Pregabalin: increased side effects with increased dosage?

[dickJones]

I've been on 450 mgs of Pregabalin for a year. It's been pretty effective in suppressing my PLMs to about 2 a night, but the price has been considerable weight gain. Recently the severity of the PLMs has intensified somewhat and the number of flexions outside the roughly 6-hour half-life of the dosage has increased. It's probably a silly question, but would the weight increase again with a titration of 50 mgs to 500 mgs?

[Hidden]

If weight gain is your only concern, then i don't think an extra 50mg would make a big difference. From what I've read of others experiences, weight gain on pregabalin tends to happen quickly (ie first few months) and then level out.

Weight gain aside, 500mg of pregabalin is a particularly high dose. I'd question it's effectiveness if you're needing to go that high.

It works well at 250 to 300mg for my PLMs (recorded at 64 per hour unmedicated). Even at that dose, the side effects are considerable. Have you considered adding a low dose of another medication so that you don't need as much pregabalin?

[dickJones in reply to Hidden]

Hi, Amrob. The dosage increase notion was just speculative. I'd rather not bump it up a further 50, but some action is clearly necessary because the PLMs are becoming more severe. Yes, it's a high-ish dosage, but 600 isn't unusual. However, the side effects are an issue, notably the weight gain and what might be Pregabalin-based mild memory loss.

Re other meds, I'm pretty much at the end of the line, having gone through most of the standard go-to options. What I'll most probably do is back out of the Pregabalin and titrate Gabapentin up to 900 mg (which I was on a year or so back) in the somewhat insecure hope that it might work again. In any event, I'm hoping to get an appointment with a PLMD-friendly neurologist so maybe I'll get some informed advice as to what to do next.

Many thanks for your thoughts. All the best with your treatment.

[Hidden in reply to dickJones]

Thanks for your well wishes dickJones. To be honest, I have never heard of anyone taking 600mg of pregabalin for RLS. In fact, 450mg is the recommended maximum dose.

pubmed.ncbi.nlm.nih.gov/322...

I'm wondering whether it's gabapentin you're thinking of, where doses are approximately 3x that of pregabalin.