Gabapentin augmentation??

[SS26]

I just joined this forum. I have had RLS for about 40 years. I have experience augmentation with Requip. I have been taking gabapentin for about ten years. Has anyone experienced augmentation with gabapentin? If so, did you stop the gabapentin? Did you increase your dose?

[Hidden]

Hi, I'm not the best person to answer your question, but I just happened to be online for something to do, it being 4.25 am and given up on sleep.

I'm sure others will give you a better answer.

I've only been taking Gabapentin since August 2018 and only a relatively small dose. I'm also still on Pramipexole as yet.

I have read that the probability of augmenting on Gabapentin is less than for a dopamine agonist. However, I've also read that it's more likely if you've previously augmented.

Another factor is possibly, if you were going to augment on Gabapentin then it would have likely happened before being on it 10 years.

I KNOW that be very definition, if you are suffering augmentation, you do NOT increase the dose. This will make it worse. You need to reduce or even stop.

Befote you consider this, perhaps you need to check if this really is augmentation and not just RLS getting worse as you're getting older. There is a link on here somewhere.

[SS26 in reply to Hidden]

Thanks for taking the time to reply. The dosage of gabapentin that I take is very small (300 mg) at night. I did stop taking the gabapentin for a week. RLS was still bad. Sleeping is becoming a thing of the past . My legs have become very painful at night which is different from just the urge to move them. So I agree as much as I don't want to that the RLS is getting worse. Unfortunately I couldn't find the link that you sent. If you can please try again.

[Hidden in reply to SS26]

Sorry, I didn't send a link. I thought someone else would be prompted to do it.

However, here it is.

rls-uk.org/news/augmentation

I believe augmentation is present if

a) symptoms become more severe

b) the time between when you stay still to when symptoms start gets shorter

c) they start to occur earlier in the day, not just in the evenings.

300 mg does seem a low dose. I too take 300mg, but I take it 3 divided doses and originally it was for nerve pain, not RLS.

Even at only 300mg, you shouldn't stop taking it all suddenly as this will increase the risk of withdrawal symptoms.

The possible dose for Gabapentin for RLS I believe, can be significantly higher. I recall reading 900mg at least somewhere.

Please don't take my word for this, and, of course, you'll have to consult your doctor.

Something else to think about -

I am always curious when someone says they have pain with RLS. Pain is a very subjective experience. I have never experienced what I call pain as a result of RLS. However being a philosophical sort of person, I'm aware that what someone else experiences something they call "pain" it might be qualitatively different from what I experience. If I were to have the same experience, I might not call it pain, or vice versa.

In recognition of this I have adopted this definition of pain,

"Pain is whatever the experiencing person says it is, existing whenever and wherever the person says it does".

McCaffery 1968.

So you DO have pain.

However, I usually suspect, when someone says they have pain DUE to RLS that it might actually be due to something else. It will only be due to the RLS if it follows the same circadian pattern. If it doesn't it may be some other neuropathy.

[Hidden in reply to SS26]

Hi SS26, i think being Easter members are probably busy with family hence you not getting many replies. I dont come on here as much as i used to but decided to have peek today. The only certain meds that cause augmentation are the dopamine meds and rarely Tramadol, your dose of 300mgs is very low. It could be that your RLS has progressed as it usually does over time, so that low dose might just not be helping any more. As regards the pain, i can only say my experience, i used to get the creepy crawly sensations with my RLS then a few years ago they stopped and i get pain, like a deep aching pain in my calves but only if my RLS is present, so that can be at night if my meds are not helping and during the day IF my RLS is present. Pain with RLS is now accepted. I would suggest seeing your doctor, discuss with him/her your new symptoms , see whether your pain could be from your RLS and the Gabapentin not helping now, or you have something else going on.

[SS26 in reply to Hidden]

Thanks for taking a peek today. I have several autoimmune disorders, so I have always tried to keep my meds at a minimum. It could be as simple as just increasing my gabapentin. My prescription is for up to 900mg a night. The pain is present in my thighs. I don't have the creepy crawly sensations like I use to. It is more severe tighten of the thigh muscles and they just won't relax. I am concerned that I again could have something else going on.

[marsha2306]

I’ve been on it for 4 years.....no issues.

[Joolsg]

Hi SS26

Did you get off Requip completely?

If the only drug you are now taking is Gabapentin (300mg) then I doubt it’s Augmentation. It’s more likely to be progression of the RLS and you may need to review your meds with your doctors. 900mg is the usual dose for RLS so you could try slowly increasing the dose and monitor the effects or you could add another med at low dose. 2 meds at low dose often work better then one med at a higher dose.

Also check you aren’t taking meds that worsen RLS like most anti depressants and anti histamines and cough meds and finally- ensure serum ferritin levels are above 100.

[SS26]

I have been off Requip for about 10 years. I started taking 300mg of gabapentin mid afternoon and then another 300mg at about 10:00pm last night. I also too 500mg of Naproxen for the pain. I slept about four hours last night which is good I just had my ferritin checked and am waiting for the results from my gastro. It's interesting about your comment that two different low dose Meds do better than increasing one. I will have to discuss this with my dr. Thanks so much for taking the time to respond.