Today's Veterinary Practice

NOV-DEC 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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PEER REVIEWED 30 NOVEMBER/DECEMBER 2018 BOX 1 Recommended Gabapentin Treatment Guidelines Start at 5 mg/kg PO q12h for mild pain and 10 q12h or 5 mg/kg q8h for moderate to severe pain. The interval of q8h is preferred. Did pain relief occur in 3 to 5 days? Did pain relief occur in 3 to 5 days? If the administration is q12h, use the same dose q8h. Increase the dose by roughly 25% per dose. Continue escalating every 3 to 5 days until 1 of the 2 endpoints (sedation [or ataxia] or pain relief) is reached. Is sedation [or ataxia] reached before pain relief? Return to the previous (nonsedating/non-ataxic) dose and maintain that dose for 7 days. Stay at that dose. Stay at that dose. Is the patient comfortable? Is the patient comfortable and not sedate? Is the patient comfortable and not sedate? Return to the previous (nonsedating/ non- ataxic) dose and maintain that dose. Include more multimodal therapy. Or discontinue Gabapentin and pursue other treatment. Try increasing again. Gradually increasing the dose over time often decreases the occurrence of sedation or ataxia. If gabapentin therapy is to be discontinued (e.g., the pain is completely resolved or the gabapentin is not working), to prevent potential rebound pain, withdraw the drug gradually over 1 to 3 weeks (depending on the duration of therapy). Have the client continue to monitor the patient. Drug effectiveness is sometimes easier to identify while the drug is being withdrawn. Does the patient have renal or hepatic disease? The starting dose may be as low as 3 mg/kg q12h. Y E S Y E S Y E S Y E S Y E S Y E S N O N O N O Y E S N O N O N O N O START

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