A 65-year-old client with painful diabetic peripheral neuropathy is starting gabapentin 100 mg PO three times daily, planned to titrate up over weeks. Which client teaching is most important?

Gabapentin (Neurontin) and the related pregabalin (Lyrica) are first-line agents for several neuropathic pain syndromes including diabetic peripheral neuropathy, postherpetic neuralgia, and central neuropathic pain, and they are also used in seizure disorders and fibromyalgia (pregabalin). Onset is gradual — partial benefit in days to a week, full benefit in 2 to 8 weeks of titration; dose is titrated up to balance efficacy and tolerability. Key teaching: (1) take on schedule (typically TID for gabapentin, BID for pregabalin) regardless of pain level, (2) expect gradual benefit and do not double doses, (3) common adverse effects — dizziness, drowsiness, ataxia, peripheral edema and weight gain, blurred vision, fatigue; report worsening, (4) FDA-class label warning for suicidal ideation; report depression, mood changes, or suicidal thoughts immediately, (5) avoid alcohol, sedatives, and opioids without prescriber guidance because of additive CNS depression; reports of fatal respiratory depression with concomitant opioids exist; (6) gradually taper rather than stop suddenly because abrupt cessation can precipitate seizures and rebound pain, (7) rise slowly from sit/lie to stand to prevent orthostatic falls in older adults, (8) renal dose adjustment for impaired CrCl, (9) pregabalin is a Schedule V controlled substance because of misuse potential. Doubling doses for pain, stopping for sleepiness, or PRN use are all incorrect.

Gradual benefit, watch for sedation/edema/mood, taper not abrupt stop, no alcohol. Suicidal ideation warning is the FDA class label.