PharmPK Discussion - Rectal Absorption Gabapentin

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On 23 Aug 2000 at 21:13:51, rgillies.-at-.sfu.ca sent the message


Is there any information on the rectal absorption of gabapentin in patients
with neuropathic cancer pain unable to take oral medication?

Thanks for any help.

Bob Gillies
Pharmacy Department
Surrey Memorial Hospital
Surrey, B. C.

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On 24 Aug 2000 at 13:42:33, HRr1234.aaa.aol.com sent the message


Good question.  I would be inteested in the answers for possible use
with my Hospice patients.

Thank you
Henry Resnick, PharmD, MS
Hospice By The Sea
Boca Raton, FL

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On 24 Aug 2000 at 23:04:04, "Gilbertson-Gabel, Ann L" (gilberta.aaa.stjosephs-marshfield.org) sent the message


Good question,
I believe the answer is that gabapentin is a zwitterion sp? and therefore
is actively transported across the gastrointestinal tract. Since the active
transporters are not present in the rectum, adsorption is practically nil.

Now, with that said we did have an end stage head neck cancer patient with
neuropathic pain. As I recall we upped his dose from 100mg
tid to 300 or 400mg tid rectally ( I believe I just compounded a suspension
and it was given as an enema). I followed up after about 3-4 days of
administration to see if we should continue. According to the nurses the
suspension was working and continuing to relieve the patient's pain as well
or better than the original oral dose. Who knows, could have been placebo,
could have been effect of other meds (although none changed during this
time period), anyway not very scientific evidence.

So, in answer to your question there is no literature supporting the use of
gababpentin rectally. But, it may be possible to titrate to a high enough
dose to have some benefit.

Ann Gabel, RPh
gilberta.aaa.stjosephs-marshfield.org

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On 6 Sep 2000 at 12:02:41, Angela Birnbaum (birnb002.at.maroon.tc.umn.edu) sent the message


There is one published article concerning gabapentin rectal
absorption.  This study was done in patients with epilepsy.

Robert L. Kriel, Angela K. Birnbaum, James C. Cloyd, Beverly J.
Ricker, Carolyn Jones Seate, Kimberly J. Caruso, Failure of
Absorption of Gabapentin After Rectal Administration, Epilepsia 38
(11):1242-1244 (1997).

Angela Birnbaum, Ph.D.
Assistant Professor
Experimental & Clinical Pharmacology
University of Minnesota

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