Gunda Siska, PharmD
Gunda Siska, PharmD, has worked in various fields within the pharmaceutical industry as a licensed pharmacist for more than 20 years. She is currently a staff hospital pharmacist assisting nurses and doctors with drug prescribing, administration, and dispensing, as well as independently monitoring and dosing highly toxic and dangerous drugs. For 2 years, she was concurrently a consultant pharmacist for skilled nursing facilities and nursing homes. Dr. Siska is a member of the New Mexico Society of Health-System Pharmacists and the American Academy of Anti-Aging Medicine. Follow her on Twitter @GundaSiska
RC is a female patient, age 77 years. She comes into the pharmacy to pick up medications that the doctor was supposed to have sent over electronically. She was recently in the hospital, and she gives you her discharge paperwork to confirm the drugs she needs.
- Cephalexin 250mg bid #20
- Patiromer 8.4 grans qd #14
- Gabapentin 200mg tid #qs 30 day supply
She says she wants you put the new gabapentin prescription back to stock and delete that order. She wants to keep using the previous gabapentin that is on file.
In looking at the previous gabapentin order you see that is for a much higher dose, 900mg tid.
According the patient's discharge paper work, she was admitted for muscle weakness and difficultly ambulating. She was found to have a UTI which precipitated mild renal failure.
You see now that she is now a 100% mobile and ambulating without any difficulty.
Mystery: Why did the doctor lower the patient’s gabapentin dose?
Solution: RC had a decline in renal function, and her pervious gabapentin dose caused an accumulation of drug leading to debilitating adverse effects.
Gabapentin can have many adverse effects; some can mimic a unilateral or central type stroke. Now, with the opioid epidemic, gabapentin is being used more often. Pharmacists are in a good position to keep the public informed of the adverse effects and oversee the safe use of gabapentin.
Quintero GC. Review about gabapentin misuse, interactions, contraindications and side effects. J Exp Pharmacol. 2017;9:13–21. Published 2017 Feb 9. doi:10.2147/JEP.S124391