012. 
  62. ^ Jon Kamp (2010-03-25). "Jury Rules Against Pfizer in Marketing Case". The Wall Street Journal. Retrieved 13 January 2012. 
  63. ^ Tansey, Bernadette (2004-05-14). "Huge penalty in drug fraud, Pfizer settles felony case in Neurontin off-label promotion". San Francisco Chronicle. p. C-1. 
  64. ^ Drug Industry Document Archive
  65. ^ Narrative Review: The Promotion of Gabapentin: An Analysis of Internal Industry Documents – Steinman et al. 145 (4): 284 – Annals of Internal Medicine
  66. ^ http://thepharmaguide.com/content/view/5336/31/.
  67. ^ Gabapentin Information and Uses - rxwiki.com
  68. ^ Baillie, JK; Power, I (January 2006). "The mechanism of action of gabapentin in neuropathic pain". Curr Opin Investig Drugs 7 (1): 33–9.  
  69. ^ Jensen B, Regier LD, editors. RxFiles : Drug comparison charts. 7th ed. Saskatoon, SK: RxFiles, 2010; p.78
  70. ^ Kjellsson MC, Ouellet D, Corrigan B, Karlsson MO (June 2011). "Modeling Sleep Data for a New Drug in Development using Markov Mixed-Effects Models". Pharmaceutical Research 28 (10): 2610–27.  
  71. ^ Landmark CJ, Johannessen SI (2008). "Modifications of antiepileptic drugs for improved tolerability and efficacy". Perspectives in Medicinal Chemistry 2: 21–39.  
  72. ^ [2]
  73. ^ Jeffrey, Susan. "FDA Approves Gabapentin Enacarbil for Postherpetic Neuralgia". Medscape. 
  74. ^ Cundy KC, Branch R, Chernov-Rogan T, Dias T, Estrada T, Hold K, Koller K, Liu X, Mann A, Panuwat M, Raillard SP, Upadhyay S, Wu QQ, Xiang JN, Yan H, Zerangue N, Zhou CX, Barrett RW, Gallop MA (October 2004). "XP13512 [(+/-)-1-([(alpha-isobutanoyloxyethoxy)carbonyl] aminomethyl)-1-cyclohexane acetic acid], a novel gabapentin prodrug: I. Design, synthesis, enzymatic conversion to gabapentin, and transport by intestinal solute transporters". The Journal of Pharmacology and Experimental Therapeutics 311 (1): 315–23.  
  75. ^ Cundy KC, Annamalai T, Bu L, De Vera J, Estrela J, Luo W, Shirsat P, Torneros A, Yao F, Zou J, Barrett RW, Gallop MA (October 2004). "XP13512 [(+/-)-1-([(alpha-isobutanoyloxyethoxy)carbonyl] aminomethyl)-1-cyclohexane acetic acid], a novel gabapentin prodrug: II. Improved oral bioavailability, dose proportionality, and colonic absorption compared with gabapentin in rats and monkeys". The Journal of Pharmacology and Experimental Therapeutics 311 (1): 324–33.  
  76. ^ Barbara Forney. "Gabapentin for Veterinary Use". 

External links

  • DrugBank: gabapentin
  • Gabapentin information from MedlinePlus
  • "Gabapentin" PubMed Health. National Center for Biotechnology Information (NCBI)
  • "Suicidal Behavior and Ideation and Antiepileptic Drugs" U.S. Food and Drug Administration (FDA)
  • Neurontin collected news and commentary at The New York Times
  • "Gabapentin" Drug Information Portal. U.S. National Library of Medicine.