I have PLMD. I'm currently on 1800 mg of Gabapentin, but it's breaking down and both PLM and shortscale sleep sequence increases are making the nights intolerable. I'm able to move on to a Buprenorphine patch. Do I need to withdraw completely from the Gabapentin first or can I withdraw from it whilst wearing the patch? And what should be the dosage amount of the Gabapentin withdrawal in either event? Thanks in anticipation.
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Check with your doctor, but I can't imagine that you would need to withdraw from the gabapentin before starting the patch. You do need to withdraw from the gabapentin slowly though to avoid withdrawal symptoms. I am confused though by what you mean by the gabapentin is breaking down. If you mean it is no longer working, do you take it all at once or in 3 doses 2 hours apart? If you take more than 600 mg at one time, the effectiveness can drop off as it is not absorbed much above 600 mg. If that is the case I would suggest you try taking 600 mg 2 hours before bedtime, then 600 mg 2 hours before that and 600 mg 4 hours before that. You only need to try it for say 3 days to see the effect. If it still doesn't help then go back to taking it all at once and start your withdrawal by working with your doctor on a withdrawal schedule. If done slowly you shouldn't have any withdrawal effects.
I had the exact same problem a week ago. I asked Dr. Buchfhurer for advice. He said you don't have to taper off to start with the buprenorphine patch (I have 5 micrograms per hour). You should try to see if a low dose of gabapentin before bedtime might help you get through the night better. Sometimes staying asleep is a problem with buprenorphine. So gradually reduce most of your dose of Gabapentin afterwards, to prevent having side-effects from gabapentin, and maybe reduce it to zero.
Thank you, mipi. Your experience with both is reassuring.
Hi mipi, Are you taking gabapentin to help you sleep more soundly on buprenorphine? I sleep very lightly with the buprenorphine patches and would love to have something that will help. Can you please tell me more?
Hi restlessstoz, sorry I did not follow the chats last days.I was too busy with getting accustomed to buprenorphine myself. A hard job, because the dose of 5 microgram per hour was not enough for me, my pain escalated sometimes, so I got the double dose from my GP, another plaster of 5 microgram.And it had a lot of side effects, like dizziness and nauseousnes. But it gets better now.
About the gabapentin: I was, like you, on it when I started the buprenorphine, for 900 mg in a day, 300mg morning, 300 at 15.30 hour, and 300 around 21.00 hour. And until now I kept all the dose, because otherwise you do not know what causes what.
And I must say, until now I slept fairly good on it, except one night, when I worked too hard in my garden.
I asked, like I told you advise from dr. Buchfuhrer what to do with the gabapentin. He said It could help you sleep better if you also take some gabapentin for the night. But do not take more then necessary, because Gabapentin also has its side-effects.
So until now, I did nothing, because I want controle of my bupenorphine first. But my plan still is: leaving the first to portions out slowly. I am lucky I have only pills of 100 mg, Like 200 300 300; next day 200 200 300; 100 200 300; 100 100 300.
But what did you do until now? You had a much higher dose than me. You left the gabapentine out already?
Hi mipi, I went off gabapentin about two years ago now. I reduced really slowly but was also weaning off pramipexole and antidepressants. it was a nightmare. But, more from the pramipexole than the gaba I think. Now I am in a much better place, if only I could sleep more deeply and I'll see if my GP will agree it's worth trying a small dose of gabapentin to see if it helps. Good luck with your journey. (by the way, I'm on 15mcg patch.)
DId you start on de bup dose with 15 microgram? That seems high for a start...But watch: gabapentin takes about 3 weeks to work real good.
No I started low and when they didn't work completely moved up. I've been on the same dose for two years now which is what they say, once you've found what suits you.
I agree with Sue and mipi. I am on a buprenorphine patch too. Like mipi on 5mcg/h, which is very low / the lowest dose.
Hi LotteM, can you see my reply to mipi above and give me your advise too, if you know anything... 
Hi restlessoz, I am sorry I cannot advise you from my own experience as I do not get the insomnia on t je buprenorphine. On the contrary, I haven't slept this well and ling in many many years. Even regularly during the day. You may have read that the drowsiness and brain fog are aide issues of bup that bother me.
Have you considered reducing by cutting a small part off the patch?
Have you tried and can you try cbd oil? Otherwise I really don't know what to suggest. Sorry not to be of much help.
Thanks LotteM. I would consider reducing the dose but it wouldn't cover the symptoms and I would be awake with legs instead! Never mind, I will experiment with the gabapentin if my GP agrees and see if it helps. I'm one of those people who've never found sleepiness to be a side effect of anything, even general anaesthetics. Once I'm awake from the recovery, I never sleep again until the next night. Thanks for answering LotteM.
I know this is not what you asked. But if you can try Dipyridamole, it took away my RLS and as a side effect it took away my PLMD! You know PLMD is NOT voluntary. I have no control over it and yet it is gone. Even during the day! I take 300mg once a night about 2 hours before bed on an empty stomach. Good luck You can read about it here. It explains the mechanisms involved.
ncbi.nlm.nih.gov/pmc/articl...
Many thanks for this. It confirms anecdotal accounts I've read about Dipyridamole in respect of RLS. It's good to know that it has beneficial effects in respect of PLMD too. I did run the possibility past my consultant, but he said that he had neither experience of it nor knowledge of its role in the battle against RLS/PLMD. If the Buprenorphine doesn't work out for me, I'll mail him the attached data. Again, my thanks.
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