Gabapentin/Neurontin Advice

[Muttly]

I take gaba for nerve pain issues. I take 300 in the morning and 600 at night. I recently ran out and was having troubles getting it refilled (doctor left town). I didn't have any withdrawal symptoms except maybe troubles sleeping. If I take more in the morning I do experience drowsiness but other than that I've had no problems and it definitely helps with my pain

 

[joeylittle]

He said I will be taking 6oo mg three times a day or 900 mg twice a day (maybe not at those dosages?). So when I brought up acute relief I may be misunderstanding.

I'm guessing you misunderstood. The idea behind this drug will be to give you an overall 'blanket' of regulation. For immediate intervention, you'd be looking towards something more like a benzo. Trying the gaba approach is conceptually smarter for the long-term.

I was thinking 1 the first morning and 1 in the morning and evening on the second day...then 1 morning afternoon and evening for a spell then ramp from there. Guess I can't plan too thoroughly because I don't know how I will react to the med. God I pray it works well and for some duration.

Take your initial dose at night - it will cause some drowsiness at first. For titrating up, your doc can give you a more solid plan. Sometimes, when you're going to be taking a drug sub-clinically (aka not at 'full-strength' levels), docs just get vague...drives me nuts.

Good rule of thumb for a slow titration up is a week between increases. So, that would be a week at 300 in the pm, then either add the next three in the morning or the evening (depends on how alert you need to be, how early), another 300 a week after that, and so on. It's very slow (and not completely necessary for this medication), but if you're an anxious sort, it'll be an easier process.

For rapid titration, three to five days. 300 for three days pm, add 300 am, and three to five days later (depending on how you're feeling), add onto the evening again, and so forth.

I take 300-600 mg as needed for sleep - a very low dose. I don't use it consistently, and I don't have any withdrawal effects. More the opposite - since I'm not building it up, it usually hits me like a ton of bricks, which is exactly what I need it to do. :)

You can also ask your pharmacist about any of this stuff. They are definitely a better guide than any of us - but hearing how others have done things is also helpful, and has a proper place in the process.

 

[MrMoonlight]

Thank you joey, helps a great deal having two responsible paths to titration. I need help with sleeping so initially evening dosing sounds like a wise move. I really don't want to get on the benzo train again so I'm glad this therapy is available.

For rapid titration, three to five days. 300 for three days pm, add 300 am, and three to five days later (depending on how you're feeling), add onto the evening again, and so forth.

I think I'll roll with this initially and see how I feel along the way. I will also speak with my therapist today during my appointment and return to the pharmacy to make sure my dr didn't provide further instruction or at least get their opinion.

 

[Teamwork]

Interesting to me that in all the responses no one complained of memory loss. I struggle most with memory issues on this medication. However, I am also taking baclofen alongside it and seizure drug. Others I’ve known had similar memory issues on neurontin as I have had.

 

[MrMoonlight]

I struggle most with memory issues on this medication.

thanks for the heads-up. I spoke with my therapist about taking this medication yesterday she assured me it was for the best right now...and that right now doesn't mean for the rest of my life.

I just worry so about medications. Whe my doctor had me on adderall I didn't realize the subtle way it changes a person over time, imperceptibly. I guess with this place and the team I have assembled around me (Dr's, Psychiatrist, Therapist) I now have people watching my back which is a comfort and makes me more willing to try this medication.

I hate memory issues, I have enough of those right now. Maybe I could mitigate with a notepad in my pocket. I don't know man...do what I need to do I guess.

 

[EveHarrington]

If you have memory issues, they may be temporary so try sticking it out.

 

[Rex]

I was just prescribed a new formulation of gabepentin for migraine prevention. I took Neurontin at one point, but this one does seem better. I take 300mg at night. What I have noticed is that it knocks me out cold. I think the anxiety might be better with this, but sleep could be a confounding factor. I generally don't sleep well and I think it is possible that more sleep is contributing to less anxiety as much as the drug. I could be wrong. So far, the headache control is not there. The nightmares have increased a bit, but this could be due to increased sleep (for one cannot dream when they are awake).

I will say that I have also been prescribed benzos for the anxiety (specifically klonopin at the moment). The gabepentin seems to not last as long in terms of the grogginess, and that is a very good thing. In other words, if I take a klonopin at night, I am zoned out and/or sleepy the next day. The gabepentin seems to wear off faster.

I've only been on this about a week though, so take what I am saying with a grain of salt.

 

[MrMoonlight]

Thank you @Rex and @EveHarrington

eve I will stick with the drug for sure. My psychiatrist really knows his medicines and I trust his judgement. But yeah man I'll for sure ride through the storm if that's what it take to find more beautiful skies.

rex thanks for sharing your experience with the medicine. I really hope, at least for a time, that it helps me with sleep. I'm tempted to take one right now in hopes of restful sleep. I think it would be okay as I have felt no change from the cymbalta increase. I really don't think it would be a big deal if I started now. If if could help my migraines that would be terrific. The dosing that awaits me seems to be where this medicine is in my system for the majority of my waking hours. The amount I take is up to me. My psychiatrist wants me to tell him how much I need.

Because I need to tell him what level it's going to require my increasing the med to different levels and testing myself in and with the public in crowded places probably. At least that's the only way I can see to truly find the level that is most helpful to my life at this time in my life. I guess I'll see how it goes. Sorry rex it hasn't helped much with your headaches.

@Rex do you mind me asking if 300 mg is your final dosing level or are you to increase to some higher level?

 

[Rex]

think it would be okay as I have felt no change from the cymbalta increase.

I am super sensitive to most medication it seems. I took Cymbalta and could not tolerate the sleepiness. I was a zombie.

If if could help my migraines that would be terrific. The dosing that awaits me seems to

Neurontin is used quite often as a migraine preventative I think. This is the second doctor, 15 years apart, that has prescribed it for that. A third recommended it as well. If it assists with anxiety, that is simply lagniappe.

The dosing that awaits me seems to be where this medicine is in my system for the majority of my waking hours.

This is an interesting statement. For the record, I do not work for this drug company, nor do I have any personal agenda with this statement. Neurontin, or gabepentin (generic name) is an older drug that is off patent. If you look up the pharmacokinetics on the oral bioavailability of this drug you will find that it is quite low, and it paridoxically decreases as the dose is increased. If you read the information from the drug packaging on Pfizer's web site (for Neurontin), you will find the bioavailability is 60, 47, 34, 33, and 27% with dosing of 900, 1200, 2400, 3600 and 4800 mg, respectively when the does are even divided three times per day. It has a half life of 5-7 hours.

My doctor prescribed a new formulation called "Horizant." I was skeptical. The price tag is higher, of course, because Neurontin is off patent while Horizant is not. Horizant is actually gabapentin enacarbil. While the active ingredient is the same (gabepentin), the addition of the "enacarbil" changes the bioavailability. Apparently, this molecule allows for the gabepentin to be absorbed along the entire GI tract, which ultimately results in higher blood concentrations. Furthermore, it is an XR formulation, so it does not have to be taken as often to maintain a steady state.

I was going to beg for the generic because of price, but after reading, I decided to try this one. My first try with Neurontin didn't work out. My neurologist had some sort of coupon that brought the price down to a copay that was only $10 more per month than the generic.

I realize that you essentially asked what time it was and I am trying to explain how a clock works. Sorry about that. It is just to say that the dosing of mine (the Horizant) and yours (the gabapentin/Neurontin) might not be directly comprable. It is also to say that if you are like me and have trouble remembering to take one regularly-scheduled dose of a drug per day, there may be an easier option. I realize not all insurance and coupons work out the same and your doctor knows a lot more than me about it.

do you mind me asking if 300 mg is your final dosing level or are you to increase to some higher level?

I have no idea the answer to this. I have not been on it very long, but I would guess if he has seen some improvement but not a full resolution that he might be inclined to increase it. Also, as I said before, I dont think the dosing is directly comprable to the older formulation.

 

[EveHarrington]

Dosing is highly person specific. I see many people post about how their doc wants them at a certain dose but this makes no sense to me, especially on these off label drugs. Way to be lazy, docs! It’s all about how the individual feels at a certain dose. Target doses are pointless, especially for those of us who are med sensitive. And if you’ve ever had the genetic testing done? Yeah, you’ll understand even faster why target doses are ridiculous.

 

[Deleted member 541]

I can’t take it, as it causes severe dizziness for me. Recently I’ve been put on a sister drug Tegrotol for nerve pain. Only side effect for awhile was dry mouth. But, I’m on a low dose, 400mgs daily. Good luck!!!

 

[MrMoonlight]

thanks everyone for the guidance. I have taken the med two times now and I do feel some dizziness @She Cat . I slept better last night and today I feel a little tired with mild dizziness. I'm going to give it a lot of time for my mind/body to adjust before making any judgements. I do have hopes that this new therapy will do something for me. I haven't yet taken two doses within a 6 hour period. I think I'll keep it staggered for now and take every twelve hours + -. I see my therapist tomorrow afternoon and am hardly over the last visit. Hope it goes easier tomorrow. Feel like there is a lot on my plate, just need to calm myself and let the med do it's thing. I'm cutting way down on the MMJ during the hours the gabapentin is in my system.

I'm doing okay and just laying around in bed after an early morning car drop-off. Haven't even showered...actually I'm going to do that right now. My stomach is full now to get my body clean. That will make me feel 10% better right off the bat. Tonight I will again take the gabapentin and hope for an easy time drifting off to sleep.