Radiation can cure head and neck cancer but causes a lot of toxicity. Gabapentin may make completing treatment easier. I found this draft protocol helpful to start and stop the medication. Discuss with your pharmacist, physicians and treatment team if you want to implement at your facility to help your patients. The data are limited and one randomized trial is negative, but if you are interested look at the research yourself

1. YOUR FACILITY HERE
DRAFT – MUST VALIDATE WITH YOUR PHARMACY, NURSING and SAFETY TEAMS
WhyGabapentin?Gabapentin,orNeurontin, isknowntohelprelieve certaintypesof paincalled
Neuropathicpain.Thispainisoftenexperiencedbypatientsundergoingchemotherapyandradiation
treatmentsforHeadand Neckcancer. Controllingpainwill oftenpreventunplannedtreatment
interruptionsandallow patientstocontinue toeatanddrinkduringtreatment. Yourdosingand
medicationplanwillbe dependentonyourpainlevel. Gabapentinwill be takenby youasa liquid,nota
pill orcapsule.All dosingwillbe measuredinml.
250 mg in 5ml is the measurementfor your dosing.
You will followthisdosingof Gabapentin priorto yourstartingtreatment. Yourradiationdoctoror nurse
will tell you the date whentostart.
1. Day 1 take 5 ml X 1 at night. START DATE:___________________
2. Day 2 take 10ml X1 at night.
3. Day 3 and 4 take 5ml in the morning,and5ml at night.
4. Day 5 take 10 ml inthe morning,and10ml at night.
Once your treatment begins/or if treatmenthas alreadystarted:
1. Take 15 ml inthe morningand15 ml at nightX 2 days.
2. Take 15 ml inthe morning,5ml inthe afternoonand15 ml at nightX 2 days.
3. Take 15 ml inthe morning,10 ml inthe afternoon,and15 ml at nightfor2 days.
4. Take 15 ml inthe morning,15 ml inthe afternoon,and15 ml at nightforthe remainderof
radiationtreatment.
Take a misseddose as soon as rememberedunlessitisnear the time of the nextdose.Do not
double up the dose to catch up.
Caution: This medicine maycause drowsinessor dizziness. Do not operate machinery or
engage in activitiesrequiringalertnessuntil you know how this medicine affectsyou.
Side Effects – Less common: Skinreactionssuchas a rash, redness,swellingof the face,lips,throat
and/ortongue;fever,swollenglands,seizures,yellowingof yourskinoreyesor persistentstomach
pain,racingheartbeatdifficultymoving, mental impairment. Pleasenotifyyourradiation doctor or
nurse right away if you have any of these side effects.
Side Effects– More common: headache,fatigue,restlessness,anxiety,changesinbehavior ormood,
rash, runnynose,itching,difficultymoving,clumsiness,blurredvision,dizziness,jointpainandnausea.
Once you have completedtreatmentandasdeterminedbyyour radiationdoctor,youwill beginataper
off of yourgabapentin.Donotstop yourGabapentinall at once.Your radiationdoctoror nurse will
reviewhowtoslowlydecreaseyourdailydose.
Gabapentin Medication Guide
This medicine maycause drowsinessor dizziness.Do not operate machinery or engage
in activitieswhichrequire you to be alert. Do not drink alcohol or take otherdrugs
which make you sleepywithoutspeakingto your healthcare providerfirst.

2. YOUR FACILITY HERE
DRAFT – MUST VALIDATE WITH YOUR PHARMACY, NURSING and SAFETY TEAMS
Whydo I needto taper my dosesof Gabapentin?Evenif youhave onlybeentakingGabapentinfora
short periodof time, itisnecessary to taper or wean off your dosesand not completelystopyour
Gabapentin“coldturkey”. A taperis slowlyreducingyourdosage of adrug overa periodof weekswith
the intentionof completelycomingoff of the drug.If you stoptakingyour Gabapentincompletely
withouta gradual taper,youmay experience significantwithdrawalsymptoms.Evenwiththe tapering
downof the medication,some individualswill experience withdrawal symptomsof some kind.Itis
importantto followthe schedule of taperingyourGabapentin;if youare havingtrouble copingwiththe
withdrawal processorhave questionsaboutyourschedule,youneedtocall the radiationnurse or
radiationdoctor.
250 mg in 5ml is the measurementfor your dosing.This is the same dosing as when you started the
drug.
You will beginthistaperof Gabapentin3weeks afteryourtreatmentiscompleted.Yourradiation
doctor or nurse will tell youwhenyoushouldbeginthe taper.
1. Take 15 ml inthe morningand15ml at nightX2 days. START DATE OF TAPER: _________
2. Take 10 ml inthe morningand10 ml at nightX 2 days.
3. Take 5 ml inthe morning,and5ml at nightX 2 days.
4. Day 7: Take 10 ml at bedtime.
5. Day 8 Do not take any Gabapentin.
Caution: This medicine maycause drowsinessor dizziness. Do not operate machinery or
engage in activitiesrequiringalertnessuntil you know how this medicine affectsyou.
Possible Withdrawal Symptoms – Anxiety,appetitechanges,cryingspells,depression,dizziness,
fatigue, headaches,insomnia/trouble sleeping,irritability,itching,muscle pain,nausea,restlessness,
stomachpain,and sweating,especiallyduringthe night.
Gabapentin Tapering Medication Guide
Beloware some withdrawal symptoms that you may experience whentaperingoff
from Gabapentin.Keepinmind that you may not experience everysymptom-
everyone will be different.Ifyou are having a difficulttime with withdrawal
symptoms,call your radiation doctor or nurse right away.