Gabapentin

[Bean49]

I have come completely off ropinorole after augmentation and have been taking 3 gabapentin a night for 3 weeks. I take 2 at 7.30 and 1 at 9.30. I generally go to bed about 10.30. my legs are fine in the evenings but I have been waking up with restless legs at 1 - 1.30 and have to get up for 1 - 3 hours until they settle. Is this likely to get better as I get used to the tablets? I tried taking an extra one a couple of times but it didn't seem to make a difference. Can anyone advise a method of taking the tablets, maybe all at once or at intervals please?

[Madlegs1]

You don't indicate what strength those tablets are? 50, 100 or 300?

Gabapentin should be started low and titrated upwards until adequate relief is aquired- 80%control.

It generally takes about 3 weeks to be fully effective.

Avoid taking any magnesium medication, including antacid type, within 2 hrs of the Gabapentin.

Depending on who you talk to, 900 to 1200 mg of Gabapentin per day is the max dose for RLS, before unwanted side effects become bothersome.

Cheers.

[LotteM]

Good reply and relevant questions from Madlegs.

Additionally, you may still be suffering from withdrawal since stopping the ropinirole. It that case, it may be you 'simply' have to wait a little longer and/or try a larger dose or aak to have a painkiller added temporarily to overcome the withdrawal period.

[Hidden]

Just to second what Madlegs and Lotte say.

If you've only been on gabapentin for 3 weeks then it may not have reached full effect yet.

If you only stopped ropinirole 3 weeks ago, you may still be experiencing withdrawal effects.

If you're only taking 300mg it probably isn't enough. You can increase by 100mg a day, (or 300mg in 3 days).

There is probably no point in splitting the dose until you're taking at least 600mg. You can then as near as possible split the dose into thirds of the total dose. Take 1/3 earlier and 2/3 later, not the other way round.

I'd also suggest that you decide how much sleep you'd be satisfied with and when you'd like to wake. This would then give you some sort of target or gaal to aim for.

Also have short term goals and a long term goal. It's no good having the goal of sleeping 8 hours every night if that's not going to be achievable in a relatively short time. You will get disheartened when you don't feel you're achieving it. Set a goal of sleeping 4 hours and when you've reached that, a goal of 5 hours, and so on

Goals should be realistic and timely. Being able to sleep 8 hours may or may not be realistic. Next week, definitely not. In 2 months, maybe.

Increase the gabapentin until you've reached your first short term goal. If it gets up to 1200mg, it's better to review the situation and consider switching to pregabalin.

Also, as mentioned, a good tip is to think when would you be happy to wake? 2am is the worst possible time to wake. 7 am may be unrealistic at the moment, so 4 am may be a compromise ( for starters). If your goal is to sleep 4 hours and wake at 4 am then go to bed at midnight! Take the gabapentin 9 - 10pm.

I find rebound, which occurs with dopamine agonists isn't as much of a problem with gabapentin.

For example, I've always been a night owl, irrespective of RLS. I'm retired. I aim to get up no later than 9am, I'm happy to accept to sleep 7 hours. I therefore aim to go to sleep by 2 am. If I aimed to get up at 7 then I'd aim to go to sleep by midnight.

I hope this helps, managing RLS isn't just about the medication.