I have had rls for many years. I saw a neurologist for the first time at Newcastle (UK) last November, and she prescribed a low dose of Gabapentin (300mg) and iron infusion. After 6 weeks the iron infusion kicked in and virtually stopped the rls.
However, I’ve started a bout of water retention, which makes my legs uncomfortable and I think is starting the rls up again. I’ve had water retention previously and Furosemide helped. Has anyone used this with Gabapentin?
Yes, diuretics can exacerbate RLS, but are sometimes a necessary evil.
Beyond this, according to the BNF both Furosemide and Gabapentin can increase the risk of hyponatraemia, a common electrolyte disorder involving low serum sodium levels, so taken together increases the risk.
In that case, NiCE says that a blood test will show if this is a problem, severity classified as follows:
Mild — serum sodium concentration 130–135 mmol/L.
Moderate — serum sodium concentration 125–129 mmol/L.
Severe — serum sodium concentration less than 125 mmol/L.
Unfortunately all diuretics can make RLS worse for most people, but everyone is different and you can certainly try it. It doesn't interact with gabapentin. 300 mg is just a starting dose of gabapentin. According to the Mayo Clinic Updated Algorithm in RLS, most patients require 1200 to 1800 mg. If your edema gets worse you might want to increase your gabapentin. Gabapentin can also cause edema so that might be what is causing your water retention but it would have started probably a month after you started the gabapentin and it usually doesn't affect people until one gets up to a higher dose like 1200 mg, And I don't think once one gets it from gabapentin that it gets worse as you take more gabapentin. If you think it is the gabapentin You might want to try switching to pregabalin. Although they are basically the same drug except you don't need to divide the doses, and the side effects are basically the same, some people find that the side effects that bother them on one don't bother them on the other. If you continue with the gabapentin and try increasing it, ask your doctor for 100 mg capsules and increase it by 100 mg every couple of days until you find the dose that works for you. Take it 1-2 hours before bedtime. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. If you take magnesium, take it at least 3 hours before or after gabapentin or pregabalin as it interferes with the absorption of them. You don't need to split the dose with pregabalin. Start with 75 mg and to increase it you would ad 25 mg every couple of days.
Hi Sue,I was taking 600 about 5pm then 600 2hrs before bedtime,usually about 9pm.I had my ferritin checked which came out at 950.My gp then sent me for a scan which found that I had fatty liver disease. I then changed my diet,cut some things out .Unfortunately after my last test my gp said my ferritin is normal but did'nt get the reading.
I kept a food diary for a while but couldn't see any link between any particular food and a bad night.As I do quite regularly do walking,I still get bad nights without exercising. I cannot track a trigger as yet.
I recently tried following the instructions on my prescription, taking 300 in the morning, 300 about 5pm then 600 about 9pm,but still get bad nights.Next gp appointment I am going to ask for some 100 tablets.
I am now seeing a urologist about urinary problems which I have also had for many years.Has anybody noticed or found any links between this and RLS?
Thanks again Sue.
Hyponatraemia is an uncommon side effect of gabapentin and pregabalin so I wouldn't let it dissuade you from it nor bother would a blood test unless you have symptoms of it or you do decide to take the Furosemide and then it might be a good idea.
Thankyou both, I will try and do a bit more gentle exercise/reduce salt and see if I can manage it that way, before going for Furosemide.
I have edema because of a higher dose of gabapentin - 1500 mg and my doctor told me to drink lots of water. That seems counterintuitive but when your body is not hydrated enough, it holds onto the fluid it already has to make up for the lack of incoming water, thus contributing to swelling.
Hello Edengirl58. There are 2 supplements I use for water retention, uva ursi leaf and buchu leaf extract. They are not as strong as a prescription drug but I find they work pretty well.
Hi I also live close to Newcastle and suffer from RLS.Were you sent by your gp to see the Neurologist or did you go private.What was her name and did she have any knowledge of RLS. It's a low dose of gabapentin which made me think she wasn't too clued up on RLS?I'm already on 1200 and still having bad nights sleeping.
Thanks for all the ideas which I’ve noted down. It seems to be settling with gentle exercise- I have long covid and haven’t been able to do any for a while- though that is slowly improving at last.
My GP was initially reluctant to refer me but I pushed. I saw Claire Bolton at Newcastle hospitals foundation trust under NHS in November, but she said she was moving jobs. She seemed clued up - I went ready with a copy of Mayo algorithm but didn’t need it. I think 300mg Gabapentin is recommended starting dose for my age (64), and it certainly made the rls less aggressive. She also arranged an iron infusion which I think is helping.
Am going back on 1st March (strikes permitting) for a review, so can let you know who I’ve seen and how they are. Same department- neurology- so I’m hoping they are all on the same page.
Are you taking 600 mg of gabapentin 1 to 2 hours before bedtime and then 600 mg 2 hours before that? If you are taking it all at one time, it won't work nearly as well as above a dose of 600 mg, it is not well absorbed. Also, According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin daily." Ask your doctor for 100 mg capsules and increase it by 100 mg every couple of days until you find the dose that works for you.
Some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium, foods that cause inflammation, ice cream, estrogen, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, stress and vigorous exercise. Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, using a standing desk, listening to music, meditation and yoga.
Many medicines and OTC supplements can make RLS worse. If you are taking any and you list them here, I can tell you if any make RLS symptoms worse and if so may be able to give you a safe substitute.
To Infuse or not to Infuse
lab work 8 weeks post iron infusion - advice?
Iron Infusion in the U.S.
Infusion how long to "kick in"? Hehe. 
