# A 72-year-old client with chronic kidney disease (eGFR 28 mL/min) is prescribed gabapentin 300 mg PO three times daily for postherpetic neuralgia. Which is the nurse's priority action?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391752&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 72-year-old client with chronic kidney disease (eGFR 28 mL/min) is prescribed gabapentin 300 mg PO three times daily for postherpetic neuralgia. Which is the nurse's priority action?

## Option

1. Hold the dose and contact the provider to discuss renal dose adjustment — gabapentin is renally cleared and accumulates in CKD **✔ Correct answer**
2. Administer the prescribed dose of gabapentin 300 mg PO TID to manage postherpetic neuralgia pain effectively
3. Titrate the gabapentin dose to 600 mg three times daily since the current dose is subtherapeutic for postherpetic neuralgia
4. Crush the gabapentin capsule and mix with applesauce for administration because older adults commonly have difficulty swallowing pills

**Correct answer: 1**

## Explanation

Correct (2): Gabapentin is renally eliminated; in eGFR 15-29, dose should be reduced (e.g., 200-700 mg/day in divided doses). Failure to adjust causes accumulation with sedation, ataxia, falls, and respiratory depression — especially dangerous in older adults. (1) Standard dose risks toxicity. (3) Higher dose worsens harm. (4) Administration route does not change the underlying issue.

## In-depth explanation

Memory Tip Gabapentin/Pregabalin = "Renal Reduction Required." Check eGFR before initiation and at each dose change. Caution FDA boxed warning for respiratory depression when combined with opioids or other CNS depressants.

## Clinical scenario

Scenario 72-year-old male, postherpetic neuralgia. CKD stage 4 (eGFR 28 mL/min). Provider orders gabapentin 300 mg PO TID.

## Key concepts

- **Renal dose adjustment** — Reduction of drug dose based on eGFR or creatinine clearance; gabapentin requires this in CKD.
- **Gabapentinoid sedation** — Dose-dependent CNS depression from gabapentin/pregabalin; magnified by renal accumulation in CKD.
- **Postherpetic neuralgia** — Chronic neuropathic pain after herpes zoster; gabapentin and pregabalin are first-line agents.

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