Gabapentin dose.

[Madlegs1]

I wrote to Dr Buchfuhrer concerning the effective dosage for Gabapentin being used in an RLS setting.

This is the correspondence.-----

"I have searched your site, but am unable to find an answer to my question.

What is the highest effective dose of Gabapentin specifically for RLS? Given the balance between relieving RLS and unwanted side effects.

(Horizant is not available in my neck of the woods.)

Thank you.

David.

Dr B' s reply--

There is no official maximum dose of gabapentin for treating RLS. Some patients have complete success with doses as low as 50-100 mg but most need doses in the 300 mg to 900 mg range. Often, therapy is limited by side effects which include sedation, confusion, clumsiness, etc. The other limitation for a maximum dose is that gabapentin does not get well absorbed with higher doses (greater than 300-600 mg) and giving more medication most often does not result in higher blood levels of the drug. For that reason, I rarely go beyond 900 mg to even 1200 mg

Horizant was designed to overcome this issue (it is a pro-drug of gabapentin that turns into gabapentin after getting very well absorbed from the gut into the blood).

Lyrica (pregabalin) works on the same receptors as gabapentin but does not have any absorption limitations. You can increase the dose (maximum 300-450 mg) to get maximal therapeutic effect when not limited by side effects (similar to gabapentin).

mjb

[Pam34]

Thanks for that. Particularly the last bit about Pregabalin. I hope I never need to get to those levels but it’s reassuring to know I have got some room to increase if I ever find I need to.

Pam

[Madlegs1 in reply to Pam34]

Just be aware that the higher the dose, the greater the risk of side effects.

That's why Horizant is so attractive.

However, it is not available in some backward countries! Ireland for one!😰

[Pam34 in reply to Madlegs1]

Yep. But just knowing there is room for manoeuvre helps. Even if it’s just in my head 😜

[Madlegs1 in reply to Pam34]

👍😍

[Hidden]

Thanks for this.

It's not entirely dissimilar to what I was thinking myself.

It's always a good udea to keep the dose down to the minimum dose which is effective. I also recognise that side effects are a limitation.

900mg has been stated as a minimum (average) effective dose by other experts. It's difficult to judge when still taking a dopamine agonist. It can alwsys be reduced when the DA is stopped.

I take 600mg now with great effect. When I was still taking 0.75mg pramipexole, I took 900mg and it didn't work.

I note the response you got does NOT say 900mg is the maximum.

What I usually say is if the dose has to be increased above 1200mg then it's better to switch to pregabalin. I'm aware of the inconsistent absoprtion characteristics of gabapentin.

The advantage, I think, of gabapentin over pregabalin is that being less potent it can be titrated more precisely. This is like the difference between measuring in millimetres (gabapentin) and measuring in inches (pregabalin).

Thanks for contacting Dr B, I hope we're now on the same wavelength.

[Madlegs1 in reply to Hidden]

The key is the side effect "effect".!

Also, Pregabalin is a lot more expensive than Gabapentin, which was a factor in my case when the consultant put me on Lyrica initially. I nearly got a heart attack when the pharmacist presented his bill.😰🧐

As a side note, I see that Dr B is moving to Buclac. (Buccal, as corrected by Parminter) as first choice opioid, (after methadone). However, I imagine it will be even more expensive. Not available in Ireland, even though the manufacturer head office is in Dublin.!😆

We're good, Manerva! Cheers.😎

[Hidden in reply to Madlegs1]

Sorry to say I have an advantage in that all my precriptions are free.

You have to recognise however, that for some, medication costs are prohibitive.

When I read some posts from American members, I'm stunned!

[Parminter in reply to Hidden]

Do you mean Belbuca?

[Parminter in reply to Madlegs1]

Madlegs, I can find no information on 'Buclac'.

I assume it may be buprenorphine, but a search finds nothing.

Could you enlarge?

[Madlegs1 in reply to Parminter]

My most sincere apologies, Parminter.

It should be Buccal. It is ,as you correctly surmised, a form of Buprenorphin. A patch that goes inside the cheek, apparently.

The woes of working late at night. Again, my apologies for the confusion.

[Parminter in reply to Madlegs1]

I find confusion to be the proper condition of life. If you are not confused, you are not paying attention.

[Madlegs1 in reply to Parminter]

You are too kind!🤪😎

[hausbauer in reply to Parminter]

Dr. B. prescribes Belbuca which is a film to be applied inside the mouth.

However I take subligual tablets of Buprenorphine 0,2 mg. The manufacturer of which is in Dublin (Indivior). It is really odd that I get them here in Austria and you living in Ireland do not. I have looked up the cost. It is about € 25 for 50 tablets though here we pay for whatever medication € 6,10 . I hope this lasts because of Covid the National Health Insurance for all is in very bad figures.

[Madlegs1 in reply to hausbauer]

Thanks for the update. Very interesting.

[LotteM]

Thanks Madlegs. Very relevant. And concise and to the point. Also the other people's contributions to this post.

[WideBody]

Thank you for this information. I take 900 -1200 per day. I would just like to add that timing seems helpful. I now take the first 300mg about 3pm, then 6 and 9.

It is hard to explain, I don’t use Gabapentin to help me sleep. I do think it helps more with my RLS (twitching) before sleep.

I had some twitch free, although still buzzing inside, nights. I sleep great except for the middle aged trips to the bathroom.

[Netball-50]

Hi interesting reading I as in my posts have struggled but recently ha e started to sleep through the night I'm thi King the 1/4 of a tablet of prami has now augmented out of my body maybe?? I'm taking 1200 mg gaba take 2 at 7pm then 2 b4 bed is this correct and then am I taking too much should I try 900 mg??? Thanks again u r such a help to me this forum again yesterday my GP asking me do I want to go on ropinerole NOOOO for the umpteenth time I've just weaned off prami so no thanks no DAs don't listen 🙄

[Madlegs1 in reply to Netball-50]

The difference between 900 and 1200 is not great enough to make a profound difference. The reason for keeping to these guideline doses is that Gabapentin is not processed very well in the body and at higher doses ,it is excreted, wastefully. And may result in unwanted side effects.

You are correct to resist your GPs pushing of another DA.

You have done a great job in getting off the Pramipexol, now, just to establish what is causing the baseline rls.

Check serum iron, keep a food diary. Watch for triggers- food, drink, medications. Anything!!!😎