I have been prescribed and have been taking 600 mg of gabapentin 3x daily that has been successfully controlling my RLS for some time. I take it at 5 pm, 6:30 pm and 8 pm before getting in bed around 9. For the past couple of weeks this dosage and routine have not been working well, and I’ve had breakthrough RLS that continues well into the night.
How much Gabapentin is a typical dosage? Is it unusual for it to stop working and need to increase dosage? If I were to increase would 2400 mg total be too much? I’ll be seeing my doctor next week to discuss and worry that he may want to switch me to one of the problematic drugs that cause augmentation
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No matter what don't let him switch you to ropinirole or pramipexole. You should take your 3 doses at 4:00, 6:00 and 8:00. Try that first. If you increase your dose, add 100 mg at 2:00 every couple of days. Since that gets kind of ridiculous, you would be better off to switch to pregabalin where you don't need to divide the doses and can take it all at once at 8:00. The gabapentin dose is divided by 6 to get the pregabalin dose, so 300 mg pregabalin equals 1800 mg of gabapentin. Then you would add 25 mg every couple of days until you find the dose that works for you. However since it was working, it is likely that you started taking another medicine or over the counter supplement recently. Did you? Or did you start doing something differently like exercising more vigorously or drinking coffee or any number of things including eating something you didn't used to or otherwise changing your diet or taking magnesium within 3 hours of the gabapentin?
Hi Sue,Well, one of my doctors slightly increased my dosage of venlafaxine, but that happened a couple of months ago, at least, with no issues until now. And I do take magnesium every two or three days, but I do really try to make it 3 hours before gabapentin. I know I may have slipped up on that once or twice, but definitely not every single day I’ve had breakthrough RLS. I’m more than willing to stop the magnesium if it will help.
No reason to stop the magnesium. Venlafaxine is an SNRI antidepressant which can exacerbate RLS symptoms in some although I would have thought it would have affected you before now, To be safe you could switch to Trazodone which is safe for RLS and actually improves symptoms in a few.
You're at a reasonable rate already. I don't think upping it will do much good.I would be looking at what changed for you when the new attacks started.
Hiya. I have had the same. I am taking 2100mg Gabapentin, and am now getting breakthrough RLS during the afternoon - and it still takes me an hour of "shuffling" before I get to sleep. Am also dead as dodo in the morning, which does not help.
So I have resorted to going back to taking 0.125mg Ropinirole at night. And I know everyone will berate me for this, but I can see no option.
I have an appointment with the Neurology Hospital specialist for RLS in London - but not until February 2023 ....
Venlafaxine (Effexor) is a nasty character - efforts to get off it are met with discontinuation syndrome - like augmentation on DAs - a worsening of the depression. If needed, look into "Prozac Bridge" as a therapy to getting rid of Effexor.
I've been on 1800 mg of gabapentin and it is becoming less and less effective. I also don't like the side effect of feeling stupid and having my short term memory impacted. I don't know if my RLS/PLM is getting worse or the gaba isn't working as well as it used to. In any case I'm going to give the low dose opioids a trial run.
I assume you are taking your 1800 mg in 600 mg divided doses, one 1 to 2 hours before bedtime, one 2 hours before that and one 4 hours before that since it is not well absorbed above 600 mg? If not, try that and you will find you can probably reduce your amount, or it might begin to work again. If you are another one to try is dipyridamole. It has helped many people on this forum and has completely eliminated RLS in some. In the winter 2022 edition of Night Walkers, the publication of RLS.org there is an article by Sergi Ferre about dipyridamole discussing the effectiveness of it in a 2 week double blind placebo controlled study showing it completely ameliorated all symptoms. The study was by Dr. Garcia Borreguero movementdisorders.onlinelib...sciencedirect.com/science/a...movementdisorders.onlinelib...
Thanks Sue, I do take the gaba in 3 doses of 600 mg each separated by 2 hours. I've played around with the timing to find out what works best. I just talked with my sleep doc last week and he didn't seem to keen on dipyridamole, noting that the studies to date have been rather small. He said he was willing to have me give it a try. My great reluctance is that it increases clotting time which can lead to increased bleeding. I spend considerable time in the remote wilderness and don't want to risk an injury with bleeding that is hard to stop. For now it remains an option. I am a member of RLS.org so I did see the article.
Not sure why no one is mentioning this, but when I was started on gabapentin my neurologist explained that I will build a tolerance over time. If that’s true, it doesn’t seem like waning efficacy should be a surprise to anyone. At the time, I asked if, when the tolerance was eventually built, I could get off gabapentin for a while and then go back to it in time, with its effectiveness restored. The answer was “no.” He explained that somehow the drug would be stored in my liver or kidney (sorry I don’t remember exactly what he said, but because it wasn’t making sense, there was no actual understanding). The gist was that my body’s processing of the drug would eventually and forever render the gabapentin useless. But that eventuality is in the distant future-especially because I found relief with such a low dose. It’s just weird because the people on the site are so knowledgeable and if no one else is mentioning the possibility of building a tolerance, perhaps what I was told isn’t accurate.
According to Dr. Buchfuhrer's website rlshelp.org, "The effectiveness of this medication (gabapentin) often diminishes after one or two years". I used it successfully for a few years and it stopped working.
I contacted Dr Buchfuhrer and asked him: You say on your website that the effectiveness of gabapentin often diminishes after one or two years. Do you still believe this? He answered: " I have to admit that I have not kept that page up to date and that info is most likely incorrect."
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