Gabapentin to Pregabalin

Hi there

I am due to switch over from 1800mg of gabapentin a day to 300mg of pregabalin.

Firstly has anyone had experience of switching, do you just go straight from one to the other (without reducing the gabapentin and gradually introducing pregabalin)? I'm worried about coming completely off gabapentin and starting pregabalin ( I did think you would have to titrate these doses), my GP said "I think it's ok".

Secondly has anyone found pregabalin to be better than gabapentin. I have to say I never suffered any side effects of the gabapentin. Thanks

41 Replies

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  • These 2 drugs get more questions than any pther topic.

    Firstly who has prescribed the change over?

    Whoever it was should have given you clear instructions as to whether you just stop one and replace with another.

    Secondly - I'd be worried if my GP said it 'should' be ok.

    If you have had no side effects o far You are fortunate as many can't take them.

    Ask your pharmacist if you can not get back to the person prescribing them.

    Pat x

  • Hi Pat, thanks for your reply. It was the pain clinic who recommended the change. He just said swap the gabapentin to pregablin going from 300mg a day up to a maximum of 600mg daily. I'm presuming he feels the pregablin may be more effective, but there was no mention of tapering down the gabapentin to start the pregablin. I know I should have asked but there were so many changes made during the appt, I did not think at the time.

  • Hello

    visit NHS Choices, to check contraindications

    All the best

    BOB

  • Thanks Bob, I will have a look.

  • Hello Again

    You live in a nice area,we nearly purchased a house near Rattray an Alyth

    BOB

  • Yeah I like it here, born and raised in Blairgowrie. Tried city living for a while but soon came home again.

  • Hello

    There are a couple of you up there you should have a chat.

    We hope to come up in the near future we visit Rait, the castle there. We lost our first dog and the memories were very painful so have not been back for a while, will possibly bring our Welsh Collie up as memories of Pip are now not as strong, Pax will love it

    All the best

    BOB

    Berwick on Tweed

  • Bob. I am sorry to hear that. I lost one of my dogs just outside Blairgowrie, she ran onto a frozen loch and fell through the ice and I could not get Callie out in time, when I did get her out it was too late. It was the hardest thing I have ever had to go through in my life and I no longer go back to that loch, I know painful memories linger a long time.

  • Hello charles

    It is a nasty thing when you loose your dog,mine worked as a pat dog in mental health.

    Died of cancer from car brake fluid getting into toe ended up in lungs, a great loss also

    Keep a hold

    BOB

  • Hi I have very recently had to change from Gabapentin 300g 2 four times a day to Pregabalin - i then found it had n difference so had to change back. I have been taking Gabapentin for 6 years now. I had to go through alot of pain to do this as yes you do have to gradually reduce the Gabapenin and then introduce Pregabalin and gradually increase that the decease and increase had to be done every 2 - 3 days so as you can imagine you are in quite a bit of pain whilst you do this. Unfortunately there was no difference so i had to go through the same process again and am now back to my Gabapentin! Hope this helps

    Julie

  • Hi Julie. Thanks for this. I checked and they want me to switch right over, although they say no real studies have been carried out. I took my pregablin last night and this morning, no ill effects yet, but I wonder if I may start seeing any withdrawal effects from the gabapentin, my last dose of that was 24 hours ago. It's a minefield. Thanks for the reply.

  • Hi charles 2703, i have changed fron gaberpentin to pregabalin 4 x 150 2 in morning and 2 at night, I have had no problems, i did change at a lower capsul first i cant remember how much, but that is what i am on now i also have a fentanyl patch x 75 and tramadol when needed, best wishes

  • Hi kneesup. Thanks for the reply. Has the pregablin helped? My pain doctor also mentioned the fentanyl patch, but feels that my 30mg of MST three times daily is comparable? But I have heard some people get on much better with fentanyl.

  • i could not bare to be without my fentanyl patch, i did not find any difference between pregabalin and gabapentin, good luck and best wishes from knees-up in kent.

  • Hi Charles, I have found that the pain clinic doctors have a habit of telling me to just stop or just change medications, I have a really great GP who I see after the pain clinic and he tells me exactly how and when to do these changes so I would go and have a chat with yours. good luck

  • Hi Vivikin. I agree, I think pain doctors just have to take a bit of a stab in the dark as to what might work, the guy I saw last week told me so as its so complex. I'm not sure what to do next, he changed my MST from 40mg twice a day to 30mg three times a day. As usual with a change I feel better for a few days then it goes back to the way it was, that seems strange to me. I'm just hoping the pregablin may help as I will be on a higher equivalent dose to the gabapentin.

  • Hi Charles is your pain nerve pain? mine is, I have had a trial of Lidocaine, have you heard of it? I am seeing my pain man tomorrow to talk it over so I will let you know what he says, at the moment I take pregablin, amytriptiline, and co-codamol, but I have real problems remembering things and twitch quite a lot when im relaxing, all this and still in pain, very hard to stay positive, I do find talking to others on this site makes you feel less alone.

  • Hi Vivikin. I have the Versatis patches, they have lidocaine in them, you wear them for 12 hours then you need to take them off for 12 hours. I know that some people get lidocaine injections but not sure how effective they are. I'm not sure if mine is nerve or muscular pain (the pain clinic thinks its both). I do not get shooting or stabbing pains, just the constant ache and muscle spasms which are awful. I'm sorry to hear that you are struggling to remember things and suffering twitching ( I think both are quite common with pregablin / gabapentin. I have been lucky and not suffered side effects from gabapentin, just changed to pregablin last night and no side effects as yet. In your case, it may be the amitriptyline giving you those side effects, I take norotryptiline which is supposedly the same drug but does not come with the side effects. Good luck for your pain appt tomorrow ( is this the first time you have been seen?) charles

  • hi Charles i have been going to the pain clinic for nearly 3 years, they found a cyst on my spinal cord so had an op and still im in pain so its possibly nerve damage, ive had all sorts of treatments from injections to a spinal cord stimulator trial none of which have made any difference but I did have a lidocaine infusion about 3 weeks ago and that's what im going to talk to him about tomorrow to see where I go from here, thanks for your good wishes I will let you know how I get on. kind regards Viv

  • Hey Viv, did the lidocaine help you at all, or is it one of these treatments that you need to have a few before you can tell if it works. Please let me know how you get on at the pain clinic and I really hope they come up with something else which might help you. I will keep everything crossed for you.

  • Hi Charles, when they changed this site, I lost all my info and have only just tried again and have managed to find you again, my second Lidocaine infusion didn't work so I have just had a Ketamine infusion on Tuesday, I had the most awful nightmare whilst it was going through although I was heavily sedated to try to avoid that happening, I didn't come round as quickly as with the Lidocaine but anyway it seems quite good so fa,r although it did upset my system a bit I am ok now and not in any pain, so now I have to wait and see how long it lasts, and if it lasts for a few months my pain doctor says I will be able to have it twice a year, so as always I have my fingers crossed.

    how are you doing? I hope you are well and have been enjoying the lovely weather we are having, and I hope you are pain free. love Viv x

  • Hey Viv, sent you a private message. I hope you get it x

  • According to the book Bad Pharma by Ben Goldacre ISBN 978-0-735074-2 on page 68 it says:

    "for example in the five trials on pregabalin and pain, lots of people dropped out during the study period.

    He then goes on to say:

    "....We know, after all, that people dropping out are more likely to have done badly on the drug.

  • This is interesting. I know lots of people who really struggle with either gabapentin or pregablin, some of the side effects are scary. I do believe there are other drug they can try, but cannot recall the names. Thanks for the info John.

  • A couple of years ago my pain specialist switched me from Gabapentin to Duloxetine (Cymbalta or Xeristar). With the cocktail of morphine and co-codamol drugs it is difficult to know which one is most effective.

  • What's the difference in the two.and why do they change us from gabapentin to pregablin ,I've been on both my dr doesn't say what the difference was in them I was just told to try them,an now I feel like they make me forget things,and don't no half the time where I've put stuff .

  • Hi Blacky, I asked this very question to a neuro specialist apparently they bind to different sides of the neuron. Goodness knows what they means, presumably it's a subtle difference which for some people they can achieve better results, others don't notice nay difference.

  • Hi Charles. Is there much difference in these two drugs,I take pregabalin 200mg twice a day, I am still in a lot of pain,seeing my GP soon about pain control. I believe you live in Angus ,i also live in that area ( Barry nr Carnoustie ) it is a lovely area I moved here recently ,my home is Skye. Sorry about your dog,my last dog was a welsh corgi unfortunately I cannot have a dog,cannot walk very well. Getting back to pregabalin ,I missed 3 doses ( my own fault) and I was or felt very anxious plus plus husband stayed home from work I was so bad but if both drugs are similar then changing should not be a problem. Good Luck

  • Hey Priegi. I live in Blairgowrie so not too far, I went to Ninewells for my pain consultant review, I would ask to be referred back pretty soon (they have been given funding to run weekend clinics to clear the waiting lists in the area so the list should be much shorter). I have to say I have not noticed much difference to the two drugs to be honest, but I do not get the classic nerve pain symptoms. I had absolutely no problem with the switch, no side effects whatsoever and I switched straight over. Are you thinking of trying gabapentin? I know some people prefer gabapentin to pregabalin. I have also been out on norotryptiline as this is meant top work well together with the pregabalin. Is your pain localised to one area? If so I have had some good relief from Versatis patches, you may have tried them before. Get to your GP and see what he can do to help you, it's so horrid to hear when people cannot walk very far. Best wishes xx

  • Sorry , I forgot to ask you what kind of pain if not nerve, I get a lot of pain in my lower back,and my legs. June

  • Hi Charles ,I was a nurse for all my working life,over the years I would get lower back pain,and spasms that put me off work from time to time one of the GPs I worked for told me I had Spurs,as I thought ok alright lets get on with life.but in the last few years things have got bad, I told the doc in Perth (I was going to be in a wheel chair before the year was out) not quite but I really need one now for going further than a very very short walk. A friend gave me an electric .buggy which I have used a few times. I hate it but that's life. I have never been to a PAIN CLINIC, I must suggest that to my new GP though I am scared about change but I badly need it . I was recently on a med cruise getting about the ship was very very hard,they gave me a wheel chair which helped when going ashore which we only did twice it was easier to relax in the sun,we had the cruise because we thought it would be easier for me,not really it is easier sitting in my chair at home . So much for my retirement ,still I shouldn't complain there a folks worse than me. Will let you know how I get on with my GP it's a new practice plus GP.lets hope they understand PAIN. JUNE (peigi)

  • Hello, I quit Gabapentin as fast as I could because it made me very depressed and quite hostile (eek!). I think it was a good painkiller though, for me way better than Pregabalin. Gabapentin has been around for years, but Pregabalin (developed to have fewer side effects than Gabapentin), has I believe only been around for about ten years. If I were you, getting no side effects from the Gabapentin, I would stick with it. Remember GPs have no training in managing chronic pain. and Pregabalin is quite fashionable these days. I was told to come off the Gabapentin slowly. I didn't replace it with Pregabalin because for me, it puts on loads of weight. Not good for pain to carry extra weight! All the best. If in doubt ask to go to a pain clinic.

  • Hi again Bowbells, I have not noticed any difference between the two so part of me think I should just go back on the gabapentin since it is cheaper to prescribe. Sorry I should have said I was asked to switch by the pain consultant to see if it would help, so I switched almost 4 weeks ago, it maybe too early to decide which one is best? I still not sure what's causing more pain, the nerve pain or the muscle spasm? It's a million dollar question.

  • Dear Charles, I think you must do what you feel is right. I personally did not find any delayed effect of pregabalin, but maybe others do? Re. nerve pain vs. muscle spasm: whichever you have where is less important, in my view, than reducing your total pain load.To find out is a pain is muscle spasm, poke your finger into the flesh whefe it hurts. Muscle spasm will give a dull soreness, nerve pains will be shooting and/or electricity like. Good luck, Bowbells

  • Hi Bowbells, thanks for the reply. I had heard that gabapentin eased muscle spasm but not sure if pregabalin is the same. I will certainly try your tip on trying to determine if its muscle or nerve. I know when I cough I get a sharp pain in my spine, but this may be to do with the disc tear. Why are back so complicated :-(. Thanks again for the reply. Much appreciated

  • Hi

    I was on Gabapentin for 2 weeksbefore the side effects became so disturbing that I had to contact my Dr. who put me on Pregabalin at a lower dose, so far the side effects have been very mild tingling in hands and face.

  • you can't just change straight over have to reduce gabapentin & gradually get introduced to pregnabalin as you further reduce the gabapentin then they up the pregnabalin ,ihave not had side effects from either of them.

  • Hi folks! New to the site but have found this discussion very interesting! Ten years ago I had fusion peformed on my neck - titanium plate screwed across C5/6/7 with bone from my hip through the discs - the whole lot has now solidly grown together. Last year I started having the same problem with megapain in left shoulder and arm with little finger and one next to it going dead on left hand. I am currently on 3600 mg a day of Gabapentin - 4 x 300 three times a day. Amazingly, I have had few side effects but notice that brain is getting a bit foggy and blurred vision on times - I guess depression goes with the amount of pain. I also take two Paracetomol twice a day but I still have lots of pain! The hosiptal told me yesterday that there was nothing that they could do surgically - no obvious spinal pinching as before - and I am being referred to the Pain Management Team. Fortunately, I know the specialist as he killed some nerves in my lower back two years ago - another story! I was on Butrans patches and tramadol prior to those two operations. So, he may well tell me to change to Pregabalin as it does provide similar pain relief at much lower doses according to all the medical sites that I have looked at! He may also suggest patches again as he put me on them last time. I have Tramadol in for my lower back problems and was on Amitryptiline prior to Gaba for the arm pain! Any thoughts or updates on your experiences would be welcome!

  • Hi there, I have done the revers having switched from Pregabalin to Gabapentin - I did not get on with the Pregabalin at all. Not to say you won't - but the switch was easy - I was slowly taken off one and switched over the other - am personally worried about long-term side effects as I take a lot of Gabapentin - am taking 7 x 300 and trying to get me to 8 but it is a slow process. Hope it goes well for you? I am interested to know about other medications you take with the Gabapentin and if they help you - I have Fibromyalgia and neuropathic pain from a cervical spine injury so any tips would be great thanks Susan

  • hi Susancar, just noticed you are suffering pain relating to a cervical spine injury. My husband did a forward roll in february at BB and thot he had suffered a whiplash type injury. Now he is in constant pain and despite numerous appts with physio, chiropracters, gps and going private for a MRI which came back clear, he still hasnt received a diagnosis. At the minute he is on Lyrica (Pregabalin) only 50mg twice daily. He is in a lot of pain with sore fingers and numbness in a few toes. He is waiting since August for appt with pain clinic but we are attending a private spinal consultant this week. Did your injury show up on a MRI?? ever had any of the symptoms he is having??

  • I too am switching from the same dosage of gabapentin to 150 milligrams of Lyrica per day. I have tried lyrica because my mom takes it but, at the same time as taking gabapentin. I find that the gabapentin over a period of time has affected my long term memory and short term memory. In which I am finding a little frightening. I am hoping that lyrica will not be the same way but as far as the way it works I am finding that lyrica works the best. It gives me alot more relief from neuropathy pain on my feet at night caused from post-operation on my back going from back to back surgeries (no pun intended), all within a year. My numbness seems to be getting worse, and the pain is off the chart from a "from 0-10 scale". I hope it all works out for you. Good luck.

    P.S. I also have experienced withdrawal symptoms similar to that of someone withdrawing from opiates. Has anyone else gone through this?

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