Pregabalin to Gabapentin rough ride

[wantokporo]

Switched from 100 mg Pregabalin to 600 mg Gabapentin 8 nights ago. Getting maybe 4 hours disturbed sleep, mostly just shaking all night with PLMD. Pregabalin, after years, was causing nervousness that kept me awake for over 8 hours. My body, in the past, has adjusted to Gabapentin within a week, but I know you don't get guarantees and that this adjustment can take longer. Normally walking around or hot baths or shaking my legs will help but not now. Any thoughts about how to help this transition?

[SueJohnson]

If you haven't adjusted by now it is unlikely you will. Instead to come off it reduce by 100 to 200 mg every 2 weeks or so. If you do this slowly, you will have no withdrawal effects.

[wantokporo in reply to SueJohnson]

Thanks, Sue. I am wondering if it might help to increase the gabapentin by 100mg, although maybe that dosage is not available here. Have you ever heard of mixing pregabalin and gabapentin (like maybe I could add 25 mg of pregabalin to the 600mg gabapentin)?

[SueJohnson in reply to wantokporo]

You could but why? If you are having problems at the dosages you are on, they won't get any better by increasing the dosage.

[wantokporo]

The problem I am having is the dose is not strong enough to deal with the PLMD, so wouldn't more possibly do that?

[SueJohnson]

True but you are having side effects. If you want to put up with the side effects then you could.

[wantokporo]

The main side effect--at the moment on the gabapentin--is the PLMD. I am hoping I can somehow escape the nervousness that the pregabalin was causing (maybe not, but that is not a complaint at the moment). The hope is that if the PLMD is controlled and I get more sleep I will have a life, or a better life. Having spent a long time trying many things, I am trying to avoid revisiting that. I do poorly on so many medicines. I even think if this fails, I would try the pregabalin again, likely a fool's errand.

[Munroist]

From other posts on this site I believe that the upper limit for gabapentin is 1800mg a day and although I can't easily find information to support that and I recommend you check the packaging and get advice from your doctor. If that is the case then you are taking a relatively low dose and increasing this might give you the benefits you are looking for specifically reducing the PLMD. The following are extracts from posts by Sue Johnson and Joolsg on gabapentin:

"According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin " If you take magnesium don't take it within 3 hours of taking gabapentin as it will interfere with the absorption of it and don't take calcium within 2 hours. Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment and refer your doctor to it if needed as many doctors do not know much about RLS or are not uptodate on it at Https://mayoclinicproceedings.org/a..."

and..

"900mg is a low dose. You can increase the Gabapentin and take it in the evening in split 600mg doses 2 hours apart. Your GP will need to increase the dose.If the RLS/PLMD doesn't settle on 1800mg after 3 weeks, you may need to switch to a low dose opioid"

[Caperry]

I’m taking 2100 mg of Gabapentin and I split the dosage and it works most of the time!

[SueJohnson in reply to Caperry]

Does that mean you are taking 600 mg 1 to 2 hours before bed, 600 mg 2 hours before that, 600 mg 2 hours before that and then 300 mg 2 hours before that which is the way it should be taken? If so you would be better off switching to pregabalin which can be taken all at one time 1 to 2 hours before bed. You can switch directly and the dose would be 350 mg pregabalin. Also if you take magnesium, take it at least 3 hours before or after gabapentin (it is OK with pregabalin) as it interfere with the absorption of gabapentin and if you take calcium don't take it within 2 hours for the same reason (not sure about pregabalin).

[Caperry in reply to SueJohnson]

this is working fine

[SueJohnson in reply to Caperry]

Have you had your ferritin checked? Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. If not when you see your doctor ask for a full iron panel. Stop taking any iron supplements including multivitamins that have iron in them 48 hours before the test, fast after midnight and have your test in the morning. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. You want your transferrin saturation to be over 20% but less than 45% and your ferritin to be at least 100. If they are not, post them here and we can give you some advice.